Botox® and Dysport® - Revision and Correction Treatments

The active ingredient in Botox® and Dysport® is a purified protein called Botulinum toxin. This protein prevents the the release of the neurotransmitter called acetylcholine, causing muscle flaccidity and temporary paralysis -- effectively ‘relaxing’ muscles for months at a time. Even though the active ingredient is a “toxin”, if applied correctly by a qualified and trained provider, it is very safe for human use, and has been successfully used to treat strabismus, cervical dystonia and other conditions for over 20 years.

Botox® and Dysport® are very popular and are most commonly known as injectable treatments to reduce facial lines and wrinkles. However, they are also used therapeutically for medical conditions such as:

Why might it sometimes be necessary to revise or correct a Botox® or Dysport® facial rejuvenation treatment?

There are several reasons why you may need to revise a Botox® facial treatment, but the two most common reasons are either:

  1. Your previous treatment had unwanted side effects due to poor placement resulting in undesirable results. This includes brow asymmetry, brow or lid ptosis (drooping), smile asymmetry or other suboptimal outcomes.
  2. Your previous Botox® or Dysport® treatment has worn off and your lines have returned. 

If your previous Botox® or Dysport® treatment has faded this is normal. Typically. the results of a single Botox® or Dysport® treatment will last 4-6 months, but if you have several treatments in a row, the effects may last longer, especially if you return for treatment before the full effect of the product have waned. Botox® and Dysport® work by temporarily disrupting the communication between the nerves and muscles of facial expression. Over time, this effect wanes, and communication resumes, resulting return of muscle movement. The time that Botox® or Dysport® lasts is determined by how quickly this process takes- typically about 3 or 4 months. With repeated use the muscle becomes less bulky and active, occasionally reducing the amount of Botox® or Dysport® required, or the interval between treatments may increase somewhat. This is why repeat treatments are recommended for longer lasting results.

If your previous Botox® or Dysport® treatment was inappropriately performed and resulted in unwanted or negative results, then a revision treatment to fix the problem may be more complex. In some cases, it may take a few weeks or months for the results of the initial treatment to resolve.

If your previous Botox® or Dysport® provider was unskilled or unqualified they may have injected the product into the wrong muscle group, or too deep or too shallow into the muscle. This may be evidenced by asymmetry, drooping, or other functional changes. Additionally, it is important to place the product precisely into the intended muscles for optimal results. Failure to do so can inadvertent paralysis of other muscle groups, rendering a suboptimal outcome.

Side effects of cosmetic treatment with Botox® and Dysport® may include partial facial paralysis, trouble swallowing or chewing, or muscle weakness. Unfortunately, there is no instant “fix” to these unwanted results, apart from waiting out the time that Botox® or Dysport® takes to fade, about 3 months in most cases. Once the old treatment has faded you may then repeat your Botox® or Dysport® treatment with a more skilled and qualified provider.

Why might a hyperhidrosis Botox® treatment need a revision?

Botox® and Dysport® are also used therapeutically -- and very successfully -- for the relief of excessive sweating in the underarms and palms.

Typically, our patients may need a revision or correction treatment because their previous provider was unskilled and therefore may have injected the Botox® or Dysport® in a pattern insufficient to affect the sweat glands. This results in an ineffective treatment, lleaving the patient still suffering with hyperhidrosis.

Most typically, our patients need Botox® or Dysport® hyperhidrosis treatment because the effects of a single treatment have worn off. Most often, a treatment will last about 6 - 8 months, however some patients are free of excessive sweating for up to 9-12 months if treatments are performed on a regular basis and before the effects of the prior treatment have dissipated.

The placement of Botox® or Dysport® injections is the critical factor to effectively stop sweat glands from producing excessive sweat. In fact, all Botox® or Dysport® treatments for therapeutic and cosmetic use must be performed by a medical professional to ensure strategic and precise placement of Botox® into the body to have a positive outcome. Botox® or Dysport® must be performed by a physician, nurse practitioner, physician assistant or registered nurse under California law.

Why might Botox® or Dysport® for migraine relief need repeated treatment?

Another therapeutic use for Botox® is for the relief of migraines or severe headaches. This is a recent development but it works by interrupting nerve impulses from the brain to relax specific muscle activity in three areas of the head and face:

  1. The supratrochlear and supraorbital nerves (inner upper eye area);
    The zygomaticotemporal nerve, (in front of the hairline outside the brow); 
  2. The greater occipital nerve, (back of the neck). 

Again, this is a highly specialized use of Botox® or Dysport® and must be administered by a medical professional who is highly trained and qualified to use Botox® Dysport® in this way. Your provider will administer a series of 31 injections into seven specific head and neck sites, so they must have an in-depth understanding of the craniofacial skeleton along with its muscles, tendons, and underlying structures.

The most common reason for a repeat treatment of Botox® for migraine relief is that that a single treatment will last for 4-6 months. After this time, migraine headaches may return to their original severity. Ideally, we recommend several sessions of treatments for accumulative effect with the goal of reducing migraine symptoms for up to 8 to 10 months.