{"id":441,"date":"2015-05-26T08:53:19","date_gmt":"2015-05-26T08:53:19","guid":{"rendered":"https:\/\/www.injectionartistry.com\/modesto-botox\/?p=441"},"modified":"2015-05-26T08:58:50","modified_gmt":"2015-05-26T08:58:50","slug":"botox-doesnt-work-as-well-anymore-what-to-do","status":"publish","type":"post","link":"https:\/\/www.injectionartistry.com\/modesto-botox\/botox-doesnt-work-as-well-anymore-what-to-do\/","title":{"rendered":"Botox doesn&#8217;t work as well anymore &#8211; what to do?"},"content":{"rendered":"<p>I&#8217;ve decided to tackle on another question in a public forum about <a href=\"https:\/\/www.injectionartistry.com\/botox\/\">Botox<\/a>.<\/p>\n<h1 id=\"question-title\" class=\"content-title\">I&#8217;m a Botox user but over the last 3\u00a0&#8211;\u00a04 times I&#8217;ve had Botox it hasn&#8217;t worked as well. What unit of Botox would I ideally want?<\/h1>\n<blockquote><p>I&#8217;ve been getting Botox for a few years,recently its not worked as well ,getting top ups is a hassel, especially when it doesn&#8217;t work again.i asked my doctor what units he used, what type and the dilution solution , &#8216; Azzalure which is the same as Dysport. Diluted with bacteriostatic saline solution to produce 200 Speywood units per ml. &#8216;frown 50-60units&#8217; is this good? I&#8217;m thinking of changing doctors, what would the best thing to ask them?how many units do i want injected if this didnt work?<\/p><\/blockquote>\n<h3>My Answer:<\/h3>\n<p>There are so many different ways to inject a neuromodulator and there are so many possibilities for a neuromodulator injection to work less effectively. \u00a0I&#8217;m going to use the word neuromodulator to describe Botox, Dysport, or Xeomin. \u00a0I agree that Dysport is sometimes called Azzalure.<br \/>\n\u200b<br \/>\n\u200bWHAT CAUSES VARIANCES IN OUR RESULTS?<br \/>\n\u200b<br \/>\n\u200bPatient factors<\/p>\n<ul>\n<li>\u200bIs the patient Zinc deficient? \u00a0Zinc seems to play a role in neuromodulator<\/li>\n<li>Did the patient develop antibodies to the product?<\/li>\n<li>How long ago was the patients previous neuromodulator treatment. \u00a0Often, when the treatments are close enough together, there&#8217;s a synergistic effect of the previous injection along with the new injection. \u00a0Thus don&#8217;t wait too long between injections where to facial muscles have gained back all their strength.<\/li>\n<\/ul>\n<p>Product factors<\/p>\n<ul>\n<li>\u200bDilution of the product. \u00a0Was it diluted appropriately.<\/li>\n<li>Age of product. \u00a0How long has it been on the shelf? \u00a0Shelf life can matter.<\/li>\n<li>Which product? \u00a0I feel that the neuromodulators are somewhat different from each other. \u00a0The units cannot be interchanged very easily. \u00a0It&#8217;s sort of like asking &#8211; how many tangerines does it take to make a washing navel orange? \u00a0Similar, yet different for the discriminating injector\/patient.<\/li>\n<\/ul>\n<p>Injector factors<\/p>\n<ul>\n<li>\u200bWhere were the injections made?<\/li>\n<li>Was there waste of product?<\/li>\n<li>Was the measurements accurate?<\/li>\n<li>Three dimensional injection, was the neuromodulator placed within the muscle or right under the skin, or right above the bone?<\/li>\n<li>How many injection points were chosen?<\/li>\n<\/ul>\n<p>\u200bI&#8217;m probably forgetting a few variables. \u00a0But you can see that there&#8217;s so much going on here.<br \/>\n\u200b<br \/>\nTHE ANTIBODY QUESTION: \u00a0Try more Dysport and\/or go back to Botox.<br \/>\n\u200b<br \/>\n\u200bConsider going back to your injector and asking for a higher dose of Dysport. \u00a0If that still doesn&#8217;t work, then consider asking your injector to switch back to your original &#8211; Botox &#8211; which seemed to work for you. \u00a0If both the higher dose and switching back to Botox &#8211; this might point to an antibody problem. \u00a0This will degrade the product faster. \u00a0This is a very rare possibility. \u00a0I think in the past, this happened more because of the higher percentage of albumin mixed in with the Botox. \u00a0But it&#8217;s a much lower amount of albumin used now and thus the antibody reactions are much rarer. \u00a0If antibody reactions occur, I believe that you&#8217;d be forming reactions to all Botulinum Toxin Type A&#8217;s: \u00a0Xeomin, Dysport, and Botox. \u00a0These are the ones available in the USA.<br \/>\n\u200b<br \/>\n\u200bSWITCHING INJECTORS\u200b<br \/>\n\u200b<br \/>\n\u200bBut if you have doubt about your injector. \u00a0You can switch. \u00a0Neuromodulator injection styles are incredibly different &#8211; this might be what you&#8217;re looking for &#8211; something different. \u00a0And hopefully better results. \u00a0I think you have a good idea on this one.<br \/>\n\u200b<br \/>\n\u200b<br \/>\nOR SPEND MORE TIME DISCUSSING THE PROBLEM<br \/>\n\u200b\u200b<br \/>\n\u200bConsider spending even more time talking to your injector. \u00a0Perhaps he\/she will come up with a comprehensive plan of figuring out what&#8217;s happening with your new dissatisfaction. \u00a0Above is just my own plan of what I do with my patients who present with such a scenario. \u00a0But most of the time, it&#8217;s because I&#8217;ve gotten patients who have decided to switch to me due to dissatisfaction with results from another injector.