Disappointed with Botox

I had Botox many years ago right after it came out...

I had Botox many years ago right after it came out.  The result was amazing.  Unfortunately, I couldn't afford it for awhile so I never went back.  About a year ago I decided to try it again. 

I went back to the same dermatologist several times because the furrow was not smooth at all.  He had taken before pictures in which he made me furrow my eyebrows as hard as I could, then he used these pictures to try to tell me I looked great.  I was disgusted as he had been written up in the NY area as being the BOtox KING.  I waited until recently to try again with a plastic surgeon.  I told him my story.  He said he "just didn't use enough". 

I had the injections with some initial smoothness but a few weeks later I was completely able to furrow that brown again,  He gave me more and said "I've given you a huge dose" this should do it.  I still see the line.  I've read that some people are trying the restylane for this area.  I think I'm immune.

Rockland Plastic Surgery Center

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Dr Chris and Julianna,
I was thinking the same thing. I can't afford to always keep up with botox. therefore the lines do not remove completely but the dynamic wrinkle cannot be dynamic. my "czechoslovkian anger line" is present but not deepening, and it is flat enough that i don't look angry. i am 45 so the line doesn't bother me enough to get a filler. best wishes. btw--i love botox. i had it from the carruthers in vancouver a long time ago and do it as much as i can afford to, which isn't often enough!
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Hi Julianna. Not having seen you personally, my comments have to be limited by what I have read. You first got Botox when it first came out, which was 20 years ago. You decided to use Botox again for the same wrinkle which has had many years to deepen and become "etched" into your skin. Botox cannot erase wrinkles that exist "at rest". Think of a piece of paper that you fold; even if you unfold the paper, the line is still present. Botox will keep the muscles from contracting and causing the wrinkle to deepen, but it will not "erase" the wrinkle. Someone should have explained this to you. You can treat the area with a filler to help the wrinkle, but you need to use Botox to prevent the muscles from contracting and continuing to form the wrinkle. It is a two part process to achieve maximal results.
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I have been using Myobloc as my Botulinum toxin of choice for three years. It has been a good experience. I don't miss Botox a bit.
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Dr. Verret, What is your feeling on Myobloc being used in place of Botox when it is ineffective? I've heard that it may be unstable and that it may migrate? As for handling facial lines around the eyes and forehead is laser skin tightening effective? Perhaps in conjuction with some feathering of fillers when Botox does not work? Thanks for your feedback
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Myobloc is a good alternative to Botox in people who have developed antibodies but I have no personal experience. There is a new muscle paralytic which is undergoing clinical trials and has been used in Europe for some time which should be available in a year if it achieves FDA approval. As to your laser question - depending on the lines, laser resurfacing can be a good alternative. This is permanent and often does not require other treatments to be beneficial. It is more of an investment and obviously more down time than Botox.

