Is There a Way to Help Your BOTOX Last Longer?

There are indeed several ways to help make your BOTOX last longer! In this post, we will interview Dr. Alex Sobel on the subject of neurotoxins and cover the following:

• BOTOX, current competing brands, and upcoming options
• Reasons neuromodulators fade (and the potential benefits)
• Ways you and your injector can make your BOTOX last longer.

BOTOX and competing brands overview

On the eve of the launch of a new BOTOX-like neuromodulator, it is interesting to ask the question, what can a new BOTOX-like product do for me? To get some perspective, let’s go over the history of alternative neuromodulators that have been brought to market over the past decade.

When Dysport came to market, it promised to deliver faster results at a relatively lower cost. Unfortunately, both of these hopes were subsequently disproven. On Xeomin’s arrival, the data already indicated that its duration of activity would be less than that of Dysport or BOTOX, however “less expensive” seemed to drive this product’s value proposition. Most injectors agree, however, the cost versus efficacy value of BOTOX remains higher than Xeomin.

The most recent entry to market is Jeuveau, which has been somewhat unapologetically brought to market as #Newtox. Similarly to Xeomin, the promise here is a cheaper product with the same efficacy. Early injector experience, plus the heavy burden to bear of beating the heretofore unsurpassed BOTOX, suggests that Jeaveau will only take a small bite out of BOTOX’s market share.

Yet there is one product that may give BOTOX a run for its money: buzz is building around the launch of DAXI, a neuromodulator that promises to surpass existing neuromodulators by lasting up to 24 weeks. When this product receives FDA approval, we look forward to offering it to patients who prefer longer-lasting results.

What is it about BOTOX that makes it such a spectacular neuromodulator?

Consistent results. While all of the aforementioned FDA-approved neuromodulators can provide consistent results in skilled and experienced injector hands, the learning curve seems to be easiest with BOTOX (literature, education, and training is widely available for this neuromodulator). Further, most senior injectors have had extensive experience with BOTOX as it has been out the longest.

Reasonable cost. BOTOX isn’t cheap, but newer entries in the market have not been able to deliver its excellent results at a meaningfully lower price.

Brand recognition. Though this should never be a high selling point in the practice of medicine, it is tremendously useful that one can say “BOTOX” rather than “neuromodulator” and readily get the point across.

Appropriate duration of action. The three to four months BOTOX remains effective for the treatment of fine lines and wrinkles seems to be right in the sweet spot for many patients and injectors. However, as will be explained shortly, there are ways to tweak the duration of activity of BOTOX to either shorten its duration (to approximately six weeks) or to prolong its duration (to approximately six months).

Why you may want BOTOX to only last 3-4 months

Now let’s explore why it’s useful to have a less-than-permanent effect from your neuromodulator.

You are getting to know your treatment. This is particularly useful when first experiencing BOTOX or similar products. Every patient is different, and you and your provider must personalize treatment with regard to dosage and balance among muscle groups.

Your treatment needs will change over time. As your BOTOX helps diminish lines and wrinkles, it can also help restore balance to your face. This is especially true of brow position. However, brow position will need to be adjusted over time in consideration of new lines that form when new muscles are recruited in substitution of those that have been weakened by BOTOX.

Aging continues. As we progress through our decades, BOTOX can be used in different ways to minimize wrinkles and maintain facial harmony.

Life happens. Events such as an unexpected accident or facial surgery can alter muscular balance and BOTOX can come to the rescue, helping to restore balance.

Reversibility. While patient satisfaction with BOTOX is exceedingly high, its reversibility in time allows you to make ongoing choices about your appearance. Though no immediate reversal agent is known, it is comforting to know that the effects of BOTOX will reverse in a reasonable timeframe.

Based on the above, it’s easy to understand why we don’t want permanent results from BOTOX. However, can we make it last just a bit longer? Absolutely.

How your injector can help you make your BOTOX last longer

Use more units of BOTOX

The most effective way of getting BOTOX to last longer is simply using more units. The way BOTOX works is by disrupting the release of chemicals from nerve endings. The effect fades because our nerves have the ability to create new endings in a nearby area of that muscle. However, the more nerve terminals that are disrupted by the neuromodulator, the more time it will take for this rewiring, a.k.a. neuroplasticity, to occur.

…And use a higher concentration of BOTOX

In conjunction with using more units, BOTOX must be used in a more concentrated manner to avoid more-than-desired spread. Some degree of spread is desirable for a smooth look and to limit the number of necessary injection sites, however, as dosing ramps up, small and concentrated volumes are required to obtain an extended effect.

Things you can do to make your BOTOX last longer

Aside from purchasing the right number of units and asking for a prolonged duration of the effect from their injector, what more can we as patients do?

Relax into the BOTOX

Do not try to struggle against the muscle relaxation induced by the treatment in an attempt to “test” out its effectiveness. By forcing the eyebrows together when they’ve been weakened with BOTOX, other muscles can be recruited to aid in the effect, creating secondary lines and wrinkles. Also, I believe that neuroplasticity happens faster when the nerves are being stimulated to engage their target muscles.

Keep a regular maintenance schedule

Discuss with your injector when you should expect your effect to wear off and keep an eye on it. It is best to retreat the muscles prior to the effect wearing off completely so that the muscles remain weak from atrophy, or disuse, and weakening of the neural patterning that tends to make our use of these wrinkle forming muscles less automatic.

How much longer can BOTOX be made to last?

It does seem that BOTOX can approach the 24-week duration that we are seeing with the anticipated new neuromodulator, DAXI, expected to be available to the industry around the end-of-year 2020.

Although any neuromodulator’s dosage can be adjusted, it is important to remember that trying to push a treatment, and your expectations, too hard can lead to less predictable and, at times, less palatable results. Thoughtful conversation among yourself and your treatment provider will yield the most satisfaction. As we look forward to new and enhanced ways of mitigating lines and wrinkles while balancing harmony in the face, we can expect treatment flexibility and enhanced results—but I caution patients to be wary of any product that may last indefinitely and have no availability of reversal.