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January 27, 2026
Dr Tim Pearce
As aesthetic clinicians, you want to be able to treat your patients and see that your handy work has achieved the desired results. But after a while – once you have perfected the BOTOX® treatment for an individual patient and improved your overall understanding of how botulinum toxin works in different regions of the face – you need to be able to reduce the number of review appointments required and put a stop to costly top-ups and unnecessary follow-ups.
In this blog, Dr Tim Pearce will consider whether BOTOX® follow-ups should be routine or not, as well as how to stop patients from asking for ‘top-ups’ or extra botulinum toxin treatment.
Dr Tim will be discussing more medical aesthetic training tips as part of his upcoming webinar series, so if you’re looking to increase your CPD-certified learning and want to learn more skills to make you a better practitioner, then step one is to register for the free webinars by Dr Tim.
Should BOTOX® follow-ups be routine?
When you are starting out in your aesthetics career, it can be immensely helpful to ask your patients to come back to see you for a follow-up appointment after BOTOX® treatment. It gives you the opportunity to experience the real-world effects of the theory that you employed when delivering the treatment.
Use the time to note the changes against the before photographs. Dr Tim also recommends taking a photograph of your patients once you have marked them up ready for treatment, as this enables you to study the effects of each injection point on the movement subsequently present of the patient’s face. It also allows you to learn to adjust your injection sites if the desired effect has not been achieved precisely on that occasion, taking you beyond the theory.
Get more help from Dr Tim Pearce’s free guide to the 26 essential injection patterns for botulinum toxin.
As you progress in your career, you will reach a point whereby you feel that you know what you are doing, and you do not want patients coming back to see you for no reason, i.e., the result achieved the aim and there is nothing more to observe and learn. These unnecessary follow-ups will simply cost you time and money, often resulting in needless tweaks because the patient has come ‘all that way’ and is now expecting a free ‘top-up’, even if it is not clinically required.
How to stop patients asking for BOTOX® top-ups
‘Top-up’ is a dangerous phrase, and you should avoid using it. Patients can start to expect top-ups of additional toxin after a couple of weeks and see it as part of the treatment process. Nip that in the bud straight away.
As an aesthetic clinician, you need to educate your patients about follow-up appointments and the purpose they serve. You can teach them how to assess themselves so they correctly understand a successful outcome of treatment and will learn to know if they require a review appointment, and more importantly when they do not need to see you again.
Keep it simple, but ensure you explain what to expect when the toxin starts to take effect, the time it takes to reach peak effect, the process of asymmetry which may occur during the activation period and subsequently settle, and what to look for which may mean that they need to come and see you for a review. All this education is a core part of your consultation before you perform the treatment and should not be rushed or skipped. Send them home with good aftercare literature to embed their understanding and you will save yourself from numerous calls and messages in the intervening days.
BOTOX® Foundation eLearning Course
Learn more about the fundamentals of botulinum toxin injections with Dr Tim’s eLearning course BOTOX® foundation eLearning course.
Aesthetics Mastery Show
BOTOX® follow-ups
Most Aesthetic Clinicians offer BOTOX® ‘follow up’ or ‘review’ appointments. But, should we be doing them as a matter of course; what causes them in the first place; and how should we tackle issues such as the dreaded ‘Spock brow’ or – every injector’s worst nightmare – an underwhelmed patient?! In this Aesthetics Mastery Show, Dr Tim and Miranda Pearce discuss how to handle botulinum toxin tweaks, follow-ups and top-ups.
Are you still anxious about delivering cosmetic injectables safely?
If you want to learn more about mastering medical aesthetic treatments and complications or conquering the anxiety of where to place your needle, then register for the next Dr Tim webinar.
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Dr Tim Pearce eLearning
Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.
Our exclusive video-led courses are designed to build confidence, knowledge and technique at every stage, working from foundation level to advanced treatments and management of complications.
Thousands of delegates have benefited from the courses and we’re highly rated on Trustpilot. For more information or to discuss which course is right for you, please get in touch with our friendly team.
