Will botox cause any permanent effects over the years if used repeatedly at the same spot?

Doctor's Answers 4

Great question! Botulinum toxin (‘botox’) is great for treating and preventing unwanted lines on the face. It is also often used (off-label) for face and body shaping and lifting (e.g. Dermalift). I use botox (I’ve used all the brands) extensively in my practice and often recommend it to patients. However, patients are often worried about long term effects of botox treatment for example:

  • Requiring more and more botox to maintain the same result.
  • Permanently affecting muscle movements such as facial expressions.
  • Making the face age even faster over time

Thank you for allowing me to address these concerns!

Will botox cause any permanent effects over the years if used repeatedly at the same spot?

Botulinum toxin has been used for cosmetic indications for more than 30 years (since the 1980s!). Over the years, many many botox treatments have been performed and to my knowledge, no negative permanent effects have been reported. There are however some beneficial long term effects with repeated botox treatments.

The effect of botox remains consistent over repeated treatments with no cumulative adverse effect

In a study of more than 4000 treatments, long-term, repeated botox injections were found to be safe and effective. The amount of botox required at each treatment, the duration that each treatment lasted, as well as the high doctor and patient satisfaction remained stable even after repeated injections. In fact, the rate of adverse events decreased with further treatment cycles.

The muscle relaxation effects of botox are temporary

To my knowledge, there have not been any reported cases of permanent muscle relaxation from botox treatment. After 3-4 months, the body bypasses the effect of botox by generating new nerve terminals. It has been shown that repeat botox injections do not lead to irreversible muscle atrophy or other degenerative changes.

Botox treatment would actually prevent some of the signs of aging over the years

A study conducted with a pair of twins, one of whom had received botox treatment over 13 years and one of whom had not, showed that long-term treatment with Botox can prevent the development of imprinted facial lines that are visible at rest. No adverse events were reported over the period of treatment.


Your eyes aren't playing tricks on you, the twin that had botox definitely looks younger.

Patients are often apprehensive about using botox, in part because of exaggerated negative media representation. In my experience, the careful judicious use of botox is safe, cost effective, fuss-free and has great short and long term results. No amount of expensive skin care products will produce such potent anti-aging effects.

In fact, many aesthetics doctors actually botox themselves. I don't think that they would do that if there were doubts about long term safety and efficacy.

I would encourage you to speak to your doctor who can share his/her experience over the years with you!

Hope this helps clarify your doubts!

Warmest regards,

Dr Wan Chee Kwang


  1. Carruthers et al. History of the Cosmetic Use of Botulinum A Exotoxin. Dermatol Surg. 1998 Nov;24(11):1168-70.
  2. Rzany, B. et al. Repeated Botulinum Toxin A Injections for the Treatment of Lines in the Upper Face: A Retrospective Study of 4,103 Treatments in 945 Patients. Dermatologic Surgery, 33(s1), S18–S25.
  3. Borodic GE et al. Effects of repeated botulinum toxin injections on orbicularis oculi muscle. J Clin Neuroophthalmol. 1992 Jun;12(2):121-7.
  4. William J. Binder, MD. Long-Term Effects of Botulinum Toxin Type A (Botox) on Facial Lines. A Comparison in Identical Twins. Arch Facial Plast Surg. 2006;8(6):426-431.

botox used regularly over the same area can lead to semi-permanent atrophy (shrinking) of the muscle.

This is why I always advise "jaw botox" not to be overdone. Hope this helps!

The effect from Botox injection is only temporary. However if you use it repeatedly over the same muscle, you can expect a longer lasting result and you may require a smaller dose to achieve the same result subsequently.

There has been quite a bit of studies done on Botox over the years. So far, has been no evidence of permanent side effects after using it, making it one of the safest products used in medical aesthetic treatments. In fact, some patients would wish that Botox effects were permanent so that they would not need to go for repeated treatments!


Dr Terence Tan

Similar Questions

What are your recommendations for good botox clinics in Singapore?

Most frequently, dermatologists and aesthetic doctors provide botox treatment in Singapore. You may also want to read this other post about Botox in Singapore to help guide your decision in choosing a doctor.

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From what I know of radiofrequency treatment, it is used for facial rejuvenation of the underlying dermal network (non-surgical face lifting). I have not heard of it being used for treating muscles. I have also not heard about electrocautery for facial muscles. This sounds like it might lead to scarring or facial muscle paralysis/deformities. Some patients with chronic pain in the head and neck may benefit temporarily from TENS (transcutaneous electrical nerve stimulation) that can reduce muscular tension.

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