Managing the 2-week review — top-ups, asymmetry, and 'it didn't work'
What's your framework at the two-week review? Occasionally someone says it hasn't done much and I want a calm, systematic way to work through it.
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Two-week review is where good injectors are made. My framework: 1. Reassess in animation, not just at rest — ask for a full frown/raise/squint. 2. Genuine partial response → conservative top-up to balance. Add small; re-review if needed. 3. Asymmetry → usually a couple of units to the stronger side rather than chasing symmetry with big doses. 4. 'Nothing happened at all' is rare — before blaming the patient, check your own variables: dose, dilution, reconstitution/storage, injection accuracy and whether the product was in date and handled correctly. True antibody-mediated non-response exists but is uncommon and a diagnosis of exclusion. 5. Document everything and photograph again. Starting conservatively at the first visit is exactly what makes this review easy — you're topping up, not apologising.
- Dr Tom Reilly★ 69
The 'check your own variables before blaming antibodies' point is so important. 90% of my early 'non-responders' were actually dilution or storage issues on my end.
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