Will Massage Make My Botox Wear Off Faster?

Q: Dr. Eppley,  Will massage make my Botox go away more quickly? I got Botox to my forehead several weeks ago and love the results! I regularly get facials and massages and am worried that putting pressure on my forehead or rubbing bit too much will make the Botox wear off. I have read that this can happen. Is is true?

A: I have heard that question many times from numerous patients and I can tell you emphatically that it is not true. When you understand how Botox actually works, and more importantly, how it wears off you will see that rubbing or massage has no bearing on the length of its effectiveness.

Current understanding of how Botox works is that it goes into the nerve endings and blocks the release of the neurotransmitter, acetycholine, from the mitohondria where it is produced.  This is why it takes days for Botox to work. The nerve ending must use up the acetycholine that still exists (has been released) into the nerve ending. Once depleted (and it is not making anymore) the nerve ending can no longer send its chemical signal to the motor end plate of the muscle and make it move. Conversely, Botox wears off by growing new sprouts or axons from the nerve around its non-working ending to attach to the muscle to start working again. To the best of our knowledge, massage or any other manipulation does not increase the growth rate of these axons. Thus, you can’t really make the muscle start working by pushing around on it.

Dr. Barry Eppley

Indianapolis, Indiana