Skip to content 
“How long will this last?” is the first question most people ask before getting Botox.
The simple answer is 3 to 4 months. But the complete answer is more nuanced. Duration varies by treatment area, individual factors, and whether you’re a first-timer or regular patient.
This post breaks down what clinical research actually tells us about Botox longevity, what affects how long your results last, and what remains uncertain despite common assumptions.
Botox (onabotulinumtoxinA) has been studied extensively in clinical trials. According to the FDA prescribing information and peer-reviewed research, here’s what we know:
Glabellar lines (frown lines between eyebrows): Duration of approximately 3 to 4 months. In clinical studies, 80 percent of adults showed significant improvement at day 30. By week 16 (about 4 months), roughly 23 percent of patients had returned to baseline.
Crow’s feet: Similar 3 to 4 month duration. Clinical studies showed 26.1 percent of adults achieved a 2-grade or better improvement at day 30, and 67.9 percent had mild or no crow’s feet lines at day 30 after treatment.
Forehead lines: Generally lasts 4 to 6 months when treated together with glabellar lines. The forehead often maintains results slightly longer than other areas.
Around the mouth: Shorter duration of 2 to 4 months due to constant muscle activity from talking, eating, and facial expressions.
Underarms (hyperhidrosis): Longer duration of 6 to 9 months because sweat glands respond differently than facial muscles.
The key takeaway: different areas of your face will see results fade at different rates.
If you’re getting Botox for the first time, your results may not last as long as they will with subsequent treatments.
The American Society of Plastic Surgeons notes that first-timers commonly notice the effects don’t last as long initially but may last longer after the second treatment.
Why does this happen? The precise mechanism isn’t fully understood, but the pattern is consistent enough that practitioners routinely discuss it with new patients. Some theories suggest that repeated treatments may “train” the muscles to remain more relaxed, or that the neuromuscular junction adapts over time.
A published literature review on long-term Botox outcomes found that “repeated BoNTA treatments may prolong duration of effect or potentiate the effect.” However, the researchers also noted that most studies don’t extend follow-up past 6 months, so long-term data remains limited.
Several factors are commonly cited as affecting how long Botox lasts. Here’s what the evidence actually supports:
Dosage: Higher doses generally produce longer-lasting effects. As one practitioner puts it: “Dose equals duration.” However, there’s a balance. Using more product than necessary can result in an overly frozen appearance that most patients want to avoid.
Treatment area: As noted above, different facial zones have different durations based on muscle size, depth, and how frequently those muscles move.
Injection technique: Proper placement into the correct muscles at the right depth affects both efficacy and duration. This is why injector experience matters significantly.
Repeat treatments: Multiple studies suggest that consistent Botox treatments may produce longer-lasting results over time.
Metabolism: You’ll hear this one constantly. The assumption is that people with faster metabolisms break down Botox more quickly.
Here’s what’s interesting: one clinical review specifically noted that “unlike fillers, there does not seem to be much of a correlation between metabolism or body type and general neurotoxin lifespan.” The same review pointed out that “there are just as many cases of people who have a fast metabolism and fillers that last a long time” as there are cases of the opposite.
The metabolism theory is widely repeated but lacks strong clinical evidence specific to Botox. Individual variation exists, but we can’t reliably predict who will metabolize Botox faster based on general metabolic rate.
Exercise: High-intensity exercise is often blamed for shorter Botox duration. The theory is that increased circulation speeds up how quickly the body processes the treatment.
The evidence here is mixed. Practitioners commonly recommend avoiding strenuous exercise for 24 to 48 hours after treatment to let the product settle. But whether regular intense exercise significantly shortens duration overall isn’t clearly established.
Age: Some sources claim younger patients see longer-lasting results due to skin elasticity. Others suggest older patients may experience shorter duration due to muscle changes. The reality is that age-related effects on Botox duration haven’t been definitively characterized in clinical studies.
Sun exposure: UV damage can accelerate skin aging and may affect treatment longevity, though direct causation with Botox duration hasn’t been established.
Smoking: Associated with reduced circulation and accelerated skin aging, which may impact results.
Alcohol consumption: May speed breakdown of Botox, though evidence is largely anecdotal.
One of the most compelling pieces of evidence about long-term Botox use comes from a 2006 study published in Archives of Facial Plastic Surgery.
Researchers examined identical 38-year-old twins. One twin had received Botox in the forehead and glabellar region approximately 2 to 3 times per year for 13 years. The other twin had received only 2 treatments total (7 years and 3 years prior to the study).
