Botox did not work at all after 21 days! Was it because of the doctor, or bad botox?

Question

I have been getting botox for about 8 years every 6 months with excellent results. New Dr. this time, 57 units in forehead, around eyes, bunny lines and upper lip. Dr. barely went beneath the skin, certainly not into the muscle. Bad botox, bad Dr. or a combination of both? Do I go back? What should I expect? Do I have to pay more of my hard earned money?

Houtan Chaboki, MD · Answer

Persistent wrinkles after Botox treatments may be due to many things, including the Botox itself or technique. Also, some patients may respond differently. The amount of Botox, 57 units, is normally sufficient to see at least some results. If you're not satisfied with the Botox treatment, then ask the office for options. Some practices may give a touch-up after 1-2 weeks from treatmentBest,Dr. Chaboki

Christopher V. Pelletiere, MD · Answer

With 57 units of Botox injected, you would expect to see a difference after a week.  It is hard to say where the problem is at.  I would recommend contacting the office where you had the injections and let them know.  They may be very receptive to your complaints or they may not.  You never know until you try.  I suspect the Botox was either diluted too much, did not get into the muscle, was old ( reconstituted more than a day ago), or was just a bad batch(?).  If you liked your previous injector, you may want to go back to them.  I hope this helps.

Kelly Gallego, MD, FACS · Answer

I am sorry to hear that you had such a negative experience.  I tell my patients that it takes a day for the Botox to start working, and at least a week for it take effect completely.  If you can't see any difference at all by three weeks, something obviously is awry.  You should certainly sit down with your doctor to discuss your results, or lack there of.  Hopefully, your doctor took photos so that you can get a real comparison.  It may have been an old batch of Botox that was reconstituted previously, or it could just have been that something went wrong during the manufacturing process.  If you were one of my patients, and we truly did not see any difference after treatment with 57 units of Botox, I would treat you again at no additional cost.

Stephen Prendiville, MD · Answer

Although I agree that 57 units is a reasonable dose of Botox for the areas treated, it would probably be best to return to your Doctor for a discussion.  Hopefully, your injector is a Facial plastic surgeon, Plastic Surgeon, Dermatologist, or Occuloplastic Surgeon who performs Botox procedures frequently.  If not........"There's your trouble".

Michael A. Zadeh, MD, FACS · Answer

The most common reason that Botox doesn't work is that there was not enough of it given. That being said, 57 Units sounds like enough to give you some result. I wonder if you actually got the 57 Units. You should definitely return to see the Dr. who did your injections and voice your concerns. You may require additional injections to achieve the results you desire. Good luck to you!

Michele S. Green, MD · Answer

There an be various reasons why your  Botox did not work.  It could be due to the batch, the dilution, or improper placement.  You should return to your treating physician and consult them as to why your Botox did not work and have the doctor touch-up or re-do your Botox.

Daniel Shapiro, MD · Answer

It is difficult to say what exactly went wrong and why you are not seeing your typical results. I suggest letting the office know as they may be willing to do some revisionary/touch-up work.

Niels C. Krejci, MD · Answer

You definitely want to  go  back to your provider and have him/her evaluate your response to the injection. If there was a problem with the Botox they will want to know and they can also help you getting the result you are looking for.

Ramona Behshad, MD · Answer

Injection technique is rarely a cause of incomplete muscle weakening, since the Botox does not need to be injected in the muscle to see an effect. The medication will spread to the muscle. It is more likely that additional units are needed. Comparing the number of units used this time to previous visits will make this clear. If the units are the same, the Botox bottle may have been open for too long before injection or it may have been reconstituted in a different way. Following up with the injector is important, so he/she has an opportunity to address the situation. If there were other patients with a similar complaint, the injector may need to contact the company to get a replacement bottle. Some patients become resistant to Botox over time. Although this is less likely than the previous possibilities, it can happen.

Steven Wallach, MD · Answer

Not sure why you did not get a result from Botox. Why don't you go back to the doctor that gave you successful results?

Botox did not work at all after 21 days! Was it because of the doctor, or bad botox?

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