40 units wore off after 6 weeks, will 50 units of Botox cause my face to be frozen? (photos)

Question

Hello, Had botox in May only it lasted 6 weeks!! The nurse I spoke to thinks it maybe due to the fact that I workout a lot,( fitness instructor.) I had 40 units in May, she thinks we should try 50 units spread between, forehead, 11's, Crows feet, and bunnys. Only had glabella, crows feet, and bit to even brows, done in May. Have uneven heavy brow as is, worried she will leave me too frozen and heavier, causing a droop. About 30 units to forehead,11's, and to even brows too much for me?

Matthew Richardson, MD · Answer

Sometimes people do metabolize Botox faster than others, but in most cases, patients simply are getting under-dosed. For the forehead, glabella, crow's feet, and bunny lines, I use 60-70 units for most patients. Without the bunny lines being treated, I would generally use 50-60 units. Patients will generally get 3-4 months out of this treatment. Be sure to use an expert physician injector.All the best,

Jonathan Kulbersh, MD · Answer

Yes, some people metabolize Botox faster than others. Typically it lasts between 3-4 months, but you can have a touch-up around 6-8 weeks to help maintain results. Hope this helps.

Jason Emer, MD · Answer

Additional Botox may give some improvement. Deeper wrinkles need a combination approach with Botox and lasers, microneedling/prp and fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Robert W. Sheffield, MD · Answer

Thanks for your question. In some patients, Botox in more readily metabolized than others but in majority cases, patients merely get a lower dose. As mentioned, for your glabellar region, crow's feet, forehead and bunny lines, you would need 60-70 units of Botox. Many people would even do more than this without looking frozen. It also relates to the method of injecting Botox. Placing Botox in muscles, deeper than muscles, or superficial to it will have varying effects. Correct dilution with an appropriate diluting solution is essential for optimal results. Different skin regions need a slightly altered technique for desirable results. In the right hands, there certainly is no harm in injecting 50 units in a repeat treatment. I always advise to consult an expert cosmetician for desirable prognosis.I hope this helps.

Monika Soni, MD · Answer

Thank you for your question. You may require more Botox or not.  40 units is not a “large” dose for glabella, forehead, and crows feet but i’d say it’s pretty typical.  I have many patients that do more without looking frozen. There is also the manner in which it was injected. Was it placed in the muscle, deep, or superficial to the muscle?  Was the botox diluted appropriately?  Each area requires a slightly different technique for maximal effect.  If your confident in your injector certainly there’s no harm in giving it another go. There are numerous providers offering Botox in every major city now so there are other options.  I always recommend seeing a board certified physician in one of the core specialties.

Mehdi (Robert) Motazedi, MD · Answer

When you first begin getting Botox or Dysport, it may only last 6 weeks before you start seeing movement.  If you have heavy muscle movement and deep lines on your forehead, Botox may not last as long for you as it would for someone with minor wrinkles.  Because you get muscle atrophy with Botox due to reduced movement of these muscles, it should last longer with subsequent treatments. Since everyone's reaction to Botox/Dysport is different, it can take several sessions to figure out how much to use and where it needs to go,  to get the desired result.

Shlomit Halachmi, MD, PhD · Answer

The "standard" dose, meaning what Allergan writes in the product information, is 40 units to the forehead and glabella (11's/frown) combined. If you have more muscle mass you may need more. Teh crow's feet and "bunny lines" are dosed separately. IF you had 40 units to cover all the areas and it wore off earlier than you expected, you may not have had a sufficient dose for your needs. However, be careful - a high dose can lower the eyebrows, making your upper eyelids look full and hang lower over the eyes.

Another possibility is that you have developed antibodies to Botox. Discuss this possibility, which is uncommon but not impossible, with your provider.

Another possibility is that you have developed antibodies to Botox.  Discuss this possibility, which is uncommon but not impossible, with your provider.

Deborah Kessler Hudak, MD, MHA · Answer

If you were happy with your face for the six weeks that the Botox was working, do not change the amount. Your injector was correct in that your frequent work-outs cause you to burn through neurotoxins (Botox) faster. Putting more Botox in there will cause you less movement, and it may not last any longer than the six weeks. (No good deed goes unpunished!)

Susan Longar, MD · Answer

Hi MonicaLS,
Thank you for your photos.  There are several ways to go about optimal dosing with botox.  Different dilutions, more frequent treatments, more units--botox does seem to ear off sooner on very active people, but by working with your injector you should be able to maximize the length of time your botox lasts.  
Good Luck!

Blue Medi Spa - Sherman Oaks - Account Suspended · Answer

Hi, I agree with the nurse who treated you. Patients who are very active tend to metabolize neurotoxins faster than others. You may also try Dysport to see if that product could last you a bit longer than Botox. In regards to the amount of units, 40u is not going to "freeze" your face and leave you expressionless if dispersed in all those 3 areas. 50u may last you longer. Many studies have also indicated that diluting the neurotoxin with a decreased amount of saline helps to prolong the longevity of the product. 
Hope that helps,  -Melody PAC

40 units wore off after 6 weeks, will 50 units of Botox cause my face to be frozen? (photos)

Answers (17)

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