Thank you for your question!
You state in your question that it has been 5 days since your Botox™ injection of exactly
42 units and you submitted 3 photos demonstrating your ability to squint your eyes, to raise
your eyebrows and to frown and these are the typical 3 areas of botulinum injection that’s
performed routinely and so 42 units is an appropriate dosage.
Well, I can give you a little bit of guidance as far as my perception from the photos you
submitted in your question. I’m a board certified cosmetic surgeon and fellowship
trained oculofacial plastic and reconstructive surgeon. I’ve been practicing in Manhattan
and Long Island for over 20 years. And as an aside, oculoplastic surgery as a group
was one of the first group of doctors to use botulinum toxin because of the indication
originally for facial spasms, spasms affecting the eye and the rest of the face. So certainly,
I have a lot of experience using Botox™ and I can certainly see why you are concerned.
Now, the general rule of thumb and if you have experienced having gone Botox™ injection,
then you’re probably aware that the onset of effect can take about 3 days and the peak
of the effect is about 2 weeks. So at 5 days, it would have to be a question of whether
or not you feel that your movement is as strong as it was prior to injection which I would
think would be unusual. So assuming that that’s the case, you can certainly reach out to your
doctor and ask about this.
You know, as someone who has had a large group of patients who I have been taking care of
for years, I get to know my patients in terms of their desired results and the ideal dosages
and I record these on my charts so I know what kind of amounts work best for each individual
patient. Now, there are going to be times when people need a little bit more or sometimes
when they need a little less. As times goes on, if you use Botox™ continuously, the
muscles tend to relax more and actually thin so sometimes you actually need less Botox™.
In other situations, there could be a point where a person may actually develop some degree
of resistance. Now, there can be a lot of different reasons for it. In some patients,
it can be antibodies to Botox™ which is possible that can actually negate the effect
or it can be a tolerance. It is an individual case by case basis.
And the simplest possibility is that the vial of Botox™ maybe when it was reconstituted,
it wasn’t a good vial or it wasn’t a vial that was agitated. There has been a lot of
discussion in our field about treating these vials very delicately where you don’t shake
the vial like when you with an antibiotic. But there are some people who disagree with
that and certainly have been able to show that they can agitate a vial and still get
good results.
Again, it’s reasonable to actually ask this question but I would say, it’s also reasonable
to wait the full two weeks because there may be a change. We tell our patients in our practice
that routinely for injectables for Botox™ whether it is for Restylane or Juvederm we
tell our patients to allow about 2 weeks for things to settle in and that to come in for
a follow-up appointment and we evaluate at that time to see how things look and then
we can add let say for Botox™ a little bit more if appropriate. If there is no movement
then there is no reason and again there is also a gradation a lot of people prefer some
movement, some people prefer no movement, some people want partial movement I mean there
are different levels in each individual.
So if you feel like you’re going in the same doctor for a while and you feel like
this is unusual then certainly having relationship with the doctor figuring out what went wrong
is important otherwise it might just mean you need to try again and have another injection
and see if it works but I would allow about a full two weeks you don’t want unnecessarily
doze an area and set the bar at a much higher dose than it is necessary it is wasteful and
not appropriate. So I would suggest again contacting your doctor and finding what their
thoughts about your situation and chances are they would want you to wait or come in
to take a look and see what’s going on. Everybody has different schedule and sometimes
they can’t wait the full two weeks because of important events or something like that.
So I hope that was helpful, I wish you the best of luck and thank you for your question!