Does the amount of neurotoxin necessary lessen over time?

Dear mholly,Patients that come in consistently for Botox (every 4-6 months) will see weakening of the muscles and may see a decrease in dosing. What I more often see in my practice is the same dosing lasting longer.Hope this helps,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
RealSelf Top Doctor

Hi @rnholly! From my experience, neuromodulator like Botox appear to last longer after multiple treatments are performed. Best of luck to you!

Thank you for sharing your question. Botox appears to last longer after multiple treatments are performed. The seems to be a weakening of the muscles where the Botox has been placed. Also, the muscles of different patients require a different treatment dose. See and experienced oculoplastic surgeon for questions/ suggestions. Good luck!

Botox and Xeomin are identical in dose, onset and duration, but these all vary with individual patients. We presented a study at the Boston Plastic Surgery Meeting in which ten women had Xeomin injected into the right forehead and Botox on the left with a space in the middle.  Identical dose and injection technique.  The women were videotaped pre injection and during injection.  They then sent selfie video of their forehead daily for the first two weeks and weekly there after until the effects wore off.3 responded in 24 hrs, 3 in 48 hrs. and all by 72 hours.  Whatever the onset, both sides were 100% identical as documented by split screen video.  The interesting finding was that EVERY patient responded differently with 9 lasting between 3 to 4 months, but one outlier lasted 7 1/2 months!No matter what the duration, both sides were the same onset and duration.  Xeomin was 100% identical to Botox in onset and duration.  This means that all previous research using a different product in different patients and comparing them, were fundamentally flawed.10 t0 12 units per site, forehead, frown lines, and divided 5/5 on crows feet suffices in most patients and can be individually customized. 20, 30 units per site is usually overkill and a waste of neurotoxin. Theoretically as muscles atrophy, less neurotoxin would be needed, but don't compare yourself to others.

Thank you for sharing your question.  It is rare to ever need "less" neurotoxin over time as the reason that less "could" be used or needed is because the muscle has atrophied and requires more time to build itself back to its original size and strength to create a patient's original wrinkles.  Hope this helps.

Everyone is different. Some patients can get some bio-feedback and use their muscle less. They can also get some atrophy or shrinkage of the muscle over time and they may need less Botox. However, others never get this and will need a full dose every time and will need to continue to get treatments every 3-4 months. Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa

Hello,      Thank you for the very good question.  The answer to your question is pretty easy to understand when explained in the most simple way. Neurotoxins such as Botox, Xeomin and Dysport work by blocking muscle contractions.  The treated muscles become partially to fully paralyzed by the Botox or as your friends Doctor said, the muscles become “not used to working”.  The repetitive use of Botox, over time, has caused muscle atrophy (wasting).  A now smaller and weaker muscle than once before will not require the same higher dose of Botox to keep it from moving. I hope this makes good sense to you. Also, keep in mind that each person is unique and responds differently to toxins. But, in general, thicker, stronger muscles require more toxin while thinner, less strong muscles should require less toxin to achieve the desired result  

It is difficult to generalize about results from Botox because everyone is different and the strengths of muscles can vary for each person.  For some people, I do find that the amount of Botox needed can decrease over time.  This is not true for everyone though and some people may actually need more over time as they age.  You could always tell your injector that you want to try less and see what results you get.  The amount used could always be increased after that if needed.  

Patients are able to use the same dosage for many years.
The amount of Botox a patients receives is based on their individual musculature. 
Your friend most likely has weaker muscles than you in general (having nothing to do with the treatment), so she requires less product regardless.
When patients get older they tend to need more Botox since the skin is thinning from loss of collagen and elastin...just aging in general. 
You can use less treatment however you may have lines you do not love and worst case scenario you can go back to your injector and have more added. 

Some patients who use Botox consistently over many years may notice that a lower dose of the product is needed for the same result.  The amount needed is unique to each patient based on how their body metabolizes the product as well as anatomy differences.  I encourage you to discuss your concerns with your injector to determine what is best for you.