Botox Top-Up

A frequently asked question is when your patient should return for a Botox top-up after receiving neurotoxin treatment, what signs to look for, and how much neurotoxin is required.

The first rule of Botox top-up is to avoid offering it before the two-week mark. Because the botulinum toxin is still active during this period, it is necessary to allow enough time for the administered dose to reach its full potential.

The botox top-up assessment is based on post-treatment movement.
If the glabella continues to dynamically pull, causing a rhytid in the skin, this area must be retreated. The dose is determined by the magnitude of the movement. If the movement is the same as when the Botox was first administered, the full dose is required; if there is little movement, the top-up will obviously need a lesser dose.

The frontal area is assessed in the same way. Often, one side or a small section is overlooked during the initial treatment. This can be corrected in these instances by treating them directly.
However, if the patient is concerned about tethering lines above the brow, this cannot always be topped up. The reason for this is that if the frontalis injections get placed too low, it can increase the risk of causing ptosis. This should be discussed with the patient during the initial consultation. Remember that informed consent must also be presented at the review appointment to underline any dangers of ongoing treatment.

The ideal time for a post-treatment review is 2-4 weeks. This allows you to document the results of the initial dosing you gave them as well as any areas that required additional treatment or tweaking. This method can help you make dosing decisions for their next full treatment in three months.

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