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Dr. Verret, Thank you again for your very helpful information. As I mentioned previously, I'm not in need of an upper bleph just yet, but having this knowledge will certainly be beneficial to me when the time does arrive! Be well... allie
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Yes thanks you, it is very helpful to learn about all this. I really had no idea. I really just went in for the simple procedure at the local clinic. Good Luck everyone!
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Dr. Verret - Thanks so much for such a prompt and thorough response! I actually had a brow lift some years ago, so I'm guessing my procerus muscle was left intact since I still have issues with the brow furrow unless I Botox it. (?) The corrugator muscle removal procedure sounds promising, especially since it can be done in conjunction with an upper bleph. I'm not in need of that (the bleph) just yet, but this is certainly excellent information to have. Incidentally, are there commonly-reported complications or adverse effects (post-procedurally) resultant of the actual muscle removal? Besides the numbness, I mean... like a sagging, caveman-like brow? Again, I appreciate your time and expertise. Have a great evening! ~allie
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Not all surgeons remove the procerus muscle with a brow lift. As for other effects - there are always more effects that can be procedurally related which you would have to talk over with your surgeon. I don't find the sunken look as I take either fat or fascia and fill in the space where the muscle is removed. This serves two purposes: 1) it fills in the dead space, 2) it helps to prevent the muscle of scarring back together. Again, ever surgeons performs the procedure slightly differently and I would highly recommend bringing up these concerns whenever you are consulting with a surgeon about the procedure.
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AliGrace, Thanks for your inquiry. As I mentioned there are two reasons for lines between the brows - activity of two muscle groups, the procerus and the corrugator, or tethering of the skin to the deeper structures. During brow lift procedures, the procerus muscles are often cut to help prevent movement of the brow area. For a more complete denervation of the area, removal of the corrugator muscle can be achieved through the same incision that an upper eyelid blepharoplasty is performed. There really is no medical term for the procedure, more of a description. The biggest risk involved with corrugator resection is numbness of the forehead which could be permanent. As for removing the tethering, there is a relatively new procedure using the Surgiwire device (made by Coapt systems). The device undermines the skin then either fat, filler, or fascia is placed in the undermined area to create a permanent raising of the area. This is a good alternative for people who want a more permanent solution than temporary fillers can provide.
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There are a couple of things that should be mentioned here: 1) Hawry1 - I'm surprised at the response that you got from Allergan. From the medical use of Botox for conditions such as neck muscle spasm and facial twitching we know that in some reports up to 10% of people will develop clinically significant antibodies to Botox. This means that your body develops antibodies to the protein to make it not work like it should. This has been known for some time and is a known occurence with Botox cosmetic. In some patients this means that increasing doses of the medicine are needed for the same result and in other cases the medicine does not produce the desired results at all. 2) Julianna - Without seeing exactly what you are talking about I can't comment specifically on your case but a word of advice. In patients who get Botox infrequently, you will notice that it does not last quite as long as you think. If you get repeated injections at the first sign of muscle activity you will notice that the Botox appears to last longer, and in some people several months or even a year. This is due to 'disuse atrophy' of the muscle. Even though the Botox has worn off, the muscles have been so weakened from not being used that they cannot produce the wrinkling that you can see for some time. 3) As for fillers for the wrinkles. Wrinkles can be caused by two different things - muscle activity or tethering of the skin to underlying structures - or both. For some people, fillers (such as Restylane and Juvederm) are a more desireable option while for others both Botox and fillers must be used for the best result. Other more permanent methods of repairing certain wrinkles are possible. For lines between the brows, removal of the muscles which cause the lines and procedures to break the tethering bands are possible which give good long term results.
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Dr. Verret, Thank you so much for your informative and valuable contributions here on RS. I would be very interested in learning more about the procedures you mentioned: the removal of the muscle between the brows, and the procedures to break those tethering bands. What are the actual (medical/proper?) names of these procedures, and have you personally performed any of them? This is definitely a very interesting topic... thanks again! I look forward to your response. ~allie
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Myobloc is apparently a competitor to Botox used more widely in Europe. It is the botulism type B rather than A (Botox). Allergan is very opposed and says that it is very unstable. I'm in Canada where it has not yet been approved, however I've spoken with a clinic in Syracuse NY who uses it. Their comment is that it doesn't last as long as a successful Botox injection, no more than 3 months but you see the results within 48 hours. My doctor has been great, she is very concerned that if this is happening to me it will happen to others and if Allergan is putting this out as a no fail solution it could be real bad press down the road as more people spend money they may not be able to afford on a drug that doesn't work. The deeper we dig into this though I get the feeling that Allergan would rather sweep these cases under the carpet, as their claim is that this doesn't exist and it is impossible. We will, see I had a meeting with one their doctors this week. I should be hearing more in the next few weeks.
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What exactly is Myobloc? I have read other reviews on this site about unhappy customers. One woman found she had been exposed to Botulism before and that was why it wasn't working for her. Your doctor sounds like he/she went all out to figure this out. I feel like I get any sympathy, the doctor looks at me like I am nuts. He thinks the area looks good. I suppose it is less noticable than prior to the injections but the people in his office have completely smooth foreheads. It's really frustrating.
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have had the same experience with Botox. The first couple of times I was injected it worked fabulously. Then it became less and less effective. My doctor thought it might be a bad batch and each time she did injections from that time on she used a new, fresh bottle and still no results. She then contacted Allergan who said this was impossible either the botox had not been stored properly or her technique was wrong. Of course I was the only one of her patients to have this happen. Allergan then sent one of their reps to witness the injections as this doesn't happen to verify the injection method, massive amounts of botox were used and three weeks later the rep came back to see the results and confirmed that there was nothing wrong with the method and that I had indeed become a non-responder. From then on my doctor has been in contact with Allergan and their medical department in order to examine this further. My case is being reviewed in order to determine why this is happening. Therefore my advise would be to have your doctor contact Allergan as this is not supposed to happen and apparently has not happenned to anyone else. The more people who come forward with this the more seriously Allergan will respond in examining why and how to overcome this. Apparently Myobloc may work??
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