Why Didn't Botox Work on my 11's?

I've had botox three times within a six week period. Today my dr. injected a sronger dose, and told me if this amount doesn't work then it's not worth my time or $$. What do you think is happening? I only wanted my 11's to relax.

Doctor Answers 17


Try and frown. If the muscles move then they have not been injected enough. If they don't move and the lines are still there then they are etched into your skin. you will need some filler and repeated botox treatment to softent them.

West Palm Beach Facial Plastic Surgeon
4.8 out of 5 stars 12 reviews

Botox not working

If you have had Botox injected three times with no effect then you may not be receiving the correct treatment for your issue.  If you post pictures of your face we may be able to give you more specific advice.  Botox works on dynamic wrinkles - meaning wrinkles caused when muscles contract.  If your "11s" are severe enough that they are also there at rest, then you may have dermal atrophy requiring treatment with a dermal filler such as Juvederm.  For static wrinkles - wrinkles at rest - Botox will not be effective during the first few rounds of treatment.  Over time, however, the decreased activity of the muscles may allow some of the dermal atrophy to heal and show an improvement in the static wrinkles as well.  It is very rare to be "immune" to Botox.  While it does occur, it usually only happens in 1 out of 10,000 patients is often in patients with long time exposure to Botox.


Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Why Didn't Botox Work on my 11's?

There are a small subset of patients'11's that need additional Botox therapy and filler to teach the area. There is a stronger muscle component and deep set creases in the dermis working in unision. So treatment should include Botox + filler for the higher chances of success. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Antibodies to botulinum toxin can prevent it from working

Since botulinum toxin type A is a protein produced by bacteria, it is possible to become immune to it by developing antibodies.  If that occurs, neither BOTOX(R) nor Dysport(R) would work for you.  There is another drug, botulinum toxin B (sold as Myobloc in the US), that would still work, but it is quite expensive, and I don't know any plastic surgeons who use it.

If you can, please post the number of units used with each treatment, the dates, the areas treated, and a photograph of the area at rest and while you are trying to contract the muscles treated.  That will let us help you more specifically.

James Nachbar, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 22 reviews


Botox relaxes the muscle of facial expression which cause wrinkles.  However, if these wrinkles are very deep you may need a combination of botox and facial filler.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 42 reviews

Very Deep lines may not Disappear with Botox Alone

Botox dosing requires a certain degree of titration from patient to patient to match the physical changes and expectations present.  I inform patients that my goal is to achieve a relaxed look at rest, which still allows for some motion. If a patient desires "no motion" in the glabella, a higher dose of Botox is administered.  However, in some patients, these hyper dynamic lines are so deeply etched that Botox alone is insufficient.  Various Fillers can potentially be used in the glabella, but are not FDA approved for this purpose, and have been associated with specific complications.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

You may need something in addition to Botox!

How frustrating for you that the Botox did not work to remove your 11's.  Remember that Botox treats dynamic wrinkles (those created by muscle activity) rather than static (the wrinkles present at rest) ones.  Eventually, dynamic wrinkles become static ones over time.  If your 11's are static wrinkles now, you may need a filler in addition to Botox to correct the lines in this area.  Good luck.

Mikel Lo, MD
Tucson Oculoplastic Surgeon
4.6 out of 5 stars 15 reviews

Botox doesn't work on my 11's

I have used Botox for over 20 years and it is does dependent which means some people get a great result with small doses while others require quite a large dose for the same effect.  If you really hate the Glabellar lines, there's enough Botox to get rid of them, just increase the dose.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Botox Didn't Work, What to Do?

Hi VE.  There are a couple of possibilities, but assuming your injector is capable and there is a suitable does of Botox injected, it could be that the lines are too deep for Botox alone.

In some instances, using Botox alone will not completely resolve the frown lines you noted as the "11's".  In these cases both Botox (or Dysport) and a dermal filler like Restylane or Juvederm is required.  When the vertical lines are too deep, the Botox is often not enough and the area needs to be plumped or filled with these other products.  You may want to ask your injector about this, but it shoal have been discussed beforehand if this was a possible outcome.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Relaxing the 11's with Botox Cosmetic

Botox relaxes the facial muscles which contribute to the 11's, or vertical wrinkles in-between the eyebrows. Botox  may take up to 2 weeks before the maximum effect. While most patients respond to typical doses, some patients require more Botox than others. Lastly, Botox may not completely eliminate the facial wrinkles and complimentary treatments such as Restylane or Juvederm may be required. Other options may include skin care, subcision, dermabrasion, or chemical peel. Only after a comprehensive evaluation can a plastic surgeon or specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 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.