Why didn’t my Botox work well?

Botulinum bottle with syringe on the side

Chester Tam

September 8, 2019

Many factors affect the results of your Botox treatment. The following provides reasons why your Botox treatment may not have worked as well as you have liked:

1. Improper handling of Botox
Botox comes in a powder form and needs to be reconstituted with saline before it can be used. Improper handling of Botox during reconstitution can significantly decrease the efficacy of Botox. For example, one study revealed that aggressive shaking of Botox during reconstitution can decrease the potency by over 40%1. It is important is to be gentle when handling Botox.

2. Inadequate dose
Using too little units of Botox can be associated with insufficient muscle weakening and decreased duration of results.

3. Improper injection placement
Botox needs to be injected at the proper muscle location for successful results. Poor Botox placement could decrease the desired effect or cause unintended weakening of nearby muscles. Having an understanding of anatomy enables the provider to inject the Botox at the proper location and the proper depth. Because there are slight variations in anatomy from person to person, Botox treatment can be optimized by evaluating each individual’s muscle. This is performed by having the patient contract the muscle and identifying where the muscle is strongest.

4. Antibody formation
If Botox has worked for you in the past, but no longer provides the expected results, there is a possibility that you have developed a resistance to Botox. Fortunately, this is a very rare occurrence.


1. Reconstituting botulinum toxin drugs: shaking, stirring or what?

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