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?


F, 37, New Jersey

Once your botox wears off, your wrinkles can return (and in my case, did return). I get Botox injected every 3-4 months. It costs me $500 in VA per session. The $1500-2000/yr is worth it for me. The price of the injections will vary depending on your location, the doctor you pick and the area you need injected. I've seen prices as high as $1000/session. 

My fiance had Botox injected into her forehead and the lines did not return after it wore off. Having said that, that's most likely because she's in her late 20s and did not have deep wrinkles to begin with. I believe it is necessary to return to the doctor's office to receive continuous treatments but frequency is probably determined by your age and skin condition.  

You're correct. You will have to return to the doctor's office every few months, depending on your skin type, etc. It's not so bad. I receive injections every 4 months and I'm very happy with my results. 

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.

I have used Botox for years. In my experience, Botox usually only lasts for 3-4 months. I have never had my Botox last as long as 6 months. I keep up with my Botox injections on a regular basis, because I know that if I did not, the wrinkles would eventually return. 

Wrinkles won't look worse because of Botox. They are induced by facial animation and dryness.