Can R-CPD come back after Botox? Second injections explained
Quick summary
- For most people, the burp stays even after the Botox wears off.
- For some, R-CPD can come back after Botox, or the first one doesn't quite work.
- A second injection works for most of them.
You've had your Botox, the burps arrived, and life feels lighter. Then a little voice asks: "Will it last?" Or maybe the burps never really turned up. Either way, it's a fair question. Can R-CPD come back after Botox? Let's look at what the research says.
Is Botox for R-CPD permanent?
The Botox itself isn't. Botox (a medicine that relaxes a muscle for a while) usually wears off after about 3 months (opens in a new tab).
But here's the good bit. For most people, the burp stays after that. In a UK study of 72 people, 96% kept burping after the Botox wore off (opens in a new tab). Doctors think the body "learns" to burp while the muscle is relaxed (opens in a new tab), and keeps the habit.
In the very first study, all 51 people could burp (opens in a new tab), and most seemed to keep it for good.
How often does R-CPD come back after Botox?
It depends on the study, but most people do well. In a US study of 200 people, 79.9% could still burp well 6 months later (opens in a new tab).
So for roughly 1 in 5 people who got relief, the burps faded or weren't strong enough by 6 months (opens in a new tab). That can feel really disappointing. But it isn't the end of the road.
Why might it not work, or not last?
Nobody knows for sure in every case. A few things seem to matter:
- The dose. Units are how much Botox is used. People react differently, and some people need a bigger dose than others (opens in a new tab).
- Where it goes. The doctor has to get the Botox into the right muscle. Accurate placement means less may be needed (opens in a new tab).
- Awake or asleep. You can have it awake in clinic (in-office) or asleep (under general anaesthetic, medicine that puts you to sleep). Both help at first. But in one study, people treated awake needed a repeat more often (opens in a new tab).
Also, it can take time to kick in. One specialist says there may be no relief for the first 1 to 5 days (opens in a new tab). In the UK study, everyone could burp within 4 weeks (opens in a new tab). So don't panic on day two.
Does a second injection work?
Usually, yes. In the 200-person study, 16 people had more treatment, with the dose raised by at least 25 units (opens in a new tab). Of the 12 who had a second injection, 8 got long-term relief (opens in a new tab).
A big review pulled together 17 studies. In it, 53 people had more treatment because their symptoms came back or didn't clear (opens in a new tab). More Botox sorted it for 40 of them (opens in a new tab). In the end, 44 of the 53 (83%) got long-term relief (opens in a new tab). Where doses were recorded, people got the same dose or a higher one (opens in a new tab) the second time.
Two awake injections can also work about as well as one asleep. In one study, two in-office injections did about as well as one in theatre (opens in a new tab).
What if Botox keeps not working?
This is rare, but there are other options. A small operation called a myotomy (where the surgeon cuts some of the tight muscle so it can't squeeze shut) is one. In the big review, 6 people had a myotomy, and 4 of them got long-term relief (opens in a new tab).
One US clinic has tried teaching special head and neck positions to help the burp out, with a speech therapist. In a small study of 7 people who still had symptoms, 6 got lasting relief using Botox plus this training (opens in a new tab).
To be honest, there isn't loads of research yet. A 2026 review said the evidence on what to do when treatment fails remains sparse and largely anecdotal (opens in a new tab).
What about cost and insurance?
If you paid privately the first time, ask your clinic what a second round costs before you book. Our Find a specialist page lists prices people have reported.
Health insurance can be tricky. Some people in online groups say their insurer paid for the first round but not a second (opens in a new tab), and some say a second round was turned down as "experimental" (opens in a new tab). These are personal reports, not official rules. Check your policy and ask early.
Frequently asked questions
Is Botox for R-CPD a one-time treatment?
For most people, yes. Most keep burping after the Botox wears off (opens in a new tab), but a few need a second injection.
How long does Botox for R-CPD last?
The Botox itself lasts about 3 months (opens in a new tab). The ability to burp often lasts much longer.
What happens if R-CPD comes back?
Talk to your clinic. In one review, more treatment gave long-term relief to 83% of the people who needed it (opens in a new tab).
Will my insurance pay for a second injection?
It depends on your insurer and policy. Some people report being refused a second round (opens in a new tab), so ask before you book. See our insurance page for more.
Key points
- The Botox wears off after about 3 months, but most people keep burping.
- In one big study, about 1 in 5 people who got relief had lost it by 6 months.
- A second injection, often with a bigger dose, works for most of them.
- Give it up to 4 weeks before you worry.
- Check insurance cover for a second round before you book.
Read next: Treatment · Recovery · Insurance
This is a free resource and not medical advice. Speak to your doctor or clinic.
Sources
- Karagama 2021, Eur Arch Otorhinolaryngol (free full text) (opens in a new tab)
- Bastian and Smithson 2019, OTO Open (free full text) (opens in a new tab)
- Hoesli et al. 2020, OTO Open (free full text) (opens in a new tab)
- Malhotra et al. 2024, OTO Open (free full text) (opens in a new tab)
- Kutler et al. 2025, Laryngoscope (opens in a new tab)
- Keltz et al. 2025, Laryngoscope (opens in a new tab)
- Chia and Leong 2026, Curr Opin Otolaryngol (opens in a new tab)
- Laryngopedia: What to expect after Botox for R-CPD (opens in a new tab)
- r/noburp: UK insurance thread (Oct 2026) (opens in a new tab)
- r/noburp: UK insurance thread (June 2025) (opens in a new tab)
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