The findings:
The regularly treated twin showed no visible forehead or glabellar lines at rest, even though her last treatment was more than 4 months prior.
The minimally treated twin showed visible imprinted lines in the same areas.
Crow’s feet were also less noticeable in the regularly treated twin, even 7 months after her last treatment to that area.
For the regularly treated twin, the clinical effect was “consistently sustained for at least 6 months after each injection, and the duration of effect did not diminish with repeated treatments.”
This single case study isn’t definitive proof, but it suggests that long-term, consistent treatment may produce cumulative benefits and potentially longer duration over time.
Understanding typical dosing helps set realistic expectations. According to FDA guidelines and clinical practice:
Upper face combined treatment:
Full upper face total: Most patients receive 40 to 70 units total when treating forehead, glabella, and crow’s feet together.
Lower doses (sometimes called “baby Botox”) may produce more natural-looking movement but typically don’t last as long. One practitioner explains: “When we treat patients with lower doses, it is important to tell them about the duration of their treatment. The higher the number of units given, the longer it will last.”
Understanding the timeline helps you evaluate your treatment:
Days 1 to 3: Most people notice nothing yet. The toxin needs time to block nerve signals.
Days 3 to 5: Effects typically begin to show. Some people see initial smoothing.
Days 10 to 14: Full results visible. This is when practitioners recommend evaluating whether a touch-up is needed.
Weeks 6 to 8: Peak effectiveness for most patients.
Months 3 to 4: Gradual return of movement. Results don’t disappear suddenly. Instead, you’ll notice muscle activity gradually returning.
Month 4 and beyond: Most patients are ready for their next treatment, though some maintain results longer.
A common concern is whether stopping Botox will make things worse. The research is clear: it won’t.
When you stop treatment, your muscles gradually return to their normal function. The wrinkles that existed before treatment will return to approximately their previous state.
However, if you’ve been treated consistently for years, you may find that your lines are less pronounced than they would have been without treatment. The twin study supports this: regular treatment appears to prevent the deepening of expression lines that occurs from repeated muscle movement.
Cleveland Clinic summarizes it simply: “Botox is temporary, so once the treatments have stopped, the effect goes away.”
Based on clinical data, here’s how to think about your treatment schedule:
First year: Plan for treatments every 3 to 4 months as you establish a baseline. Your first treatment may wear off closer to the 2 to 3 month mark. A customized skincare plan can complement your injectable treatments.
After the first year: Many patients find they can extend intervals slightly. Some maintain results for 4 to 5 months between treatments.
Long-term patients: With consistent treatment over several years, some patients report intervals extending to 5 to 6 months, though this varies significantly by individual.
Budget accordingly: At current Canadian pricing (roughly $10 to $15 per unit in Ontario), a full upper face treatment of 50 units might cost $500 to $750 every 3 to 4 months. Annual costs for maintaining all three upper face areas typically range from $1,500 to $3,000.
A good consultation for neuromodulator treatment should include:
Realistic duration expectations based on the specific areas being treated and your treatment history.
Dosing rationale explaining why a particular number of units is recommended for your anatomy and goals.
Follow-up guidance on when to schedule touch-ups and how to evaluate results.
First-timer context if applicable, explaining that initial results may not last as long.
Honest assessment of what clinical evidence supports versus what’s commonly assumed but not proven.
Be wary of anyone who promises results lasting 6 months or longer from a standard treatment. While some individuals do achieve this duration, it’s not typical and shouldn’t be presented as the expected outcome.
Clinical research supports these key points about Botox duration:
The standard duration is 3 to 4 months for most facial areas, with some variation by treatment zone.
First treatments may not last as long as subsequent ones.
Consistent, repeated treatments appear to produce more sustained results over time.
Metabolism is commonly blamed for short duration, but clinical evidence doesn’t strongly support this as a primary factor.
Dosage matters. Lower doses produce shorter duration. Finding the right balance between natural movement and longevity is part of the treatment planning process.
Individual variation is real but hard to predict. Some people simply maintain results longer than others, and we can’t always explain why.
The goal of treatment should be looking refreshed and natural, not maximizing duration at the cost of a frozen appearance. Work with your practitioner to find the dosing and schedule that produces the results you want.
Ready to discuss what Botox might look like for you? Contact Kontour Medical Aesthetics to schedule a consultation where we can assess your specific concerns and recommend a personalized treatment plan.
Stay informed with expert insights, treatment guides, and the latest developments in medical aesthetics from Nurse Practitioner Belita Savage.
