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Botox for Frown Lines (52 Units) Doesn't Seem to Work. Why? (photo)

I'm 36 yrs old. 4 wks ago I had my 1st Botox for frown lines. My doctor said that I needed at least 42 units. It seemed a lot to me considering that ONLY frown lines would be treated. But I trusted him, plus I have kinda big folds when I frown. After 2 wks I didn't see any difference & I still was able to frown. At my follow-up appt. he said 42 wasn't enough & added 10 units more. Now 12 days after my 2nd treatment, 4 wks after 1st & total 52 units I still can frown & don't see any results.

Doctor Answers 14

Botox and other options for frown lines.

Thank you for your question. The frown lines between the brows can be address two different ways:
1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve.
2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.
In your case, I would recommend adding Restylane or Juvederm to soften the remaining static frown lines.

Botox should reduce frowning and usually its lines

Usually my upper limits of Botox in a woman has been 25 to 35 units for just the glabella (5 to 7 insertion sites) between the eyebrows. In some men with larger muscles, I have used rarely, more than 50. Your doctor, might have injected other areas other than just the glabella. If it was Botox and not Dysport, then the units you had should have reduced the frowning ability although that doesn't guarantee the lines or creases diminish right away. Some people have creases that have been present from years of contraction that they need a long time of relaxed skin overlying relaxed muscles before the lines fade. Regardless, you need to make sure that it wasn't Dysport because if it was, then the number of units can be increased.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 34 reviews

Botox and dosing

52 units to this area is very high and it's unclear to me where exactly you were injected if you aren't seeing any reduction. If you are visting a reputable office/injector, the Botox would likely have had a negative effect at this point.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 177 reviews

Botox and frowning

It appears that the Botox has minimized and relaxed your frown but you have deep creases that will not resolve with Botox alone.  Botox relaxes movement and you may not be able to completely stop all movement and still have a natural look.  You require some filler into the creases for plumping.  Please have your treatments with a certified dermatologist or plastic surgeon to obtain the best possible results.

Martie Gidon, MD, FRCPC
Toronto Dermatologist
5.0 out of 5 stars 20 reviews

Botox for frown lines dosing

Every person is different, and your muscles appear fairly strong, so 36-48 units would not be unreasonable. At the same time, adding a bit of filler if you have lines etched in at rest can be useful too. Would be nice to see your before & after photos, as there is likely some benefit, though not as much as you expected. The batch may have been expired or improperly reconstituted, or you may have antibodies against Botox and so it won't work in you (unlikely).

Benjamin Barankin, MD
Toronto Dermatologic Surgeon
5.0 out of 5 stars 34 reviews

Botox for glabella works very well

I generally do not have to use that much Botox to treat the glabella area.  It is possible that your 11's are so deep that you may need your forehead treated with Botox.  You may need a hyaluronic acid filler if the depression is very deep.  If you can still move that area then your Botox was ineffective.  You should go back to your treating physician.

Botox fro glabella

I never had to use that many units for the glabellar lines. It often takes 10-15 units max.  If there is still a depression from "etching" I will sometimes fill it with an HA.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

Botox does not work?

It is unusual that have not seen any improvement with 52 units of Botox. Many factors can affect the results, from the dilution, how long ago the vial was open, if has been properly stored, the site where it was injected. Also you need to aks if you really got Botox, or a different botulim toxin, like Dysport, Xeomin, etc.

Botox not working for frown lines

The problem may lie in the distinction between "static" frown lines present at rest, for which Botox will not have a significant immediate effect, and "dynamic" lines that occur with an active attempt to frown, for which you ought to see a noticeable difference with 52 units of Botox.  Some long-standing, deeper frown lines present at rest unfortunately can be permanent because they have scar tissue.     

Antibodies to Botox, rendering the medication ineffective is not common.  Furthermore, since antibodies take time to develop, if you did not see any reaction whatsoever even within the first few days following your injections, this explanation would seem unlikely. 

For deeper frown lines present at rest, fillers might be an option to explore.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Botox not working

Did you doctor take a picture of you at rest and frowning prior to your first injection?  This would be useful to compare.  If you have no effect whatsoever, then either the Botox was bad or you have an antibody.  It would be very unusual to not have complete effect from that much Botox.  I typically inject 15u for the frowners and it is plenty for the vast majority of patients. 

Matthew Bridges, MD
Richmond Facial Plastic Surgeon
5.0 out of 5 stars 13 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.