6 reasons why patients return for a BOTOX® follow-up

Dr Tim Pearce

June 21, 2021

Further to our recent blog Do aesthetic practitioners always need to offer BOTOX® reviews, follow-ups, or top-ups?, this time we take a deeper look at why your patients might be wanting, or even worse, expecting additional follow-up appointments and top-up botulinum toxin treatment.

In this blog, Dr Tim Pearce will share the 6 main reasons that patients seek reviews and top-ups after botulinum toxin treatment and how this can often be costly, unnecessary, and burdensome to you as an aesthetic clinician.

Knowing the signs of each type of follow-up request will help you to understand whether you should routinely be offering BOTOX® review appointments, and how to educate your patients away from asking for top-ups that they do not need.

1) The unnecessary or routine follow-up

Sometimes, patients simply expect a follow-up appointment, whether it is needed or not, and some clinics seem to get into the habit of promoting it as part of the treatment process, meaning that it becomes fixed and unquestioned.

This can quickly create a repeating cycle of treat > follow-up > treat > follow-up, without either party feeling that there is a completion to the treatment.

This sets a bad precedent, and you need to break it by educating your patients about the signs of a completed treatment, so they understand that there is no need to routinely come back for a follow-up.

2) The “it’s part of what I paid for” follow-up

Often, we see marketing from clinics which implies that a follow-up, or worst case a top-up, after botulinum toxin treatment is included in the price.

This means that patients begin to believe that if they do not come back for a follow-up then they have not received everything that they have paid for or got their money’s worth.

Re-education is key and be mindful of how you pitch the treatment journey to your patients.

3) The over-testing movement follow-up

Many patients will spend the days and weeks post BOTOX® treatment studying their face in the mirror and testing their facial movement. They will do this to a point that they end up recruiting other muscles to achieve similar movement and will then be on the telephone complaining that the treatment has not worked and demanding a top-up.

For example, a patient may have their glabella treated and will try as hard as they can to test for movement by frowning repeatedly until eventually, they recruit their orbicularis oculi and start to squint, producing a crease in their glabellar region.

It is important to educate your patients that recruiting other muscles to achieve movement does not mean that the initial treatment has not worked, because normal movement will demonstrate that it has been effective.

4) The mismatched expectations follow-up

An example to illustrate this would be the case of a deep frown line which is starting to fade at the two-week point post botulinum toxin treatment, but the patient complains that they can still see the line and want a top-up.

Educate your patient about the short-term effects of the toxin on the activation of the muscles, as distinct from the longer-term and continuous effects on skin improvement from repeated muscle inactivation.

5) The underwhelming results follow-up

A patient may report that there is still a lot of movement and requests further treatment or top-up.

The reasons why this may occur are numerous and can include those patients who require higher doses than the norm, those who were undertreated at their initial treatment due over caution by the practitioner or an attempt at frugality, those who were undertreated because the patient demanded lower doses to avoid a total lack of movement, but has now changed their mind, and finally those who become non-responders, due to rare cases of antibody resistance to the botulinum toxin.

If patients fail to respond well to individual toxin brands, despite changes to dosing or additional top-ups, then you can consider trying alternative brands of BoNTA (or even a BoNTB) at their next routine appointment.

6) The asymmetric follow-up

Asymmetry is probably the most common reason for a follow-up appointment post botulinum toxin treatment.

It is not simply an indication of a bad injector, however, because there are many variables that you cannot control which may result in the toxin failing to be adequately absorbed. A difference in placement, a few millimetres here or there, can be enough to cause a minor asymmetry in the result, most often observed in the eyebrows, which may result in a minor brow drop or the so-called Spock look.

A small tweak, with a few units will usually be all that is required to correct the problem. A more severe drop or ptosis would be regarded as a complication and should be addressed as such. Get the lowdown on the different types of brow drop and what causes brow ptosis.

BOTOX® Complications

One reason clinicians like to arrange follow-ups is fear of complications. Learn more about how to manage and avoid BOTOX® complications with Dr Tim’s eLearning courses on botulinum toxin complications mastery.

At the end of the day, the top tip when it comes to BOTOX® follow-ups is to inform your patients that every face is unique, and you are learning about the uniqueness of their face as you start to treat them. The more you learn, the fewer follow-up appointments they will need as you formulate a successful repeat treatment plan with them over time.

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.

Subscribe to our YouTube channel for really useful regular tips and advice.  

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.