Botox: is Some Trial and Error Expected to Get the Look You Want, and Can It Build Up over Time?

I've gone to the same doctor for my Botox for the last 3 times (I go every 6 months). The first time I looked great (glabella). Second time, I had uneven eyebrows and this last time left me with a slightly lowered brow line where it looks like my forehead was ironed. Is some trial and error expected? I want to give my derm the benefit of the doubt. He's well regarded and known for injectable work,

Doctor Answers 8

Botox result can vary from treatment to treatment

If there were significant changes to the number of units given and the areas of treatment with the second and third treatments, then there could be an undesired result of eyebrow drooping or flattening from too much forehead treatment or botox injected too low on the forehead.  On the other hand, there are a number of my patients who over the years, can't have the same areas treated as they used to because their natural aging process has made their forehead more droopy. If the same areas and units of Botox were injected as they age, then they might obtain unwanted drooping that they wouldn't have had when they were younger.  Some times the area that can be safely injected on the forehead without causing a droop of the eyebrows becomes very small and eventually, only the glabella is treated without treating the forehead. I have recommended Ultherapy on many of these patients to help lift the forehead slightly to see if we could resume treating some of the forehead horizontal creases again with botox.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox Results

The sign of an expert and experienced injector is to be able to reproduce quality results. Ensure that you communicate clearly your objectives, and if these objectives are obtainable he/she should be able to deliver on or close to them. If your objectives are not realistic, then the injector should be able to explain why they are not obtainable.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 42 reviews

Botox Works Well for Wrinkles in Experienced Hands

In medical lingo, the results achieved with Botox (as well as with the more recently introduced neuromodulators, such as Dysport and Xeomin) are referred to as "operator dependent." This simply means that the doctor administering the treatment has a lot to do with determining the ultimate outcome.

In the over 21 years I have been injecting Botox for cosmetic reasons I have found the results of treatment with this agent to be reproducible, meaning that the aesthetic benefits obtained are pretty much the same following each treatment session--with the notable exception in some individuals of the rare occurrence of the development of antibody resistance to the material. If anything, repeated treatments of the same area at periodic intervals often yield better and slightly longer-lasting results due to a thinning of the treated muscles of expression that occurs with time owing to the prolonged presence of the Botox within the muscle tissue. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Experience counts

The more Botox you do, the better you get. Also, Botox only lasts three months, you may need it done more often.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Reproducible botox results

Thank you for your question. When you get botox, you want to specific about what you want to achieve and convey this information very clearly to your doctor. This will get you the right injection sites and makes your results more reproducible.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

The problem here is that there is no agreed upon right way to do BOTOX treatment.

This means that every doctor has their own flavor of treatment.  Many of the treatments make absolutely no sense, cause forehead paralysis, or muscle recruitment (think Vulcan forehead or bat face).  I suggest that you google microdroplet botox which is an entirely different approach to periocular BOTOX that preserves forehead movement with a very natural eyebrow elevation.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox results

I wouldn't call it trial and error but everyone has different expectations and a different starting point. First, it's important to evaluate whether Botox is the correct injectable for you, as opposed to faical fillers. Second, everyone has a different threshold, although generalizations can be made. I, too, recommend starting conservatively and then re-evaluating as additional product can always be injected. Also, keep in mind that Botox does not slow the aging process.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 42 reviews

Expect some "trial and error" when starting Botox

Since every patient's wants and needs are different for many reasons, when starting Botox treatments even new areas in an existing patient, the dose we use and the pattern of injection is just the physician's educated guess. We bring patients back to assess effectiveness and need for additional treatment for that reason. My philosophy is to start out conservatively and to add more if necessary. Medicine is a science but it is not an exact science.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 38 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.