Very Little Change After Botox on Forehead

I'm 38, and 12 days ago, I had Botox on my horizontal forehead lines. I only see very little difference. Is this normal? Is it possible it will 'kick in' in the next 2 days? I did drink alcohol at a friend's party the night before the procedure and wondered would this have any impact on how it works? The physician also said that I would need an extra dose (which she applied) as the lines were already visible at rest--so I am especially disappointed that I can still see those lines!

Doctor Answers 14

Most likely, you did not get enough Botox.


Cannot be sure without seeing you, of course.  But almost all of our Botox patients in New York get significant improvement with 25 units after 12 days.

Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

It may take a few treatments


It may take a few treatments of Botox to eventually smooth your forehead.  Look in the mirror and try to raise your eyebrows.  If you are unable to raise them, then your Botox is working.  Patience.

Kenneth R. Francis, MD, FACS
Manhattan Plastic Surgeon
4.6 out of 5 stars 47 reviews

It took 38 years to make those lines.

Botox does not treat wrinkles, it treats the muscles that make them. Therefore one should not expect prominent horizontal lines of the forehead to go away after one injection. Be patient, with continued ,regular use of Botox, the lines should soften because the muscles that created them have been weakened.

Leslie H. Stevens, MD
Beverly Hills Plastic Surgeon
4.2 out of 5 stars 10 reviews

Botox for the horizontal lines on the forehead

botox for the horizontal lines on the forehead is tricky. If you put too much in you drop the eyebrows and create a heavy upper lid. Put too little in and you don't get an effect. I would recommend going back to the doctor and getting a little more Botox. If you don't respond to more Botox you may be someone who has Botox anti-bodies and Botox does not work for you.

Lenore Sikorski, MD
Orange County Dermatologist
4.3 out of 5 stars 24 reviews

Lines at Forehead After Botox

Normally at this point, most patients would see noticeable results after a Botox treatment. If you can still raise your eyebrows, then you may possibly be able to have more Botox injected to help soften those lines. If the lines are present, but you are not able to raise your eyebrows at all, then more Botox will not improve your result - it may actually cause ptosis. Botox does not always eradicate lines. It can soften them and prevent them from worsening over time with repeated treatments. It is best to consult with the person who performed your injections to be evaluated in order to determine the right course of action for you. 

Steven H. Williams, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Botos and forehead wrinkles

You may get further improvement over the next few days.  If not, your doctor may be correct, you may need an additional dose of botox.  The amount of botox required to paralize a muscle and subsequently cause the overlying wrinkles to resolve is dependent on the size and mass/strength of the muscle and the number of neuromusclar receptors in the muslce.   This can vary greatly amoung different individuals. 

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.8 out of 5 stars 56 reviews

Ineffective Botox

Dear Annie,

As the post above attest, there could be MANY reasons why your Botox treatment may have been a disappointment to you.

By 12 days you would have seen a complete effect of the Botox. So - the period of elapsed time is not the answer.

Nor do I believe that your surgeon would have partially treated your frontalis muscles generated wrinkles without telling you as some of the above posts was suggesting. Yes -- weakening the frontalis in people who need it to prevent upper eyelid skin from dropping lower is counterindicated BUT a surgeon would tell you why they chose not to treat those folds rather than allowing you to believe they did.

Botox is most effective in smoothing active wrinkles - the wrinkles that appear on facial animation. You plainly state that "the lines were already visible at rest". The likelihood of Botox erasing established lines is very low. To do so would require Botox AND a filler (Restylane/Perlane OR Juvederm).

Botox efficacy depends on how it was reconstituted (gently or allowed to bubble which reduces its potency), was it over diluted (ie you are getting less Botox units than you should) and was it old and less potent. Always possible when a surgeon is not busy and reconstituted Botox sits in his/her fridge.

Lastly, Botox injectors are NOT the same. Some surgeons are better at doing it than others. Witness if you will the plethora of freakish botoxed celebrities with the "Spock look" (depression of the medial brow with unnatural elevation of the lateral brow). I am sure they paid a lot for their treatments -- but such Botox results are far from optimal.

Hope that helped.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Not enough Botox?

It is difficult to answer this question without actually seeing you. There are many factors that come into play here. If you did not receive enough botox, then you would still be able to move your forehead muscles and make the lines. However, if you are not able to move your forehead, but still see lines across your forehead, this is because the lines have been there for so long, they are what you called a "static crease", meaning even if you stretch out the skin, the line is still there.

If you continue to get Botox at regular intervals, the lines should start to soften up. Patients sometimes get disappointed because they expect Botox to erase all wrinkles, and they have to be educated that sun damage and strong muscular activity over a long period of lines can create deep wrinkles that will still be visible despite muscle activity inhibition with Botox. You can complement your results with fillers and/or laser treatments.

Peter Newen, MD
Orange County Plastic Surgeon
4.5 out of 5 stars 31 reviews

Botox takes a while

If you have had forehead lines for a while, it will take a while to soften them up. Of course, Botox is designed to treat the underlying muscles that cause the wrinkles, but it does not actually change the skin. So, after the muscles are paralyzed, and done so on a continuous basis (meaning you have to keep up with re-treatments), eventually the wrinkles should soften up.

Sun damage, smoking, etc. can damage the skin and work to increase wrinkling. Protecting the skin, exfoliation and hydration will help treat the skin while the Botox works on the muscles that contract and can accentuate the folds (wrinkles) that are more likely to appear in damaged, as opposed to healthy skin.

Also, people require different doses of Botox. Some people need minimal units injected. Others need more. It sometimes takes a session or two or your doctor to figure out what dose works best in your case.

Phillip Langsdon, MD
Germantown Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Lines visible at rest may take several treatment cycles to abate

Botox works well for dynamic lines and usually will help within 2 weeks.  Lines that are present at rest may take months to remodel and may take up to 3 cycles of Botox over a year to remodel and smooth out,

Robert A. Weiss, MD
Baltimore Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.