Botox still hasn’t worn off after 6 months, is this abnormal?

Question

Is it normal for Botox to not have worn off after 6 Months, I’m panicking that this is permanent. I can move my forehead it’s prob back to 80-90% movement as it was before but at the sides of my eyes it just isn’t wearing off. My cheeks are still being pushed forward instead of creasing at the sides of my eyes as it did before. I’m desperate for it to wear off as I hate it, the clinic who did the Botox said they can’t give a timescale for it wearing off, advice would be greatly appreciated.

Douglas Wu, MD · Answer

After 3-4 months is when Botox usually begins to dissipate, and in rare cases, it is possible for it to still be active at 6 months. Duration of effect is typically related to the dosage used and the baseline strength of the muscles being treated.  My best recommendation is to schedule a follow-up with a board-certified dermatologist so they can assess your results in-person! Thanks for your question!

Sabrina Fabi, MD · Answer

It is possible for Botox to still be active up to 6 months, as results are dose dependent, however Botox typically begins to wear off around 3-4 months. My best recommendation is to schedule a follow-up with a board-certified dermatologist so they can assess your results in-person! Thanks for your question!

Joseph J. Castellano, MD · Answer

Sorry to hear you’re unhappy with your BOTOX® results. While the average length of time for this product to last is around 3 to 4 months, everyone is going to respond differently, which means that it could last shorter or longer for some people. Unfortunately in your case, it seems to be the latter. Over the next several weeks, you should begin to notice its effects entirely diminishing. If you’re still concerned, it can’t hurt to get a second opinion from a different provider.

Mitchel Goldman, MD · Answer

Botox usually begins to dissipate after 3-4 months, and while it’s rare, it is possible for it to still be active up to 6 months. Studies have demonstrated longer lasting results when a higher dosage is given during the initial treatment. My best recommendation is to schedule a follow-up with a board-certified dermatologist so they can assess your results in-person! Thanks for your question!

Emmanuel De La Cruz, MD · Answer

Hello l.stead,
Thanks for your question. It is unusual for Botox’s effects to not have worn off after 6 months. But the results are definitely not permanent. The duration varies among patients and increases the more units are injected and the more frequent the sessions. Best wishes! Dr. De La Cruz.

Christopher J. Davidson, MD, FACS · Answer

Thank you for your question.  Botox cosmetic is not a permanent treatment and does dissipate in approximately 3-4 months.  It would be a very rare occurrence for a Botox treatment to be active after 6 months.  Ask your injector for a follow-up appointment and consultation with the Allergan representative for an evaluation.  Good luck.

Michael Loffredo, MD · Answer

The average patient sees Botox wear off at around 3-4 months but I have had some patients that swear it lasted 6 months or so.  I would just wait it out.  It should slowly going to go back to normal.

Leonard Grossman, MD · Answer

The breakdown of botulinum toxin is different in every individual. I have had patients in whom it lasted only 6 weeks and I have had patients in whom it lasted more than a year. It would be advisable for you to visit either the same clinic or another physician who is either plastic surgeon or dermatologist to address your issues. Good luck from New York City

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You expressed in the details of your question a concern about the effect of Botox® lingering beyond 6 months. You state your forehead has returned to 80-90% activity. You describe the area around your eyes being injected that made your cheeks push forward as opposed to the way they behaved prior to the injections around the eyes. The clinic is not offering you a timescale, so you’re looking for some guidance on when the effects of Botox® will wear off.
I can share with you my experience. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. My specialty of oculofacial plastic surgery was among the first doctors to use botulinum toxin, so I have been using Botox® for my patients since 1993, so I can  share with you some guidance. 
We use Botox® in our practice very extensively, with everything from forehead lines, crow’s feet lines which is what you had, lip lifting, treating vertical lines around the lips, chin dimpling, and lifting the brows- it’s remarkably versatile. The number of things we can do with Botox® as a tool is pretty amazing. 
I am surprised you perceive it lasting longer than 6 months. Generally, in our practice, I tell our patients that the average patient comes back about every 3-4 months. Very often, it’s because they want a certain level of inactivity, or limited activity of their muscles to be maintained, so they don't let it wear off completely. 
There is a certain amount of learning about the patient when we first start doing anything, whether it’s an injectable neurotoxin like Botox®, or an injectable filler such as hyaluronic acid filler. I usually see our patients about 2 weeks after the procedure, and then we see them after several months. I make it a point taking photos before the procedures so I can document what the facial movements are so we can compare them. There are a lot of reasons for this, one of which is to show our patients the improvement. Another reason has to do with the perception people have with their appearance, regardless of whether it’s the use of a neurotoxin, injectable filler, or even surgery.  I don't want to imply or assume that this is applicable to you, but I think it’s important to know about the observer’s bias. Often people feel they have certain things after a procedure, and with conviction they didn’t have it before the procedure. When I show those photos where they did exist, it’s an opportunity for clarity and realization that something was a certain way. 
It’s curious you’re describing a situation where your cheeks are pushing forward. When you treat the crow’s feet lines, which I think is what was most likely treated, you are affecting the orbicularis oculi muscle. When that muscle is engaged, typically during squinting, the muscle forms those crow’s feet lines, but when the muscle is relaxed those lines soften. With attempted recruitment of that activity with Botox® or any other neurotoxin, it doesn't contract as much. That’s to be distinguished from the area becoming compressed and creating the lines when the cheeks move upward,  which is more of what I call an accordion effect. 
I don't see how the muscle reduction of activity and the crow’s feet area would cause your cheeks to push forward. I suggest you discuss this in a way that if your doctor could show you the images taken. I take these photos without expression, and with expression to help my patients see the dynamics. I think you might see whether or not there’s a direct relationship. 
Usually these neurotoxins wear off. It’s actually a challenge to stay on top of the rate of reduction of activity because it’s always about, at least in my practice, keeping my patients looking natural where they can have reduced activity, but still preserve some of their natural movement so they don't look like they have been, “Botoxed”. 
I think in your situation you can be confident, even though it is lingering a little longer than expected, that it will wear off. There has yet to be any awareness in my practice of doing this for so long where a person would have a long-term effect due to the natural pharmacology and physiology. Botox® just wears off. 
It’s important you maintain this dialogue with your doctors, and hopefully you had some photos taken beforehand. If you were to get a second opinion, I think another physician can simply evaluate the muscles that were treated, and give you some sense of those muscles working at this point regardless. Maybe they can give you some guidance on any residual effect of Botox®, or if it has worn off. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Alexis Parker, MD - Account Suspended · Answer

It would be unusual for Botox to last more than 6 months.  You may find that all of a sudden it's effectiveness has disappeared even in the crow's feet.  It would be a good idea to follow up with the doctor that did your injections so that the treatment course can be refreshed and so that you know what to expect.  All the best.  Alexis Parker MD

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