The result is not quite what you hoped for: one side still moves, a line is still there, one eyebrow looks higher than the other. It is tempting to ask for a touch-up straight away. This article is part of our guide to problems after a botulinum toxin injection: it explains what the official labels say, why waiting is often necessary, and how the decision is made with the doctor.
What is a touch-up?
The word usually refers to a small additional injection, given a few weeks after the session to adjust the result. Note that this idea does not appear in the summaries of product characteristics (SmPCs), the official product information written for doctors. They talk about sessions or treatments, and set a minimum interval between two treatments1,2,3,4.
A touch-up is therefore neither a right nor a step planned in advance: it is a medical decision, made case by case, after examination.
First, wait for the peak effect
Botulinum toxin does not work immediately, and its effect keeps building for several days. Judging the result too early means you may ask for a correction that would not have been needed.
With a type A toxin, the first effects usually appear within 2–3 days3,4. The peak effect comes later: depending on the product, during the second week4 or around day 303. With the short-acting botulinum toxin (serotype E), the effects begin to appear 8 hours after the injection and the peak effect is seen around day 75.
An asymmetry visible on day 3 may therefore fade on its own once the effect has set in on both sides. This is why the doctor usually waits for this phase before reaching a view.
What the labels say about the interval between sessions
For the type A toxins approved for aesthetic use, the labels agree: the interval between two treatments should not be shorter than three months1,2,3,4. One label specifies that, if there were no adverse effects after the first session, a second session may be given if needed, at least three months later1.
For the short-acting toxin, the label provides for occasional use. Repeat injections less than 6 weeks apart have not been evaluated and should be decided by the doctor5. This toxin is approved in the European Union5. As of 9 October 2026, it is also approved in Canada (since 22 June 2026)7.
A small additional injection in the weeks after a session is therefore a matter for the doctor’s judgement, outside what the labels describe.
Why injections close together raise questions
Two reasons explain the caution in the labels.
An effect that adds up. The labels point out that excessive neuromuscular weakness may be made worse by giving another botulinum toxin before the effects of the previously administered one have resolved1,5. They do not specifically describe a second dose of the same product a few weeks after the first: they set a minimum interval between two treatments1,2,3,4. Adding toxin to a muscle that is already relaxed, or close to it, can strengthen the intended effect but can also spread to a neighbouring muscle.
The risk of antibodies. Doses given too often can increase the risk of antibodies forming, which make the toxin less effective, or even ineffective2. A literature review attributes these antibodies to shorter dosing intervals, booster injections and higher doses6. This remains rare6, but it matters if you are considering treatment over several years.
After the short-acting botulinum toxin
The effect of the short-acting toxin usually lasts 2–3 weeks5. Its label states that administration of a type A toxin less than 30 days afterwards has not been evaluated5. In a phase 1 study in 90 people, a type A toxin injected on day 30 had a similar effect whether the participants had first received the short-acting toxin or a placebo5.
The label also states that giving this toxin at the same time as another botulinum toxin has not been studied and that the two must not be combined5. The decision to follow one product with another lies with the doctor, who knows the intervals to respect.
When the effect is absent or too weak
If no clear improvement is visible one month after a first session, the labels speak of treatment failure and ask for its causes to be analysed1,2. One label lists several: the choice of muscles injected, the injection technique, the formation of antibodies that neutralise the toxin, or an insufficient dose1. It then asks for the relevance of the treatment to be reassessed, and a new session only takes place after the planned interval1,2.
The reasons why an injection may not work, and what can be done, are explained on our page about when botulinum toxin has no effect.
When the effect is too strong or uneven
The labels describe no product that reverses the effect of the toxin: it wears off as the nerve endings recover and the nerve regains control of the muscle5. A touch-up therefore cannot "remove" an effect that is too strong.
If the result is uneven, an additional injection on the less treated side is sometimes considered to rebalance the face, but it adds more toxin and is decided only after examination. If the face looks frozen or the effect has spread to a neighbouring area, such as a drooping eyelid or eyebrow, the answer is most often to wait. These situations are described on our pages about a frozen face and the feeling of having had too much toxin and about expected and worrying side effects.
Preparing for the follow-up visit
Your first point of contact is the doctor who gave the injection: they know the injection points, the product and the dose. To help them:
- write down the date of the injection and the day the result first seemed unsatisfactory;
- take a photo every day, in the same light, at rest and while contracting the area;
- ask for the name and batch number of the product, which the labels ask to be clearly recorded5.
Avoid going from one practitioner to another for further injections to fix a result: none of them then knows exactly what has been done, and the units of one product are not interchangeable with those of another2,5. Finally, difficulty swallowing, speaking or breathing, or a problem with your vision, is not a matter for a touch-up: call emergency services (15 or 112 in France, or your local emergency number).
Key points
- The labels do not mention touch-ups: they require at least 3 months between two type A treatments1,2,3,4.
- Wait for the peak effect before judging: week 2 to week 4 depending on the type A product, around day 7 for the short-acting toxin3,4,5.
- Another toxin given before the effects of the previous one have resolved may worsen muscle weakness1,5.
- Any additional injection is decided with the doctor, after examination.