So many clients come to me and have been having Botox treatments for many years and often lead the consultation by requesting I put as much as I can in so it lasts longer because ‘the Botox I have had before just didn’t last’.. and this made me keen to start our 2022 blog section on this very topic and on the way we can answer a few other questions, ‘how long does Botox last?’, ‘How long does Botox take to work’, ‘What is Botox’ and a few more on the way! Lets have some fun and I will try my best to ensure you don’t fall asleep whilst reading this!
So, lets get a few facts in before we start with my famous analogies! What is Botox? Well, Botox is a protein made from Botulinum toxin, which the bacterium Clostridium botulinum produces- it’s a neurotoxin. These substances target the nervous system, disrupting the nerve signalling processes that stimulate muscle contraction. This is how the drug causes temporary muscle paralysis. For any muscle to contract, the nerves release a chemical messenger called acetylcholine at the junction where nerve endings meet muscle cells. Acetylcholine attaches to receptors on the muscle cells and causes the cells to contract or shorten. Botox injections prevent the release of acetylcholine, which stops the muscle cells from contracting. In this way, the toxin helps the muscles to become less stiff! This leads me to another point.. Botox is a prescription only medication, yes, medication.. and with that statement it also means we need to treat it like such: more on this later!
A really important question to answer early on is, ‘How long does Botox take to work?’ Botox takes anywhere up to 14 days to take effect- in general, but changes can be seen as early as a matter of days in, but this is dependent on the patient, and it is important to allow the 14 days to pass before having any adjustments! Not all muscles on the face are the same so we need to give them time to respond! Plus it is always handy to think of the face as a puzzle, each piece being a different muscle with a different density, different purpose and directionality etc sooooo, they have to be treated in their own special way!
Really common question is, ‘How long does Botox last?’ Botox on average lasts approximately 3-4 months. There will certainly be patients that have results that last around 6 month and others can notice significant movement back in as early as 6-8 weeks. It’s important to understand you are a human affected by external factors and with it is not uncommon for the same individual to respond differently at times to the same treatment with the same dosing! It is a medication, and with that comes variation in results depending on the host! Plus, the longer you treat a muscle with Botox, the density breaks down, so naturally, the muscle becomes weaker and therefore it loses its biceps! In other words, you’ve managed to keep those muscles out of the gym so over time and with regular Botox treatments the results will improve and last longer! Win-win! My famous analogy always helps me explain this to my patients... If you have a man who has been going to the gym and has been working out hard for many, many years and he has a month off he is not going to be a skinny, weakling overnight! But... if we keep him out of the gym (and by him I am metaphorically referring to your facial muscles) if we stop those muscles working.. then fast forward 12 months he will ultimately look different and will be weaker and his muscles will have lost density..
So if I stop having Botox treatments will I return back to where I was? Let me explain it in this way.. If you have a very strong frown this means your two corrugator muscles (the small, narrow, pyramidal muscle close to the eyebrow) draws your eyebrows closer together (downward and medially) creating two lines that people refer to as the ‘elevens’ .. Over time and through repeated movement these muscles can become hyperactive and in simple terms thicker than they should be causing the muscle not only to protrude but also causing furrows in the skin (deep wrinkles). If a patient was to have a single treatment using Botox then they can expect paralysis but should the treatment not be maintained they can expect a full return to their baseline and no long term benefits in that sense.. should a patient commit to the treatment and regularly treat the Glabella area (treat not OVER TREAT) then in time there will be no return to baseline and the muscle will become less dense and the area flatter: this is why is it important to have a gold standard consultation so you can understand the commitment needed and the results you should expect to get.
This brings me not to grand finale!! drum roll please....‘Put more Botox in and make it freeezeeee’ there are two points here that need to be addressed.. the first is this illusion of a ‘frozen’ face… by this we are referring to a tight ‘face lift’ look where the movement is extremely limited. Firstly this is a difficult and ultimately soul destroying ideologic ‘look’ to aspire to and that is because in order for us to look ‘Frozen’ it is not about paying homage to the God of Allergan (the manufacturers of Botox!) but it is about educating your patients on the basic process of ageing and the reality of what the treatment is likely to achieve.
To summarise we age at all levels: Skin- Superficial fat- SMAS (muscle..)- Retaining Ligaments and spaces- Deep fat layer- Periosteum and Bone… With all those 7 layers in mind it is preposterous to consider or ‘pitch’ to a 64 year old patient that they could get a ‘face lift’, ‘frozen’ appearance using Botox as if the face is ageing at multiple layers: there is likely to be bone changes and fat redistribution and therefore limiting muscle contraction is not going to create a ‘frozen’ face lift treatment: it may be there is a volume loss that needs addressing too.. It may be an easy goal with a patient in their twenties ... That is the first part of the Botox myth addressed, so lets move on to the next and that refers to the dosage.
Botox is a medicine.. let me explain in terms of a child and Calpol.. If a child has a temperature and this child is treated with 5ml of Calpol which equates to 120g of paracetamol that may successfully address the temperature for that child. If we were to give another child who is the same age but significantly taller and heavier in weight it may not address the issue.. and a healthcare professional would weigh the child, assess the child and may recalculate a safe dose based on the child’s individual physiological needs. My point is this, over treating a patient with Botox is not the answer and will only cause adverse side effects. The goal is to assess each muscle in terms of its strength and using the correct Botox dosage to treat the anatomical structure specifically: meaning everyone is different!
Placement, depth and dose is dependent on the patient and that is why it is important to choose a practitioner who understands anatomy in detail, understands medication and that you trust to give you the right advice. I hope you found that interesting and have not fallen asleep just yet!
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Stay safe x