Dr. Ashley Corey
Demystifying Neurotoxins: Does dose effect result duration?
Updated: 3 days ago
There is a common myth we see at Wellspring, in which patients believe that dosing of neurotoxins like Botox, Dysport, and Xeomin does not change how long the effects of neurotoxins last.
The opposite is in fact true. Virtually all manufacturers of neurotoxin have published data on the impact of dosing on the duration of the muscular inhibition, and is different for each product [6-10]. Each product is FDA approved at specific doses that are determined by several factors, such as: potency, efficacy, duration, rate of side effects, and many more.
As with results and reaction to each product is unique to each patient, so is the response to higher doses. Studies have demonstrated a clear positive correlation between the dose of product and both the magnitude and duration of the effects on muscular inhibition [1-5] across all brands.
For example, the FDA approved dosing for Botox is 20 units in the forehead lines, 24 units in the lateral canthal lines (crows feet, 12 each), and 20 units in the glabellar lines (11's between eye brows). Therefore, the FDA approved dosing for the upper face of Botox is a total of 64 units. Do you recall how many units you received at your last treatment? Many injectors under dose their patients for many different reasons including budget, patient desired outcomes, previous dosage used or for fear of complications. Under dosing can lead to great results for a few weeks, but will often yield unsatisfactory results long term, as the under-treated areas recover quickly.
We believe this my originates from studios who under-treat their clients, leaving unrealistic exception of what dose is required for long lasting results. The importance of experienced injectors with the clinical skills to administer appropriate doses of neurotoxins, while minimizing risk of poor outcomes is so important, and why "Studio Hopping" or "Special Chasing" is such a gamble, and often costs more in the long run.
Dr. Corey is the owner and Physician Injector at Wellspring Skincare in Roswell, Georgia. Wellspring Skincare is a boutique medical spa servicing the Roswell and North Atlanta areas for all skincare needs including wrinkle reduction, skin tone correction, lip and face volume augmentation, or just a day of treating yourself with a feel good facial.
Joseph, JH, Maas C, Palm MD, et al. Safety, pharmacodynamic response, and treatment satisfaction with onabotulinumtoxinA 40 U, 60 U, and 80 U in subjects with moderate to severe dynamic glabellar lines. Aesthet Surg J. 2022;42(11) :NP1318–1327.
Polacco MA, Singleton AE, Barnes CH, Maas C, Maas CS. A double-blind, randomized clinical trial to determine effects of increasing doses and dose-response relationship of incobotulinumtoxinA in the treatment of glabellar rhytids. Aesthet Surg J. 2021;41(6):NP500-NP511.
Kerscher M, Fabi S, Fischer T, et al. lncobotulinumtoxinA demonstrates safety and prolonged duration of effect in a dose-ranging study for glabellar lines. J Drugs Dermatol. 2021;20(10):1052-1060.
Joseph JH, Eaton LL, Robinson J, Pontius A, Williams EF. Does increasing the dose of abobotulinumtoxinA impact the duration of effectiveness for the treatment of moderate to severe glabellar lines? J Drugs Dermatol. 2016;15:1544-1549.
Carruthers J, Solish N, Humphrey S, et al. Injectable daxibotulinumtoxinA for the treatment of glabellar lines: a phase 2, randomized, dose-ranging, double-blind, multicenter comparison with onabotulinumtoxinA and placebo. Dermatol Surg. 2017;43:1321-1331.
BOTOX® Cosmetic Prescribing Information, July 2020.
Dysport® Prescribing Information, July 2020.
Xeomin® Prescribing Information, August 2021.
Jeuveau® Prescribing Information, January 2020.
Daxxify™ Prescribing Information, September 2022.
Brin MF, James C, Maltman J. Botulinum toxin type A products are not interchangeable: a review of the evidence. Biologics. 2014;8:227-241.
Samizadeh S, De Boulle K. Botulinum neurotoxin formulations: overcoming the confusion. Clin Cosmet Investig Dermatol. 2018;11:273-287.