<br \/>\n\u200b<\/p>\n<p>IDEAL BOTOX UNITS FOR THE <a href=\"https:\/\/www.injectionartistry.com\/botoxblog\/botox-terminology-glabella\/\">GLABELLA<\/a>:<br \/>\n\u200b<br \/>\n\u200bHow many units of Botox for frown lines? \u00a0I call these lines <a href=\"https:\/\/www.injectionartistry.com\/botoxblog\/botox-terminology-glabella\/\">glabellar lines<\/a>. \u00a0I usually inject anywhere from 10-36 units of Botox for this one area. \u00a0Every person is different, but usually I am sticking to the same general amount of units for each treatment session. \u00a0Thus if a patient is a 36 unit user &#8211; they tend to be a 36 unit user for a few years. \u00a0I have found that they can usually space the treatments further apart though as they keep using Botox.<br \/>\n\u200b<br \/>\n\u200bOn average, I use 20 units of Botox for the <a href=\"https:\/\/www.injectionartistry.com\/botoxblog\/botox-terminology-glabella\/\">glabellar complex<\/a>. \u00a0The numbers written above in the question are probably Dysport units which could be about 3 times more than the Botox units to achieve a similar (not same) result. \u00a0I&#8217;m not entirely sure because I am nearly 100% Botox in my own practice. \u00a0My experience with Dysport spans only about 3 months in my practice. \u00a0I was pretty happy with the Dysport results, but my patients seem to want Botox more, so I caved into consumer demand. \u00a0I am happy with both products. \u00a0But I do not use the terms Botox, Xeomin, and Dysport interchangeably. \u00a0They are different products and have different effects and require different care.<br \/>\n\u200b\u200b\u200b<br \/>\n\u200bThank you for your question. Without having seen you in person, I\u2019m answering the best I can without physical examination info and a one-on-one dialogue. My comments are meant for a general public discussion to help others who may have similar concerns. I\u2019m also using my answers to build up library of information for my own patients and also to see how my answers compare with other doctors. There is always much for us to learn from each other. My answers are generalized medical information only, not directed medical advice. For medical advice please see your doctor\/surgeon in person.<br \/>\n\u200b<br \/>\n<a href=\"https:\/\/www.injectionartistry.com\">\u200bCalvin Lee, MD<\/a><br \/>\n<a href=\"https:\/\/www.injectionartistry.com\">\u200bBotox injections Modesto, California<\/a><\/p>\n<p><a href=\"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-content\/uploads\/2015\/01\/surgical-artistry-full-page-ad-never-boring.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-111\" src=\"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-content\/uploads\/2015\/01\/surgical-artistry-full-page-ad-never-boring-245x300.jpg\" alt=\"surgical artistry full page ad never boring\" width=\"245\" height=\"300\" srcset=\"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-content\/uploads\/2015\/01\/surgical-artistry-full-page-ad-never-boring-245x300.jpg 245w, https:\/\/www.injectionartistry.com\/modesto-botox\/wp-content\/uploads\/2015\/01\/surgical-artistry-full-page-ad-never-boring-838x1024.jpg 838w, https:\/\/www.injectionartistry.com\/modesto-botox\/wp-content\/uploads\/2015\/01\/surgical-artistry-full-page-ad-never-boring.jpg 900w\" sizes=\"auto, (max-width: 245px) 100vw, 245px\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve decided to tackle on another question in a public forum about Botox. I&#8217;m a Botox user but over the last 3\u00a0&#8211;\u00a04 times I&#8217;ve had Botox it hasn&#8217;t worked as well. What unit of Botox would I ideally want? I&#8217;ve been getting Botox for a few years,recently its not worked as well ,getting top ups &hellip; <a href=\"https:\/\/www.injectionartistry.com\/modesto-botox\/botox-doesnt-work-as-well-anymore-what-to-do\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Botox doesn&#8217;t work as well anymore &#8211; what to do?<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31,3,22,46],"tags":[68,32,43,69],"class_list":["post-441","post","type-post","status-publish","format-standard","hentry","category-botox","category-botox-fluff","category-questions","category-real-self","tag-azzalure","tag-botox","tag-dysport","tag-glabella"],"_links":{"self":[{"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/posts\/441","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/comments?post=441"}],"version-history":[{"count":4,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/posts\/441\/revisions"}],"predecessor-version":[{"id":445,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/posts\/441\/revisions\/445"}],"wp:attachment":[{"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/media?parent=441"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/categories?post=441"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.injectionartistry.com\/modesto-botox\/wp-json\/wp\/v2\/tags?post=441"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}