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Botox Not Working After 16 Days?

I had Botox injections done 16 days ago. This was my first time ever getting it done. I had 15 units done between my eyebrows. I can still frown. There is absolutely no change. Very aggravating since I had to BEG my husband. And now hes saying the old "I told you so". I called the doctors office and they want me to come in for touch ups. I'm wondering if they are going to charge me more. If so my husband surely won't go for that! Grrrr any advise?

Doctor Answers (13)

Touch up with no pay!


They should fix free of charge.

You already pay for the service and should receive the treatment until the end. 

Brazil Plastic Surgeon

Botox treatment of frown lines in the glabella for the "11"


Prior to injection of Botox for dynamic lines related to muscle movement, the anatomy of the patient is studied, both at rest and with active muscle contraction. A sense of the muscle bulk (mass) is made and the doctor can gauge how many of units are needed and how many insertion sites.  Many patients need more than 15 units for this region and the cost is more, depending on the total number of units. It is wise, however, to be conservative as one can always add more units.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 33 reviews

Botox not working after 16 days - likely too low a dose


I think the issue is that the dose given to you was too low. If you see an expert injector such as a dermatologist or plastic surgeon, they will ensure that you get the right amount of units, injected at the right depth, into the right anatomical place, and in combination with the right other treatments if necessary (e.g. fillers). Without seeing your frown lines, it is hard to say what would have been the right dosage, but I suspect it should have been double or so the dose you received. Dr. Benjamin Barankin, Toronto Dermatology Centre.

Benjamin Barankin, MD
Toronto Dermatologic Surgeon
5.0 out of 5 stars 24 reviews

Non-effect from Botox


The two most common reasons for your symptoms are inadequate amounts and inappropriate placement. The region that you mentioned can vary in muscle density - greater density, greater amounts of neuromodulator. If the doctors office wishes for you to come in for a touch-up, this is a good sign that they want to do right by you and it is reasonable to return. I am unable to speak to additional costs, but you can easily ask and I am certain that no caring provider would be offended.


Be healthy and be well,

James M. Ridgway, MD

James M. Ridgway, MD, FACS
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 41 reviews

Botox Not Working After 2 Weeks


Botox takes up to 2 weeks to see the full effect. After 2 weeks, minimal improvement will be seen. For this reason, many physicians will recommend that patients return at 2 weeks to check the results.


Having "no result" after the treatment of Botox can occur for several reasons, including:

  1. Too little Botox was used. For the treatment of the frown lines, most patients require 20-25 units of Botox. Some patients, can have a good result with 15 units. This is the most common reason seen for results that are not optimal.
  2. Improper injection technique. The Botox could be injected into a blood vessel or in an area that does not get to the muscle required to see the desired effect.
  3. Bad Botox. The toxin is not very stable and can become less effective with time or if the bottle is shaken (hypothetical). 
  4. Antibodies to Botox. The toxin is surrounded by a protein, that one can develop antibodies to. In other words, the body recognizes the Botox as something foreign and fights it off.  This occurs after many treatments with Botox and is not common. 



Robert S. Bader, MD
Miami Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Botox and frowning


Sometimes it take a little extra for the Botox to work.  As for the fee, that is something to discuss with your doctor.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

The area treated was to soften the vertical lines or "11"s not prevent frowning


Fifteen units between the eyebrows may be a little light for some people, and perfect for others. It will soften the vertical "11"s. You would need additional botox in the forehead area to reduce the ability to frown.

Other factors affecting results include technique, and freshness of the product. We use our botox within one hour of preparing.  

Christopher J. Peers, MD
South Bend Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Botox timeline


After two weeks, whatever Botox you had has reached its full effect.  The area you had treated between your eyebrows is the glabella, and the muscles treated in this area erase the presence of the "11's," the vertical lines present in the area of the glabella.


I usually treat the glabella with a higher dose than 15 Units, but that should be enough to produce some softening of the wrinkles.  Hopefully you had some photos taken beforehand for comparison.  Since you still have some motion in the area, it sounds like you do need a touch up.  Most offices do charge for the touch up, if needed, but they should be able to tell you what to expect over the phone.  


When properly dosed and administered, the glabella area gets consistent and outstanding results from Botox.  


Michael Bowman, MD
Montgomery Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Botox isn't working...?


Well the reason you can still frown is because you didn't have the forehead treated - you had the glabella area treated between your brows which means you shouldn't have those 11 lines there, but you absolutely should be able to frown because your forehead wasn't treated! The forehead muscles (frontalis) is what causes you to move that area and be able to frown. 15 units is a rather low amount for the glabella area - I use at least 20 units here. If the office that treated you wants you to come back for a touch-up I would ask them if they are going to charge you - different offices have different policies for touch-ups. Bur frankly, since you are going to really need treatment for an entirely different area - the frontalis muscle - this really isn't a touch-up, and probably will result in a charge. Sorry for that news.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.5 out of 5 stars 9 reviews

Reasons Why Botox May not Be Working After 16 Days


15 units is certainly enough to at least make a noticeable difference in the "11's". There are several possibilities why you feel it has not worked. First, the longer it has been since the Botox was mixed, the more it loses it's strength. This is why it is important to go to someone who does a lot of injecting (their Botox should always be fresh). Secondly, the size and strength of each person's muscles vary. If you have large, strong muscles in this area, 15 units might not have been enough. Third, it may be that your "11's" are deep enough that even if the muscles stop working, you will still have the creases in your skin (if this is the case, it should have been recognized by your injector and explained to you prior to the injection being done). Finally, it may be that their was actually some improvement, just not enough. In these cases, many patients feel like it didn't work at all (because they still see the creases), when in actuality it is better, just not gone. Hopefully your injector took before photos so that when you go back in they could at least take some more pictures and compare the before to the after. This would help to determine which of these possibilities happened. If you do need at touch up, most offices charge for this. You have to remember what you paid for. Most offices charge by the amount of Botox used, not by the result. If you have extra large or strong muscles it will take more Botox for you to get the best result than it would in someone else (unfortunately this is not an exact science). The amount that was recommend to you before the injection is just a guess as to what your injector thought you would need. Sometimes the guess (although an educated one) is wrong and you may actually need to use more (or sometimes less) the next time. I hope this helps. Good luck.

Michael R. Menachof, MD, FACS
Denver Facial Plastic Surgeon
4.0 out of 5 stars 14 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.