Why Might Your Botulinum Toxin Not Last As Long As You Want?

Hi, I’m going to run through some of the reasons why your botulinum toxin treatment mightn’t be lasting as long as you want to. Louise, our manager says my videos are too long, so I’ll summarise first and then feel free to tune out.


I bore myself frequently too, so don’t worry about that. And then we put the longer versions on YouTube and I’ll go into a more detailed explanation in this video as well.

There are several reasons.

Number one is whose doing your treatment?

How experienced are they?

Are they using genuine product from reputable pharmacies?

So ask to see the product that’s absolutely reasonable. The next is what dose they’re putting in.

Botulinum toxin is dose dependent. The more you put in, the stronger the result and the longer it’s going to last. So if you’re looking for a natural result, you’ll have to compromise on how long the duration is going to be.

The next thing is what else is going on in your life?

Are you having treatment regularly?

Are you having a bit of a hit and miss treatment with nothing for six months?

Treatment, nothing for seven months? You have to be patient to reach that sweet spot and you really have to be consistent in having treatment about three times a year to get consistent results. So if you’re sporadic with your treatment, you’re not going to get a really good, decent result out of it.

The other thing is, don’t put all your eggs in the botox or botulinum toxin basket. You’ve got to just look after your skin, you’ve got to look after the other changes that are happening in your face and don’t have expectations that are too high for what that single intervention can do.

This treatment will turn down muscle activity for a number of months and then it’ll wear off. So bear in mind, your results may not be the same as a friend or colleague, because we’re all individuals and because it’s not an exact science and you’ve got to try a dough, see how it works and get that sweet spot where the treatment is really perfect for that person.

People will sometimes say to me, oh, I’ve been coming to you for years for treatment. It was better five years ago or eight years ago, so I’m sure it was. And that’s because time has passed. Our faces are changing and ageing, our skin is getting more lax and losing collagen and picking up ultraviolet damage, and there’s quite a lot of changes happening around the bony orbit here and there’s muscles changing.

So all of those things in the basket don’t expect Botox to fix everything. It can’t. It’s just working on one layer of your face and it’s like going into a room and turning down a radiator for a few months.

Then that radiator, you go back a few months later and turn it back on so it’s not an on off switch. If we go back to dose like this medicine, when you put in a certain dose, we are predicting the response we’re going to get.

If somebody’s new to me, I do not want to overdose that medicine and make their brows too heavy, or it’ll feel like there’s a pressure and it won’t look good. So the first time I’m doing a treatment for somebody, I go cautiously, I bring them back two to three weeks later and I can adjust the dose or tweak it if I need to.

So the dose is really relevant. If I’m doing areas around the mouth where the doses are tiny and superficial, I absolutely know they’re not going to last as long as in another area where I’m putting a bigger dose.

So the dose is important. People sometimes say to me, oh, am I going to get resistant to it? And it’s a really fascinating question. During COVID especially during lockdowns, a lot of people weren’t having regular treatment.

They were on a lot of Zoom calls, they were scrutinising their faces and they were stressed and so there was a lot going on in their lives and people complained that their toxin wasn’t lasting long enough.

Now, all the various reputable manufacturers went back and analysed all their processes and their production lines and nobody found any faults. And we think this was to do with the intervals between treatments, all of that sort of thing.

But additionally, we do know that some people, in response to Covid illness or Covid vaccination, the duration of their botulinum toxin treatment could vary.

The age of the person is relevant, so somebody in their 30s can take quite a high dose and get away without side effects, whereas somebody who’s more middle aged, like me, at 58, the balance is much more delicate and it’s easy to tip over into having an overdone result.

So the older you are, really, your injector has got to be more and more cautious where they treat you.

One interesting fact here is these muscles here, the frontalis, they’re the only brow lifters, and I have to rely on those brows to be lifted for the rest of my life. They’re already getting a bit tired with age and time passing. So I do not want to have too much up here.

So my dose has got to be different to somebody who’s say, 30 or 35, who has a different pattern of movement, different fat pads, different skin quality, maybe collagen differences. They may be a smoker, they may have history of alcohol consumption that can affect collagen.

