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Why Doesn't My Botox Seem Too Last?

Botox is truly a wonder drug when it comes to cosmetic facial therapies to reduce upper facial lines and wrinkles. While it is a simple injection treatment, its effectiveness for some patients may be variable given the injector's training and experience and how the Botox solution was prepared and used.

Botox is the most popular cosmetic medical treatment and has been largely responsible for generating a wave of medspa and other office location treatment facilities. Such facilities require injector providers, many of whom are non-cosmetic physicians and nurses. The simplicity of its use and the predictability of its results makes such treatments seem easy with few complications or problems.

The simplicity of any treatment does not necessarily guarantee a good result. In most cases, it is difficult to not chose Botox as a correct treatment for undesired lines and wrinkles from hyperactive or normal facial expressions. Whether it is the glabellar furrows or crow's feet, Botox is always the first (and really only good) treatment of choice. Below the eyes, however, Botox is often not the only or even the best treatment for wrinkling problems around the mouth and neck. Most times, the mouth and neck are better off with either other minimally-invasive treatments or actual plastic surgical procedures. The problem is....if your treatments options are limited to mainly injection therapies....a patient's result will not only be limited and disappointing but a waste of a patient's money.

For Botox to be maximally effective, it must be mixed properly and used relatively promptly. Botox comes as a powder in a bottle that is so minute it is virtually impossible to see. It is reconstituted with saline on-site and, although the manufacturer provides recommendations as to how it is to be mixed (how much saline is put into the bottle), the treatment provider can do as they will. Because of potential profitability, the temptation exists for some to create a more dilute solution of Botox by simply adding more saline when it is mixed. This creates more Botox available to be injected and a greater number of patients can be treated....but it may not work very well and its results will mot usually last as long if it works at all. The patient obviously has no knowledge as to how the Botox they are to receive is mixed...and I have found most patients don't even know how many units they have or usually receive. They simply know the price they paid. How long after it is mixed that the Botox is used also affects its effectiveness. Botox is not like wine....age does not make it better. After it is mixed it should be used within 24 to 48 hours at the longest. While the manufacturer recommends hours to a day, a day or two after mixing does not seem to change its effectiveness. How 'old' the Botox you have received is unknown to any patient. How busy the practice or location is where you receive Botox is one indication of how fresh the Botox may be. (how many patients do they treat regularly with Botox) Daily? Weekly? Monthly? The busier a practice is, the more likely they will have fresher Botox.

Botox is a remarkable medical treatment that offers unparalleled wrinkle-reduction results in the forehead and around the eyes. While it is a simple injection treatmentFree Reprint Articles, its results can be affected by the training and experience of the injector and how it is reconstituted and when after it is used.

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Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, is in private practice at Clarian Health in suburban Indianapolis. He writes a daily blog on plastic surgery at

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