Can You Make Botox Last Longer?

When we lived in New York, I was regimented about my Botox injections. In my thirties, I started getting them every six months. I believe in Botox’s wrinkle-prevention power, thus my early start. Once I entered my forties, I upped the frequency to every four months. However, since we’ve moved to Ann Arbor, but I’ve refused to give up my NYC dermatologist Neal Schultz, M.D, I’ve adopted a whenever-I’m-in-New-York schedule. For most of the two years we’ve lived in Michigan, that’s allowed me to still get injected every four to five months. However, thanks to a busy summer and a hockey-filled fall, I’m now looking at seven months since I’ve seen Dr. Schultz—and forehead lines that are threatening to set up shop permanently.

Now, I’m not so vain that I’m afraid of a few lines. Dr. Schultz is conservative with his injections, and I still have pretty significant movement of my face, even when my Botox is at its peak. I have some faint fine lines around my eyes and one wrinkle (or, euphemistically, a deepening dimple) beside my mouth that doesn’t disappear anymore when I stop smiling. I’m totally fine with this. BUT. I also have thin Irish skin, I spent summers baking in the sun as a teen, and I’m about a two on the Fitzpatrick scale. So I’m basically one big dormant wrinkle waiting to happen. And while I may be okay today, tomorrow…?

Not caring to discover the answer to that question, I began asking any dermatologist I was interviewing whether there were ways to make Botox last longer. One told me wearing sunscreen can prevent its breakdown. Another said if I’ve been going for injections every four months for years, then my muscles will have atrophied somewhat and I should be able to push it to six or seven months between appointments. And a third said using serums with peptides plus moisture-attracting ingredients (to plump the skin), such as hyaluronic acid or squalene would also help prevent lines as the Botox wears off.

So, I already slather on Elta MD UV Clear SPF 46 ($32; dermstore.com) every morning (best. sunscreen. ever.),  but I added a day and night duo called Simply Venom ($59/Day and $69/night at simplyvenom.com; or $98/for both at hsn.com) that contains both peptides and squalene. And I really do believe this strategy has made my skin softer and my new lines a little less obvious.

However, when I mentioned this Botox-extending strategy to Dr. Schultz in a recent email exchange (and I do hold Dr Schultz's opinion in the highest regard), he replied that he disagreed with everything I’d been told—and to call him. Uh-oh. 

When I got him on the phone, Dr. Schultz began by saying that he is in favor of wearing sunscreen daily, as any good dermatologist would be. And he said that using serums with peptides and skin-plumping additives can make the skin softer and smoother—the same way eating well makes your body function more efficiently. However, he said sunscreen and peptides would have no impact whatsoever on how long my Botox lasts, because Botox is not something that can be made to last. My premise was incorrect from the start.

Here's why: Botox does not wear off. Ever. When it is injected, it binds to nerve fibers and turns off their ability to secrete a chemical called acetylcholine (ACH for short), which stimulates muscle movement. This happens immediately and that binding is permanent. In other words, once binded to Botox, those nerve fibers will never (ever) fire off ACH again. So why do your muscles not stay permanently relaxed? Because nerves are like starfish; they’re able to regenerate lost parts. Within minutes of Botox (or Dysport or Xeomin) injections, those nerves start growing new fibers that will eventually (in three to four months) produce enough ACH to stimulate muscles movement again. How rapidly this regeneration occurs is largely up to your genes, meaning there’s not really anything you can do to slow. things. down. Bummer.

As for that muscle-atrophy theory? Dr. Schultz said most muscles don't have time to atrophy. Once those new nerve fibers start forming (within minutes of your injections), they begin firing ACH at your muscles. And while the ACH levels are not, initially, enough to make the muscles move, they are enough to keep the muscles from weakening.

So, what's my wrinkle-smoothing plan now that I know Botox cannot be made to last longer? I will continue my regimen of daily sunscreen and skin-plumping serums because I believe that they, like Botox, help prevent deep creases—and I like the way they make my skin look.

And I've just booked a trip to NYC for next month.