Neurotoxin, or wrinkle-relaxing injections, are the most popular and well-known injectable treatment in the aesthetics world.

Some people swear by them…others swear to never go near them! Like we always say at Skin Health by Dr. Jenny, everyone’s skin, ageing and anti-ageing journeys are unique and no one should ever feel pressured or influenced to go under the needle or the knife.

But those of you who are ‘tox regulars, may have noticed some variations in the longevity of your treatments from time to time… even when you’re visiting the same practitioner, getting the same pattern of treatment and sometimes despite the same dose of treatment, a degree of variability is to be expected.

If you’re wondering why your friend’s results seem to keep up for 6 months whereas you might be noticing some unwanted movement or pesky lines at around 6 weeks, then I’m here to tell you that you are definitely not going mad!

There could be at least 10 separate factors, influencing the longevity of your neurotoxin treatments. Let’s have a look at them!

1. Initial Dosing

Botulinum Toxin is a drug. Drug effects are influenced by doses… and this is no different for Botox. Higher initial doses (including a top-up at that 2-4 week mark) are likely to lead to your Botox effect lasting longer. However, this does come with the caveat that stronger initial doses, are more likely to lead to heaviness or a more frozen look during those first few weeks. And so it’s all about having an open and honest discussion with your clinician about what your short and longterm aesthetic goals are: If you want it to be a stronger treatment and don’t mind looking a little bit frozen or expressionless in the beginning then go for those higher doses; If however you want to keep some movement and look more natural then what I refer to as ‘sensible doses’ are the ones for you, with the acceptance that you’re probably going to be popping in for another session at 3 months. My personal recommendation, especially when you are new to toxin treatments or seeing a clinician for the first time…keep it sensible and then visit for a review in 2-4 weeks time to determine if you require a small dose adjustment to tweak those results just perfectly.

2. A faster-acting metabolism/ a higher basal metabolic rate

It is thought that those with a faster-acting metabolism might notice the effects of their toxin lasting a shorter duration of time. This often leads to the question of…

“Does regular exercise make my Botox wear off quicker?”

Although there is no robust scientific evidence to support or refute this, this phenomenon is often reported by patients or clinicians. But is it the exercise itself that “wears off the botox” because it speeds up our metabolic rates or are other factors at play. It could well be that during exercise, especially the intense, rigorous kind, we often find ourselves more repeatedly and strongly scrunching up those facial muscles. Could that repeated strong contraction bee keeping the muscles stong and active and not allowing that relaxation effect to last that long?

The answer is still unknown…but my advice? Exercise is a wonderful habit and essential to physical and mental well-being for a lot of people. And so never let the fear of your Botox wearing off, put you off exercising if you truly enjoy it. Health is a holistic, multi-factorial state of being… so don’t forego physical health for the sake of slightly more prominent forehead lines! Besides exercise itself can have so many other wonderful knock on effects for skin health (looking at you, endorphin glow!) so as with all things, it’s all about balance and all about doing what is right for you.

3. Different brand or subtype of product

There are a variety of neurotoxin brands and subtypes in the market, meaning there may be some subtle variability in which brand gives you, as an individual, a quicker, stronger or longerlasting result. If you know for certain whether a particular product gives you the best results, or if you’ve noticed prior sub-optimal effect when being injected with a specific type of neurotoxin brand, then it’s always a good idea to bring this up with your clinician so that you can come up with the best action plan for you.

4. Personal factors

Personal factors can play a massive role on how you respond to a particular treatment regime. This can include things like your age at the time of treatment, your biological gender, your baseline skin quality and your underlying muscle strength. The ageing parameter in itself is an important one to consider because say you’ve been receiving toxin treatment since the age of 35, you may notice is not working the same at age 45. Some people will begin to worry about whether they have actually become resistant - and although toxin resistance is a very real possibility, it’s fairly rare - and so it is more likely that one of the many factors we discuss in this blog post are at play - age being one of them. Despite someone having regular toxin treatments and engaging in other skin care routines, our skin quality, collagen levels, fat pads and muscles continue to change over time, and so a treatment that was super effective 10 years ago might not cut it now. Thankfully, this does not mean all hope is lost! It just means that your rejuvenation treatments are likely to need a little tweak or overhaul or a few extra treatment modalities added to the mix here and there, to offset some of the parameters of gruadual, natural ageing.

