Correct expectations for duration of a Tox result
How much movement should we expect during the middle to the end of the onset-offset cycle of Tox (Botox or Dysport)? What’s the downside to re-treating early, including touch ups? Is Baby Botox beneficial? Does the old “product rotation” advice help prevent eventual resistance to Tox? Let’s discuss!
What to expect from a normal onset-offset of Tox
Tox gradually onsets from the day of injection till day 14, with it being completely onset at day 14. Sometimes it feels as though it’s fully set sooner than that, but we don’t like to touch up asymmetries before day 14 because it still can change later in the first two weeks. It’s as motionless as it will ever get on day 14, and frequently people love this result and want it to last all 3 months of the Tox cycle. Truly though, the full setup doesn’t last all the way to the 90 day mark and it’s important to emphasize that this is normal and doesn’t require a touch up. Especially in the final month of the treatment cycle, muscle movement is slowly being regained, and just because a muscle regains the ability to move a little, doesn’t mean it has it’s full strength to wrinkle the skin. Normally there should be a period at the end of the cycle where the skin remains smoother than the untreated baseline skin, and muscle movement is gradually being regained. Bottom line if you’re two months into your treatment cycle and you can move your forehead a little, don’t panic. That’s a bad time to touch it up. Wait till you’re past 90 days to retreat and here’s why…
Resistance to Tox
For many years this has been a poorly understood and poorly researched topic: a very small group of people may experience lack of responsiveness to Tox injections after many years of serial treatment. Newer research finds that 0.5% of the population receiving Tox experiences resistance and that resistance occurs because of antibodies your body makes against the actual toxin itself (botulinum toxin A).
In the past, it was thought that the body made antibodies against the accessory proteins on the toxin molecule, and Xeomin was advocated as the solution to this due to it’s lack of accessory proteins, but this has more recently been found to be not accurate. Our experience at Skinbeam has been that Xeomin is indeed not the antidote to Tox resistance.
It’s honestly unlikely that any given patient is in the unlucky 0.5% who experience eventual tox resistance, but the only way to prevent this is to get treated less frequently. Limit routine tox treatments to every 3-4 months (Shoot for 3 times a year if you can) and limit unnecessary touch ups so that your body has less of an opportunity to create antibodies against the tox.
The case against Baby Botox
Additionally this is why we at Skinbeam do not advocate baby botox (low dose tox at a young age for “prevention”) … baby botox just increases your lifetime exposure to tox, potentially making you resistant later in life when you actually need it. It’s a waste of money in our opinion. :)
Rotating products
Injectors (myself included) used to advise patients that it was beneficial to rotate tox products each treatment to stave off resistance, but unfortunately this new data tells us that strategy won’t help prevent resistance.
Do you love science?
Here’s the citation for the above discussed research:
Jankovic J, Carruthers J, Naumann M, Ogilvie P, Boodhoo T, Attar M, Gupta S, Singh R, Soliman J, Yushmanova I, Brin MF, Shen J. Neutralizing Antibody Formation with OnabotulinumtoxinA (BOTOX®) Treatment from Global Registration Studies across Multiple Indications: A Meta-Analysis. Toxins (Basel). 2023 May 17;15(5):342. doi: 10.3390/toxins15050342. PMID: 37235376; PMCID: PMC10224273.