All of those things are in the mix. So when I’m treating somebody, I’ve got to be really careful up here. And rather than over treat this, I’ll treat muscles like the frown muscles here, the crow’s feet lines, the depressors here, the depressors here, platisma. And I’m looking at the whole face. I’m not just going boom, boom, boom.

Three areas.

So the dose, the treatment you get, the areas you get treated, the age you’re at, what’s your pattern?

Have you had it regularly?

Three times a year for a number of years. All of those things play into the mix. One thing we’re very interested in is resistance. So sometimes people will come to me and say, oh, I’ve had treatment somewhere else and it didn’t work.

And that’s incredibly rare. And really, we think if people were having things like toxin prior to 1996, which is very few people, we think those original toxins had more protein in them and they were more likely to cause resistance. And that means you get to a point where the medicine no longer works. And we’re all aware of antibiotic resistance with overuse of antibiotics in the community.

So again, we need to be judicious with our toxin use and not just randomly dose and redose and add another top up and add another adjustment. We’ve got to be careful with our dosing. If somebody comes in and they have a treatment and they need an adjustment, that’s okay. If there’s a little bit of spocking on one side or it’s a little bit asymmetrical.

But if you’re new to it, don’t expect a perfect result straight away. And don’t ask for a top up, another top up, because you run the risk of exposing your body to repeated doses of protein with the botulinum toxin treatments. And the more protein doses you get over time, there’s more of a chance of resistance.

I was listening to a colleague, Dr. Michael Cain, recently talking to Alice Hart Davis, who runs the treatment guides, and they were talking about resistance. And he said that in 15 years he’d only seen two cases.

One of these was spouse of an injector. And this injector was doing treatments, a session roughly once a fortnight for his patients, and anything that was left over, he was injecting his wife with it. And so she was getting repeated little doses of toxin and she became resistant to it.

And the other was a small number of patients who had toxin prior to 1996. And most of us didn’t have treatment before then, unless we were in the states or we were early adopters or you were seeing somebody who was starting their career very early on after toxin was launched.

So resistance, very rare. Everyone talks about it. It really is very rare. I’ve seen it once in almost 20 years.

If you’re resistant to one type of toxin and be that botox, dysport, xeomin, bocatur, azalur, they’re all botulinum toxin, a, and they’re all very similar, and if you’re resistant to one, you’re going to be resistant to the other. There’s no point saying if one doesn’t work, oh, take a break or try a different one, it’s not going to work. So you’ve got to be careful like that.

Going to take a couple of days to work. You’ll have your result within two weeks. It’ll stay at a plateau for five or six weeks and it’ll gradually wear off. Your body is trying to do what it’s done for decades, is to reestablish that pattern of movement that your muscles have followed for years and years and years.

So a single intervention is not going to have a dramatic result and it’s going to wear off. So you need to be consistent and decide if you’re going to invest in regular toxin treatment and also invest in reasonably priced, good quality skincare as well. And don’t rely on botox to fix everything, because it just can’t. It’s just fixing or improving one layer for a temporary period of time, and then it’ll recover.

We take a break if somebody’s pregnant, but short breaks like that are fine. But if you are pretty haphazard and you haven’t had it for years and you were a bit disappointed with the first result, and you’re not sure if you should go again, really spend the time thinking, did it work?

How long did it last for?

What areas did I have treated?

What did I like about it?

What did I not like about it?

And all of those clues go into the picture when I’m assessing somebody and trying to decide if it’s a good intervention for me or if their money is better spent elsewhere. So it’s quite a complex situation, but fascinating. So be patient. It takes time to get to that sweet spot. Be consistent in your treatments.

If you choose to invest in it, seek an injector who knows what they’re doing and is using the absolute, genuine products. Ask to see them. It’s being injected in your face.

Be mindful that time passes and your treatment results ten years ago or five years ago are going to be different to now, and our bodies are changing. The medicine you’re putting into that body isn’t really changing. But be patient.

Have your realistic expectations and discuss those with your injector. Because people want a brow lift, no lines, no crow’s feet, all of those things. There’s a wish list, but it’s a medicine that acts in a very predictable way and sometimes what it can and can’t do.

Don’t ally with what your expectations are.

So I hope that’s helpful. We love getting your questions.

We’re always very happy to answer your queries and feel free to get in touch anytime.

Take care. Bye.

Dr Eithne Brenner