肉毒杆菌不是突然失效了：医生拆解效果变短的真正原因

Botox loyalists claim something is amiss with their favorite injectable. The neurotoxin, which has been the go-to treatment to reduce the appearance of fine lines, is supposed to last three to four months. But some allege online that their Botox isn’t working as well—at least as well as it used to work.

From accusing providers of diluting solutions to get you to spend more on treatments to people believing they are now immune to Botox altogether, the theories are conspiracy-level complicated. But before anyone freaks out and cancels their next appointment, read what the experts have to say on what’s really going on with Botox.

Your Botox Isn’t Less Effective

The good news is that Botox itself hasn’t suddenly stopped working. As New York–based board-certified dermatologist Hadley King, MD, explains, because Botox arrives at a practice as a freeze-dried powder and is turned into a liquid with sterile saline before injection, there isn’t one universal correct way to dilute it. Different injectors use different dilution volumes based on their technique and treatment goals.

King says it’s more important to pay attention to the amount of units you’re receiving and not the concentration of the saline; the units you’re receiving determine how long it will last. “Twenty units is still 20 units whether it’s delivered in a smaller or larger volume,” she says.

The Real Reasons Why Your Botox Isn’t Lasting

In reality, there are many reasons why your Botox isn’t lasting as long as you’d like it to. Some common ones include:

Low Dosage

King says that under-dosing is simply the biggest reason. “Many people are requesting a softer, more natural look (sometimes called baby Botox), which intentionally uses fewer units, [and] less product generally means a shorter duration of effect,” she explains.

Brian J. Abittan, MD, director of skin and hair rejuvenation and hair transplantation at the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, adds that patients want more movement in their faces and less of a “frozen” look, which can sometimes result in lighter doses that wear off faster.

Muscle Strength

King explains that people with very strong facial muscles (men, athletes, those who have very expressive faces, etc.) often metabolize Botox sooner because their muscles are more powerful.

Your Biology

How someone is going to respond to Botox varies from person to person. King says some patients may experience their Botox lasting three to four months, while others may only get to two to three months despite getting the same dose and treatment. It really just depends.

Injection Technique

“Precise placement matters,” says King. “Even with the correct dose, injections that don’t optimally target the muscle can reduce the duration of effect.”

The type of practice where you get your Botox done also matters. If you’re going to a licensed professional, such as a board-certified dermatologist or plastic surgeon’s office, the risk of getting counterfeit Botox or improper injection techniques are slim to none. “Those situations are uncommon in reputable medical practices,” she says. “But [they] highlight why it’s important to seek treatment from qualified providers.”

Lifestyle Factors

King lists frequent intense exercise, high muscle activity, and a rapid metabolism as things that may make it seem like your Botox isn’t lasting as long as it used to. But she says evidence is mixed and these effects are generally modest.

Generally, Botox Doesn’t Stop Working the More You Get It

For most patients, King says they don’t become tolerant to Botox. In fact, she says many long-term patients may find that they can sometimes maintain results with similar (or even go with slightly fewer) units because repeatedly relaxing the muscle may reduce its strength over time. She also points out that first-time patients might notice movement returning earlier than patients who have been getting treatment consistently over time.

There is a small subset of patients who do develop these neutralizing antibodies against Botox, she says, which will make treatments less effective. But these are usually seen in those who receive high doses for neurologic conditions, get frequent touchups, and get injections at intervals shorter than 12 weeks. Though possible, true resistance from Botox is uncommon. “An experienced injector will first rule out these more common explanations,” she says.

Competition With Other Treatments

Many have already been feeling the Botox and filler fatigue and are looking to other procedures (XERF, facelifts, etc.) to fill other antiaging needs. Abittan says it’s important to pay attention to what each treatment actually does, as they each address different issues. Lasers, for example, can help with skin tightening, improve pigmentation or texture, and address wrinkles or lines at rest. Whereas neuromodulators like Botox work on movement-related wrinkles, he says.

“These treatments are complementary rather than competitive,” adds King. “The modern approach to facial rejuvenation is increasingly individualized and multimodal. Rather than replacing Botox, newer technologies give physicians more tools to address the specific cause of each patient’s aging concerns.”

And if you’re still unhappy with how long your Botox is lasting, consider a different product. She lists Dysport, Xeomin, Jeuveau, Daxxify, and Letybo as some options that are known to offer similar but longer-lasting results. Just be sure to go to a licensed professional before injecting anything new into your face.

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