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Some of the factors that contribute to how long your Botox injections last include: How much the product is diluted The targeted area The dosage of Botox units used Your age When the wrinkles on your skin are etched too deeply or when Botox injections are used on aged patients, Botox may not smoothe wrinkles as expected

Underpotent product, degraded medication from improper storage, or formulations with poor sublingual absorption characteristics can all produce disappointing results at doses that should be effective

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While one trial did show VAX-D to be more effective than TENS, concerns about study design, limited generalizability, and safety risks have kept it from being widely accepted as a standard treatment (Aetna Clinical Policy Bulletins, 2025)