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Why Didn't Botox Work on my 11's?

I've had botox three times within a six week period. Today my dr. injected a sronger dose, and told me if this amount doesn't work then it's not worth my time or $$. What do you think is happening? I only wanted my 11's to relax.

Doctor Answers (16)

Antibodies to botulinum toxin can prevent it from working

+2

Since botulinum toxin type A is a protein produced by bacteria, it is possible to become immune to it by developing antibodies.  If that occurs, neither BOTOX(R) nor Dysport(R) would work for you.  There is another drug, botulinum toxin B (sold as Myobloc in the US), that would still work, but it is quite expensive, and I don't know any plastic surgeons who use it.

If you can, please post the number of units used with each treatment, the dates, the areas treated, and a photograph of the area at rest and while you are trying to contract the muscles treated.  That will let us help you more specifically.


Scottsdale Plastic Surgeon
5.0 out of 5 stars 10 reviews

Botox on my 11's

+1

Assuming that the botox was well stored and the injector was expert, then the problem may be with the wrinkles themselves. Botox only works with dynamic wrinkles rather than static. If the wrinkles are now static, then you will need filler in addition to or in place of botox.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 16 reviews

Botox for the glabellar forehead 11

+1

If the muscle is not moving at all when you frown, but the lines are still there, then adding more units of botox will not make your "11" go away. With some deep glabellar folds, we see that they continue to improve for months (they've been created by years and years of muscle activity) and it can't go away "overnight" so you maintain botox injections before they wear off every 3 to 4 months and the deep folds start to relax after a few cycles. Other patients will need cautious filler injections in addition to Botox.

However, if the muscle is still moving despite three treatments, then the questions are:

1. Have enough units been used at one treatment? Some patients will need 25 to 35 units. It depends on the anatomy of their muscles.

2. Is it Allergan, FDA-approved Botox?

3. Are the correct muscles of the glabella being injected?

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

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Very Deep lines may not Disappear with Botox Alone

+1

Botox dosing requires a certain degree of titration from patient to patient to match the physical changes and expectations present.  I inform patients that my goal is to achieve a relaxed look at rest, which still allows for some motion. If a patient desires "no motion" in the glabella, a higher dose of Botox is administered.  However, in some patients, these hyper dynamic lines are so deeply etched that Botox alone is insufficient.  Various Fillers can potentially be used in the glabella, but are not FDA approved for this purpose, and have been associated with specific complications.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

You may need something in addition to Botox!

+1

How frustrating for you that the Botox did not work to remove your 11's.  Remember that Botox treats dynamic wrinkles (those created by muscle activity) rather than static (the wrinkles present at rest) ones.  Eventually, dynamic wrinkles become static ones over time.  If your 11's are static wrinkles now, you may need a filler in addition to Botox to correct the lines in this area.  Good luck.

Mikel Lo, MD
Tucson Oculoplastic Surgeon
4.5 out of 5 stars 9 reviews

Botox doesn't work on my 11's

+1

I have used Botox for over 20 years and it is does dependent which means some people get a great result with small doses while others require quite a large dose for the same effect.  If you really hate the Glabellar lines, there's enough Botox to get rid of them, just increase the dose.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Botox Didn't Work, What to Do?

+1

Hi VE.  There are a couple of possibilities, but assuming your injector is capable and there is a suitable does of Botox injected, it could be that the lines are too deep for Botox alone.

In some instances, using Botox alone will not completely resolve the frown lines you noted as the "11's".  In these cases both Botox (or Dysport) and a dermal filler like Restylane or Juvederm is required.  When the vertical lines are too deep, the Botox is often not enough and the area needs to be plumped or filled with these other products.  You may want to ask your injector about this, but it shoal have been discussed beforehand if this was a possible outcome.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox

+1

Try and frown. If the muscles move then they have not been injected enough. If they don't move and the lines are still there then they are etched into your skin. you will need some filler and repeated botox treatment to softent them.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Botox not working

+1

If you have had Botox injected three times with no effect then you may not be receiving the correct treatment for your issue.  If you post pictures of your face we may be able to give you more specific advice.  Botox works on dynamic wrinkles - meaning wrinkles caused when muscles contract.  If your "11s" are severe enough that they are also there at rest, then you may have dermal atrophy requiring treatment with a dermal filler such as Juvederm.  For static wrinkles - wrinkles at rest - Botox will not be effective during the first few rounds of treatment.  Over time, however, the decreased activity of the muscles may allow some of the dermal atrophy to heal and show an improvement in the static wrinkles as well.  It is very rare to be "immune" to Botox.  While it does occur, it usually only happens in 1 out of 10,000 patients is often in patients with long time exposure to Botox.

 

Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 57 reviews

Relaxing the 11's with Botox Cosmetic

+1

Botox relaxes the facial muscles which contribute to the 11's, or vertical wrinkles in-between the eyebrows. Botox  may take up to 2 weeks before the maximum effect. While most patients respond to typical doses, some patients require more Botox than others. Lastly, Botox may not completely eliminate the facial wrinkles and complimentary treatments such as Restylane or Juvederm may be required. Other options may include skin care, subcision, dermabrasion, or chemical peel. Only after a comprehensive evaluation can a plastic surgeon or specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

 

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.