Michael Sinclair, MD

The technical term for the area you are trying to treat is called the glabella. It is mostly comprised of muscles called the procerus and the corrugators. The procerus  muscle pulls the middle of the eyebrows down. The corrugators pull the eyebrows in and down. To make the area move less you need to inject enough Botox or similar product into all three of these muscles. It is not necessary to achieve complete paralysis to get a great result. What you should be trying to achieve is reducing the motion enough so that you cannot make the 11s reappear when you try to scrunch the eyebrows in towards the middle.  If for some reason you insist upon achieving complete paralysis of the area you will simply need more Botox. For most women 20 units in this area is enough to achieve a great result. Some women due take more. Men can take a great deal more. The highest amount I have ever heard of two achieve a desired result in this area was 180 units. That is an enormous amount! If you were treated with about 20 units and you have substantially less motion another option for you would be to be retreated more often until the muscle atrophies,  in other words becomes weaker because it hasn’t moved very much.   If you re-treat the muscle every 6 to 8 weeks eventually it will move very little even between treatments. 

Although it is highly unlikely it is also possible that you have developed an antibody against Botox and are becoming resistant to it. This is quite rare. Most of the time the problem is simply you need more.

All Hyalaruronic Acid Fillers, including Juvederm can cause swelling. They all tend to absorb water after they are injected. If they are placed in a deep area, they are great for replacing lost volume. If they are used more superficially, they can be associated with swelling and even bruising. Some swelling that occurs within a few days after the injections should be expected. This can be related to needle trauma which is normal and it usually goes away with just ice in a few days. If too much filler was used, then you may look swollen or puffy for a few months. If that is the case, your doctor can dissolve some of the juvederm with a chemical called Hyaluronidase. 6 tubes of juvederm may be too much for you, but it may not be too much or even not enough! To be more specific, I would need to see some before and after pictures.

In the future, you may wish to add the Juvederm more slowly, maybe 1 or 2 tubes per month until you have the desired amount of correction.