Revision – Botox (Face, Hiperhydrosis, Migraines)

Botox® and Dysport® - Correction and Revision Treatments

Cosmetic and therapeutic uses for Botox® and Dysport®

The active ingredient in Botox® and Dysport® is a purified protein that causes temporary muscle flaccidity and paralysis, effectively ‘relaxing’ muscles for months at a time. If injected correctly by a qualified and trained provider, both treatments are very safe and have been successfully used for cosmetic and therapeutic uses for over 20 years.

Most commonly, Botox® and Dysport® are used as injectable treatments to rejuvenate and smooth the face by reducing wrinkles and facial lines. Both Botox® and Dysport® are also used therapeutically to alleviate medical conditions such as:

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

The two most common reasons why you may need to revise a Botox® or Dysport® facial treatment are that:

  1. Your previous treatment was poorly placed resulting in negative results or unwanted side effects such as asymmetry of the brows, brow or lid ptosis (drooping), smile asymmetry or other suboptimal outcomes.
  2. Your previous Botox® or Dysport® treatment has worn off and your facial lines have returned.

For most people the results of a single Botox® or Dysport® treatment will last 4-6 months, so if your previous Botox® or Dysport® treatment has faded this is normal. Botox® and Dysport® are both cumulative in their effects. This means that ideally you would return for treatment before the full effect of the product has waned so that the effects may last longer.

Botox® and Dysport® work by temporarily disrupting the communication between the nerves and muscles of facial expression. Over time, normal communication resumes, resulting in return of muscle movement, as well as the appearance of fine lines and wrinkles. The time that Botox® or Dysport® lasts is determined by how fast this process takes.

With repeated cumulative treatments, the facial muscle becomes less active. It may be possible to  reduce the amount of Botox® or Dysport® placed, or the length of time between treatments may be allowed to increase. This is why repeat treatments will ultimately create longer lasting results.

Botox® or Dysport® - about the correction procedure:

If your previous Botox® or Dysport® facial treatment was inappropriately performed and resulted in negative results, then a revision treatment to fix the problem may be complicated. Depending on your situation, it may take a weeks or months for the negative effects of the previous treatment to dissipate until a correction procedure may be performed.

If your previous Botox® or Dysport® provider was unskilled or unqualified they may have injected the product into the wrong muscle group, or at the wrong depth (too deep or too shallow) into the muscle.

It is critically important to inject the product precisely into the correct muscles for optimal results. Failure to do so can cause inadvertent paralysis of other muscle groups, rendering a suboptimal outcome. This may result in facial asymmetry, facial drooping, partial facial paralysis, or other unwanted functional changes such as difficulty chewing, trouble swallowing or generalized muscle weakness.

Unfortunately, there is no instant or easy “fix” to these negative results, apart from waiting out the time that the effects of Botox® or Dysport® takes to naturally dissipate — typically about 3 months. Once the old treatment has faded you may then repeat your Botox® or Dysport® treatment with a more skilled and qualified provider.

Why might Botox® or Dysport® for hyperhidrosis need a revision?

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

Some of our revision patients may need a correction treatment because their previous provider was unskilled and therefore may have injected the Botox® or Dysport® in a pattern that was insufficient to affect the sweat glands — leaving the patient still suffering with hyperhidrosis.

But most typically, our patients need a revision Botox® or Dysport® hyperhidrosis treatment because the effects of a single treatment have simply worn off. Typically, a treatment will last about 6 – 8 months, however some patients are free of excessive sweating for up to 9-12 months due to a cumulative effect. This means that if injections are performed regularly and before the effects of the prior treatment have dissipated then each treatment will last longer.

Injection placement is critical for a successful result.

The placement of Botox® or Dysport® injections is a critical factor to effectively stop sweat glands from producing excessive sweat. All Botox® or Dysport® treatments for therapeutic use must be performed by a medical professional to ensure the most strategic and precise placement of Botox® or Dysport® to have a positive result.

All Botox® and Dysport® injections 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® that is growing in popularity is for the relief of severe headaches knowns as migraines. This relatively new therapeutic use works by interrupting nerve impulses from the brain to relax specific muscle activity in three key areas of the head and face:

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

This is a highly specialized medical use of Botox® or Dysport® and must be administered by a medical professional who is highly trained and qualified to use Botox® or Dysport® in this way.

Your physician, nurse practitioner, physician assistant, or registered nurse, will administer a series of 31 injections into seven specific head and neck sites. To place Botox® or Dysport® in this manner, they must have an in-depth understanding of the craniofacial skeleton along with the muscles, nerves, and underlying structures.

For our patients, the most common reason for a repeat treatment is that that a single treatment will last for approximately 4-6 months. After this time, migraine headaches may return to their original severity. Because Botox® and Dysport® have a cumulative effect, we recommend several sessions of treatments (before the previous treatment has worn off) with the aim of reducing migraine symptoms for up to 8 to 10 months.