I'm really concerned about why the botox seems like it's not working after the second time around? (photo)

Question

About a mth ago and get 20 units in my 11's. seen reason I felt like they looked deeper bought expensive filler cream. Again this mth I got 20 more units and it's been 2 wks and still the same. I feel like she isn't putting the botox in the correct musle. I feel like she is ripping me off. I told her and she told me i needed juverdum . I don't need juverdum because I know the lines are not deep and she has done it once before and it worked. She should of offered me to go in to fix it. Right?

Jason Emer, MD · Answer

Some deeper lines need a combination of Botox with fillers, lasers and microneedling/prp. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Michael P. Morrissette, DDS, FACS · Answer

Neurotoxins like Botox work on dynamic wrinkles. If you have lines (the 11's) that are present at rest they will not disappear with Botox. Skin resurfacing or fillers are required.A new filler called Volbella works well for static wrinkles.

John Reilly, MD, FACS · Answer

Even though you only show one photo this seems pretty straightforward. You have lines that are present "at rest", ie without trying to furrow the brow. This can be deciphered by looking at the resting position of the inner eyebrow. These "11" lines are similar to a paper clip that is bent at the same position many times where it will thin just as your skin has. This is not a condition to be treated by Botox but  is a useful addition to a filler in the area which is required. Please see an experienced Board Certified plastic surgeon as this is a potential danger zone for complications.

Yannis Alexandrides, MD, FACS · Answer

If you're concerned, I would raise your doubts with your original practitioner. The Botox should have kicked in somewhat by now. It's possible that your lines require more than Botox alone. You may benefit from a combination of treatments including: PRP, Chemical Peels and fillers for optimal results. If the fault does in fact lie with your injector, the technique or the substance, there is no way to really identify this unless you visit another practitioner and compare the results. Always ensure that you visit a practitioner with plenty of experience in a clinic environment (the price will also be an indicator of the results; do not be lured in through discounts).

Kenneth D. Steinsapir, MD · Answer

There is a lot of nonsense that goes on out there.  You need to see a competent injector. This means working with an aesthetic core physician (dermatologist, plastic surgeon, facial plastic surgeon, or oculoplastic surgeon). Real service is often more expensive because you are not just paying for the product but also the time of an experienced physician or surgeon. Do not let well meaning individuals inject you with fillers in the 11 line areas.  This is a very vascular area and treatment here can cause blindness and stroke.

Faiyaaz Kalimullah, MD, FAAD · Answer

Thank you for your question and for submitting your photo.  Generally speaking, Botox is a neuromodulator - it is most effective for treating lines and wrinkles that are present with facial expressions, as it works by temporarily reducing movement in overactive muscle groups.  Lines and wrinkles that are present at rest may soften somewhat after Botox treatments, however Botox alone is seldom enough to fully treat deeper, "etched in" lines.It's difficult to make exact recommendations without assessing you in-person.  That said, looking at your photo, you appear to have lines at rest that likely will not resolve with just Botox.  Often times, lines that are present with rest require a combination of fillers and skin resurfacing lasers for best results.  Please keep in mind that filler injections in this area are higher risk, due to the presence of many important blood vessels - I would recommend seeing an experienced core aesthetic physician (cosmetic dermatologist, plastic surgeon, facial plastic surgeon, or oculoplastic surgeon) to discuss your concerns.  I hope this helps!

Melvin Elson, MD · Answer

First of all there is no cream no matter how expensive that will help your glabellar line. Botox should work and if not seek a second opinion with a board certified dermatologist

Jean M. Casello, MD · Answer

If the botox worked the first time,it should work again.  Sometimes if the lines are very deep the botox will soften them but may not make them disappear entirely.  Occasionally fillers are used in this area but it is a very complex area to inject.  It is possible that the botox that was used was too dilute or maybe was not stored properly and lost it's potency.  Your injector should fix this and re inject the area.

Alex Eshaghian, MD, PhD · Answer

Thank you for
your question Ceciliaann. I understand your concern. Botox is a purified
protein used to address wrinkles associated with facial expression. It is difficult to make an assessment without having before photographs. I do not use fillers in the upper face as there is an increased risk for irreversible blindness. In our office we have a policy of providing complimentary additional units if the recommended dose was used and improvement is not seen. In this way our patients do not need to have such worries. Although it is difficult to find an office with such a policy, it is worth a look. The pivotal studies demonstrated that when 20 units are used in the glabella peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. 
Please
consult with a doctor for specific recommendations. Good luck!

Praven Chetty, MD · Answer

Dear Ceciliaann:Thank you for your question and photo.  Botox works well to soften lines and wrinkles in the hands of an experienced injector.  Best wishes.

I'm really concerned about why the botox seems like it's not working after the second time around? (photo)

Answers (11)

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