Is there such a thing as a bad, non affective dose of Botox? Its been 10 days & I see no difference in my forehead & crows feet.

Baberham,

Good question.  there are many factors that can lead to botox therapeutic failure.  As you probably already know, it may take up to a week to see the effects of botox.  It is wise to keep close record of the number of units required to treat a given area.  If too few units are used, you will see a lesser effect.  3-5% of chronic Botox users develop antibodies that inactivate the toxin.  This is rare.  The potency of Botox diminishes with time after it is reconstituted.  It arrives at your doctor's office freeze-dried and is then mixed with saline.  One study showed a 50% decrease in the potency over a 7 day period.  Thus, the longer it is stored, the less effective it may be.  Botox is a fragile substance.  It is recommended to avoid agitating the vial after mixture and to avoid contact with the toxin and alcohol.  It is easily denatured and should be handled with care by your practitioner.  If you have had great results with one provider, I would stick with him/her.

Good luck

Effectiveness of Botox depends on the source (Allergan in Us vs other source), concentration of the product and the doctor's level of expertise and ability to effectively deliver the dose to the correct muscle to bring about the goal. These aspects are controlled by the physician....shipping conditions, manufacturing conditions, expiration, etc. are controlled by the manufacturer. 

We inject a significant amount of Botox in our office and have occasionally noticed variable effectiveness of the equivalent doses of the drug in certain patients that previously responded well. Have your physician report the lot number to the manufacturer. Review the dose with your doctor as well....Multiple sources of decreased effectiveness, but I would start with your doctor and review the results with him or her.

Dr. C

johnconnorsmd.com

These issues should be examined to see why your Botox didn't work.  1) Was it real "Botox", purchased in the U.S. from Allergan,  2) had it expired,  3)  was it diluted correctly so you recieved enough units and injected correctly.  There is also a rare patient who does not respond to Botox.  Best to return to your injector and discuss how best to correct the problem.

Generally botulinum toxin is very effective and it would be unusual for it not to work. However, I have had the experience and it may be attributable to transportation, storage, preparation, dilution or injection technique. Therefore, it is generally worth another attempt. You may want to try Dysport, another preparation of botulinum toxin.

Why might you not see benefit from your Botox treatment 10 days after? Before this question can be answered, it is important to know if the Botox has inhibited the muscle movement. If the eyelid crows feet muscles and the forehead muscles aren't moving then the Botox was effective but the skin creases won't go away "overnight" if they've been caused by years of sundamage and muscle motion. You may see benefit as much as two to four weeks after Botox, and in some cases, patients who have deep lines and maintain their Botox treatment for several sessions (it usually wears off close to four months after treatment) without it wearing off, may see improvement in the lines many months after the muscle stopped creating the wrinkles.

If your muscles are still moving, then it is possible that you need a larger number of units. Some physicians will start low on your first treatment to ensure that you do not get an undesirable result which could take months to resolve. Another reason would be if your muscles are so strong that they need a much higher dose than average. If the Botox were overdiluted (it must be diluted prior to use, and most doctors appropriately dilute with sterile saline in an amount between 1 and 2.5 - 3 ccs) then you may not see a good enough response. Finallly, doctors need to check that the lot of Botox being used has not expired, and that the solution once diluted is not stored for more than a reasonable time.  Experienced doctors  treat so many patients that the bottle lasts less than a week or two, sometimes only one day so there is no concern of shelf life once diluted.

See your doctor in the next week to two for an evaluation of your lack of effect. it may be better by then or you may consider getting a higher number of units.