We always want to keep challenging what we know, to continue to hold curiosity around the possibility for new understandings and breakthroughs. With injectables being both an established science and a relatively new field, it is an especially rich area in which to always be holding what’s tried and true along with what’s emerging. In this spirit, I recently listened to a Inside Aesthetics podcast with Dr. John Joseph titled “We’ve been doing toxins wrong for the past 35 years,” with an eye-opening and provocative message. It spoke to the many benefits of increasing Botox dosage to prolong results.

Funnily enough, one of the biggest complaints I hear about Botox is that my clients wish that treatment would last longer. I have found myself saying over and over that “dose equals duration”, “dose equals duration”, and now I have the studies to support this. This podcast was validating, and it offered precise findings so that I am eager to integrate into my practice.

To start, there are many benefits to higher dosing for clients. Increasing the dosage of the medicine will decrease the amount of office visits. Instead of three to four office visits, you will come in twice. You will have fewer needle pokes, too. Arranging visits with higher doses will also lead to financial savings; when you double the dose at your next appointment, I will extend a 20% discount. 

Dose equals duration, but not intensity of the treatment. Contrary to popular misconceptions, the higher dosing didn’t lead to a more frozen look. When a higher dosing is used, we increase the concentration of medicine to avoid increasing the volume.  Dose equals duration, and placement equals outcome; increasing the dosage while maintaining control of placement helps ensure natural and controlled outcomes (1). 

Dr. Joseph’s research also recognizes a plateau exists when it comes to toxin dosing.  Increasing the dosage from 20 to 40 units increased the longevity of results from about 3 months to 6 months.  Further increasing the dose to 60 and 80 units didn’t result in another exponential increase in time.  Rather, the extra time that 60 and 80 units gave, doesn’t necessarily make sense when we consider the cost of the medicine.  This is likely because once the muscle is fully saturated with medicine, there is no longer a benefit to adding more; we have basically been undersaturating the muscle with the prescribed 20 units! 

As with most medicine, there is going to be an individualized component to dosing.  The more muscle mass that is present, the more medicine required. The goal is to ultimately find that sweet spot of higher units for longevity, while respecting cost effectiveness for the client.

It’s always good to challenge what we know.  If you’re interested in trying more units for more time, let’s connect at your next appointment.  Thanks for reading and see you soon.

With love,
Heather