What happens with the wrinkles when the Botox wears off?

Can they get worse than before? Do I need to keep going with this injectable every 6 months? I heard that after few sessions, the Botox lasts substantially longer than before. Is it true?

Botox is a short term solution for fighting fine lines and wrinkles. Typically, the treatment lasts for three to six months before wearing off and requiring another treatment. Most patients go for repeat treatments every six months, sometimes less depending on the patient. According to the Botox.com homepage, it’s unknown if receiving Botox injections more frequently than every three months is safe or effective.

Many patients confuse the time the effects of Botox last with the time it takes for a dermal filler like Restylane to diminish. The effects of Restylane typically last between six and nine months. The two products have very different methods of action. Botox prevents the muscles that cause wrinkles from moving, whereas Restylane, on the other hand, creates a plumping effect and adds more definition.

To answer your question about the effects of Botox lasting longer after repeat sessions, I’d offer that it’s not really a lie but isn’t quite true either. The bottom line is that the facial muscles can become accustomed to remaining motionless, and as such this "retraining" of those muscles can delay the need for future follow-up injections for some time.

Only visit a board-certified plastic surgeon or dermatologist to ensure maximum safety, the best results, and to be confident you’re definitely receiving genuine Botox. Just recently there was a well-publicized case of fraud involving providers who were injecting fake Botox into unwitting clients but selling it as the genuine article. I don’t think I need to spell out the dangers of having an unknown substance injected directly into your bloodstream by an obviously dishonest person who is prepared to risk your health (and appearance for the next six months -- and possibly longer) in exchange for a few extra dollars. You can rest assured that any physician who has been certified by the ASPS (American Society of Plastic Surgeons) or similarly reputable body will not be misrepresenting their services to patients.

Botulinum toxin, the active ingredient in Botox and Dysport, works by blocking the signals between the nervous system and the muscles in the face. The interrupted signals cause a temporary paralysis which prevents lines and wrinkles from forming near the injection site.

How long it takes Botox to wear off depends on the individual and on how experienced your injector is. In most cases, the effects of Botox start wearing off after approximately three or four months. For most of my patients, it’s usually time to be re-treated after six months.

The most common side effects of Botox are headaches, which are minor enough that they’re treated with over-the-counter painkillers. Awkward cases of drooping eyelids and cocked eyebrows are very rare but can happen if too much Botox is injected, or if the injection sites are poorly chosen.

Some patients will experience mild bruising following Botox injections. While this is unusual, even the most skilled injector may occasionally rupture small blood vessels during an injection. Most bruises disappear on their own within one or two days and can be covered with makeup in the meantime.

Finally, no, Botox will definitely not make your wrinkles worse once the effects wear off.

Botox is not a permanent treatment for wrinkles. The botulinum toxin in Botox temporarily prevents facial muscles from moving for no more than a few months. Once the effects wear off, another treatment will be required to preserve them. While some injectors claim Botox can last for eight months or longer, I don't know what magical realm these claims come from. In my experience the effects last from three to six months max before requiring re-treatment.

While there are some minor potential side effects associated with Botox, making wrinkles "worse than before" is not one of them. Of the potential Botox side effects, center stage belongs to "drooping eyelid", which can happen if the botulinum toxin migrates through the skin to the muscle which controls the functioning of the eyelid. Once this muscle is affected by Botox, the eyelid will often “droop” to a half-closed state. That said, this side effect is very rare in the hands of an experienced injector.

While there are many clinics offering Botox injections, I advise you to get your injections from a board-certified plastic surgeon or dermatologist for both safety concerns and best results. You can use the search box on this page to find one in your area.

It's a surprisingly common myth that wrinkles get worse after Botox wears off. Surprising because it’s simply not true. However, some patients believe their wrinkles are coming back “worse than before” simply because they’ve grown used to six months or so of having a wrinkle-free complexion.

Generally speaking, it takes anywhere from three to six months for the effects of botulinum toxin to wear off. For some patients the immobilizing effects of Botox wear off more quickly than others.

Precisely how long Botox effects last depends on the area being treated, how many units of Botox are injected, the patient’s individual metabolism, and the skill and experience level of the injector.

This last factor can't be stressed enough: Successful Botox application requires skill and experience. A poorly trained Botox injector may miss the mark, leading to an unsuccessful result. Worse, a poorly executed Botox injection can cause negative results like a drooping eyelid, a cocked eyebrow, or an unnatural “frozen” look.

Unlike dermal fillers, there are very few ways to "undo" a Botox injection gone wrong. If an injection is performed poorly, the only solution in many cases is to wait it out for all those months

To answer your second question: yes, you will need to return for regular injections in order to maintain your wrinkle-free appearance.

It isn't true that the Botox itself "lasts longer" on subsequent injections. But it is true that your facial muscles can become accustomed to not moving. So while the Botox still wears off after the same amount of time, this "retraining" of your facial muscles after several injections means you may require fewer treatments in the future.

Botox provides many patients with excellent results for three to six months. The treatment relaxes the facial muscles, resulting in smoother skin with diminished lines and wrinkles. The longevity of your results depends on how quickly you metabolize the botulinum toxin, the number of units used on the area being treated, and the proficiency of your injector.

Botox works by paralyzing the nerve endings that attach to the muscle, resulting in the muscle entering a prolonged state of relaxation. Over time, as the Botox breaks down and is metabolized by the body, new nerve endings are formed that are unaffected by the botulinum toxin. When these new nerve endings re-attach to the muscle, they enable muscle contraction once more, allowing lines and wrinkles to form in the face again.

It is a myth that the wrinkles return deeper than before. What can happen, however,  is that the patient becomes accustomed to a younger-looking appearance and smoother skin. As the Botox wears off and lines and wrinkles reappear, they have the mistaken perception that they are worse.

To maintain beautiful results, you will need to maintain regular Botox injections to prevent wrinkles from returning. However,  these visits often become more sporadic the longer you use Botox. Sustained use of Botox means you can generally extend the time between treatment visits because of the long-term weakening of the muscle and possible “retraining” of the facial musculature (how you form facial expressions). So it’s not that the Botox lasts longer, but rather that the effects of the Botox last longer because it prevents the repetitive muscular activity that result in facial lines.

Botox can be very helpful in softening or even erasing the development of lines and wrinkles that usually start appearing on the face from the twenties onwards. It does so by injecting the botulinum toxin into the facial muscles that cause wrinkles and lines to appear when the muscles contract.  One Botox treatment can last up to six months, but results may vary from patient to patient. Factors such as those listed below may also influence the length of time between treatments:

  • Dilution of the form
  • Inadequate dosage
  • Substandard botulinum toxin
  • Resistance due to prolonged high usage
  • Premature massage on or around the treatment site
  • Body metabolism rates

Botox will not worsen your wrinkles or lines. It’s important to remember that the wrinkles have been temporarily smoothed out because the nerves have been temporarily paralyzed. When the Botox begins to wear off after four months or so, movement will begin to return to the facial muscles and you will notice wrinkles and lines returning to their pre-Botoxed state. What happens at this point is that many patients perceive the wrinkles to have worsened because they’ve become accustomed to their new, wrinkle-free appearance.

Most surgeons and injectors recommend not to wait for the effects of Botox to fully wear off before receiving another injection. It is advisable to have refresher injections while the effects of the previous treatment are still visible, as this leads to weakening of the muscles over time. With time and repeated injections, the lines and wrinkles will appear less severe as your facial muscles are trained to relax. At this point some patients can reduce the frequency of their treatments or the quantity of units required to address their wrinkles or lines. However, there are still no conclusive studies regarding prolonged use of Botox on wrinkles.