Dr. Sam Lam Plastic Surgery Forum

Hi Dr. Lam,

Great info. on your website! I've getting botox for years and then I stopped for about two years. I was a little scared that I might have side effects in the future. It also seemed to last a long time. anyways, I started noticing very deep lines especially after I started trying facial yoga. It was only for a few days of facial yoga, and the lines seemed deeper or maybe I just started noticing it. I went back to the same doc. And got the botox done. Its been less than two months and I am noticing the lines already. I started noticing it after just one month. Before when I used to get botox, it would last for at least 6-8months. Sometimes, even longer.

Is the botox not effective anymore? Did I wait too long to get the botox? And what is your advice on this? The doctor I go to does a touch up after a month if you can see the lines and I did go back to the dr. For this. But, it seems to be wearing off way too fast.

watch this video:
http://www.lamfacialplastics.com/galler ... rcise.html
basically, the summary is that i look at botox like exercise. when you become "fit" with repeated botox dosing and good intervals, you need less of it and less often to stay fit. you are not "out of shape" and you will not get the same results or length of duration. be careful with a lot of touch ups. it can build up resistance if done too many times then your botox will never be effective for the rest of your life. a couple of touchups are fine but you should stay with a 3 month interval until you begin to heal then you can start spreading it out to 4 months, etc.
actually watch all these videos too:
http://www.lamfacialplastics.com/galler ... Tutorials/
http://www.lamfacialplastics.com/galler ... ateau.html
http://www.lamfacialplastics.com/galler ... ainer.html
best,
sml

Hi Doctor!

I got a bit confused concerning the "resistance" comment you made. I wish I could access the videos, since the explanation might be there, but I am having all sorts of problems when trying to watch any type of video (not sure yet of what is going on with my computer).

Anyway, my questions are:

- why and how could botox build up resistance if at the same time the continous action of botox is what in the long run rejuvenates the skin more and more?

- how not to get rather frequent injections if injections in different areas of the face require sometimes a different injection timing?

I mean, in some areas the botox action lasts way longer than in others. At least in my case and in a few people I know, botox last way less in areas that we naturally tend to move more...

It's as if the botox had to fight harder right where we naturally gesture more and wrinkle more because of the way we talk and gesture naturally... while it seems to last a lot more in areas where we do not tend to gestures as much anyway.

Say, botox for forehead lines can last very long in me, because I normally do not raise my eyebrows except for rare occasions, and the furrow lines between the eyes are lines I never even really got (just too too faint before they got botox for the first time) because I always hated the gesture - I recall that one day I saw so many people at the street doing that gesture, and thought it was so horrible how angry it made people look, that my teenage self swore to herself to not furrow... and the habit of avoiding it got ingrained (not to avoid lines, back then, I was so young... just to not look angry). Anyway, this means that between my eyebrwos, the botox lasts eons.

On the other hand, I am extremely expressive with eyes, and the botox under the eyes works for me, but for short amounts of time. It's not a technique problem, I always got it just fine and no problems in the least (and the same doses you have suggested in other threads, etc., I go to the one derm who seems to be totally in sync with your take on how to treat that area).
I just happen to naturally tend to try to move those muscles, so to speak, all the time, so I guess the botox must fight harder against my "trying to innervate" those muscles.

If I waited until all of it was about to wear off, actually, part of the areas would have still some botox working maybe enough to not really need another shot yet, while others would be so back to "not botoxed" that I'd lose with the latter the chance to "remain fit", using the metaphore you gave.

I must, then, use botox at different lapses and moments for different areas, and for some it means relatively frequent doses (undereye area).

What to do, then? if I let the botox wear off totally, I would be going back to square one or at least not making the most of its use. But from what you say, maybe not waiting for it to fully wear off means having relatively frequent botox injections and maybe developing resistance?

My undereye area needs it every three months, sometimes two months!, usually. Again, I am extremely expressive with my eyes, AND I noticed that if at a given time of the year I have laughed and cried more than in other times, the botox wears off faster- and viceversa.

What to do, then?

Hugs!

hi,
in answer to your question, the thing that i would do is stay with a 3 month interval. yes, the lower eyelid area tends to fade much much much faster than other areas but that is the nature of the beast. i personally do not like pushing botox too frequently for the very small but real chance of antigenic buildup which can then cause permanent resistance. at the doses we use for cosmetic purposes and since allergan cleaned up the antigenic load in the late 90s this is pretty small chance but given the fact that there is only botox or related toxins to do the job it is not worth the risk. even though some wrinkles come back early, a steady diet of solidly performed botox can lead to long-term results even if there is some early fading. that is my opinion.
best,
sml

Perrfect, thank you! super clear!

I wish I had that problem! I had dysport in boulder, co to help even out my eyes. After having facelift and bleph up north {not dr L} I have one that sits too low.so we used dysport in attempt to even them out.....not a great look. Well it made matters worse. Dr Lam, how long does Dysport last,please? Thank you <3

think of dysport and botox like pepsi and coke. they both last about 90 days. however, at this time i do not prefer dysport because it migrates too much, as far as what i have observed. i have absolute control with my botox with the method i use.
best,
sml

May be botox has stropped working on you skin or your skin have been more flexible then before which may required some other kind of treatment for good results. Excessive botox can harm your skin as well and for future you may be restricted for such treatment when you would really need it.
Meet an expert and find some better solution apart from botox therapy.

ok, answering questions and making suggestions is not allowed on this forum. i am feeling very much like you are advertising for someone else. sneaking suspicion. if so, i am going to delete your posts. sorry.