What do I do when Botox is no longer taking care of my nasty 11? (Photos)

Hi @michelleeaston! Neuromodulators like Dysport or Botox in combination with hyaluronic acid dermal fillers like Juvederm can be an effective treatment to smooth out the 11 lines. I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications. Best of Luck, Dr. Nima!

Hello, thank you for your question. If Botox it is not helping you, you can ask your doctor to use different toxin Dysport/Xeomin. 

Patients who are inadequately treated with botox, getting a combo with fillers.  Just don't overdo the fillers in that region or it will cause it to stick out and look unnatural.  Removing or cutting the corrugator muscle is also an option but often leads to contour irregularities later and is not often performed any more.  

If you are not experiencing the results you want with Botox, then you may want to ask your doctor to see if a similar botulinum toxin A injectable may work better, such as Dysport and Xeomin. All three products differ in terms of the number of proteins around the main part of the botulinum toxin A molecule. Individuals and their immune systems will respond differently to these unique variances, benefiting from one, but not another. At my practice, the Dr.U Hair and Skin Clinics in Los Angeles, we made a video of one of our patients who had been treated with Botox for a long time and switched to Dysport. He noticed a faster onset. Like you, he was also experiencing difficulty with strong glabellar muscles and stubborn frown lines between the brows. Dysport was able to overcome this challenge by successfully relaxing these muscles. I’ve included the link to his case study below.

Thank you for your question and for providing pictures. I would use a combination of botox and fillers to achieve your desired look. Many have found that they get results with Xeomin or Dysport as well. It would be best to speak to your injector to see which treatment plan would work best for you. Hope this helps. 

If you are no longer seeing results from Botox, it's possible that your body has started to form neutralizing antibodies.  You might want to try another molecule like dysport to see if you respond to that better.

Hi,Thank you for your question and sharing your photo.If you find that Botox is not working as well, the next step might be to try one of the alternative neuromodulators such as Dysport or Jeuveau. Though these brands are essentially the same group of medication and mechanism of action, there are slight differences that may be more effective for you if you've only been using Botox for the past 10 years.You can also consider fillers to fill the lines but it's recommended to continue Botox/Dysport/Jeuveau at the same time to reduce muscle movement. Fillers in this area is particularly risky for vascular occlusion and blindness. Make sure to see an experienced provider to discuss to make an informed decision.Hope this helps!

one option you have is to try fillers or fat transfer to fill out the wrinkles. It's an area that can be problematic so make sure you see an injector who is experienced. 

There're certain people who become immune to Botox and it will not work. HA Filler can be a possibility. Surgically, you are a good candidate for a direct excision of the two major glabellar muscles that cause the frown lines. In our practice -this procedure is most always combined with other surgical facial procedures - to rejuvenate the face.

Thank you for sharing your excellent question.  There are a number of options available to improve the appearance of your 11's and I would recommend dermal fillers.  Careful placement below and into the skin should make a nice steady improvement in your results.  You may also wish to consider a different neuromodulator from Botox to see if you have better results with a competitor.  Hope this helps.