5. Area being treated

Although the aesthetic use of neurotoxins started off with the sole focus being the frown area (aka 11s lines or glabella complex), the product is being increasingly used for a whole variety of muscle groups. For this reason, you may notice it working for longer in some parts of your face compared to others. For example in highly mobile or high use areas such as around the eyes or mouth (which also tend to be treated with lower doses due to safety parameters…) you may experience a shorter duration of action, than in an area less engaged in animation. Or if your frown is much stringer than your eyebrow raise, even if you have the 2 areas treated at the same time, you’ll find one wearing off quicker than the other.

6. Frequency of treatment

How often you receive treatment is a very individualistic thing. Although on average we advise that in most people the effects of Botox will last around 12-14 weeks before a further session is recommended, some individuals may find that they can stretch this longer. However how long you leave between treatments is a bit nuanced… let me explain. Ensuring that your treatments are NOT spaced sooner than 3 months apart will ensure that you are avoiding over-treatment that could theoretically increase the risk of resistance; similarly waiting several months after your ‘tox has completely worn off to get re-treated means that your muscle strength is going to be returning to baseline and so your treatment journey will be starting from scratch each time. So balance is key: always wait 3 months and if the return of movement at that point is still very mild and subtle then go ahead and push it a bit longer; if however its coming back in full-force, then it’s probably best to schedule in a treatment to prevent those movement lines from getting too etched to budge.

7. Injection technique

Although there are some fairly standardised areas that we aim to inject, there are specific nuances of where and how an injection point is delivered, which can affect how well the product works. Even within the same muscle, there are certain points where you need to be injected more superficially and others more deeply. Subtle variations, even only a few millimeters apart can produce differing results and effectiveness of treatment. Although this can happen even at the hands of the most skilled injector, by chosing a clinician who has trained extensively in facial anatomy and understands the differences in muscle position and depth, can help to reduce the risk of these issues.

8. Post-procedure factors

There are some factors within the post-procedure period that are believed to effect how effective treatment will be. This can include things like exposure to extreme heat or exercise in the initial 24hour period or excessive pressure or rubbing on the area. The true impact of this is not robustly evidenced or proven but to exercise caution we will advise that you avoid sitting in a steam-room, sauna, hot yoga class or taking a long hot shower or bath in the first 24hrs post treatment, avoid heavy exercise in that time and avoid rubbing the area or applying pressure for a prolonged period of time. For this reason we also ask that you leave some time between having botox treatments and then undergoing aggressive facials, waxed, LASER, IPL or energy based treatments - for these I would advise leaving at least a week.

9. Overall skin-care habits

Any other skin-care habits that you implement such as your at-home skin care, use of collagen boosting treatments or regular facials will positively improve your overall skin quality and therefore compliment the benefits and likely longevity of your toxin treatment. For example, if your skin is congested and dull then even though a few lines may be erased withthe neurotoxin, then it is unlikely that your skin will look luminous, healthy and plump. Similarly, if your skin is dry and dehydrated, then even the smallest line will start to show as your toxin effects start to subside because your skin will not be hydrated and bouncy. Neurotoxin treatments are great as part of an overall, holistic and multifactorial approach to facial skin rejuvenation. If however it is the only thing you are doing as part of your rejuvenation journey and not actually looking after your skin from a skin health point of view, then you are unlikely to be experiencing the full benefits of undergoing toxin treatments. Remember that what makes our skin look healthy is NOT the abscence of lines, but instead things like plumpness, hydration, glow, even tone, even texture and abscence of inflammation.

10. Lifestyle and environmental factors

Just like your skin routine could be playing a massive impact on your results, it is also vital to consider that general lifestyle factors could be worsening the quality of your skin and making the benefits of neurotoxin less noticeable. This is especially true of factors that contribute to inflammation and collagen breakdown - there is a reason why inflammaging has become a newly-coined term: chronic inflammation can lead to premature ageing. And so it is important to try and reduce or eliminate the main cultprits of chronic inflammation such as: UV exposure, stress, smoking and a diet high in sugar or processed foods. I promise you that if you feel your best from within, if your healthy life-style choices start to reflect in the glow and quality of your skin then that little forehead line that creeps up before your Botox is next due, will be far, far less noticeable because you will be radiating health from within.

If you want to know a little bit more about the neurotoxin treatments on offer in the clinic then visit our dedicated treatments page here or book yourself in for a bespoke consultation and treatment plan.