Has Botox Ever Not Worked for Frown Lines, and if Not Why?

Thank you for your question. The frown lines between the brows can be address two different ways:1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve. 2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together. I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

  Nothing always works for every patient.  That said, you may want to have the treatment repeated a few times to be certain that Botox will not work for you.  Dysport is a very acceptable alternative if you are not getting the response you wish to Botox.

Provided the dose of Botox has been correctly stored at the right temperature, and reconstituted with the correct formula, I can't recall a case where Botox failed to make the muscle activity lessen, when injected in the correct area in the correct dose.  When done right, it's pretty reliable.

All the best,

I have never seen a case in which Botox didn't inhibit the muscular motion in the treated area, but I have seen times where the creases in the skin remained the same. Mimetic lines, or wrinkles related to repetitive motion, usually improve with Botox inhibition of muscle movement, but as the lines were created by years of activity, it may take many months to a year of inactivity for the skin creases to improve. This especially occurs when the lines are deep folds.  During the time that we are waiting for the skin folds to flatten during successive Botox sessions, a filler can be injected to help lift the crease. The Botox's affect on minimizing muscular action, may increase the longevity of the filler in the area. Usually the filler is Juvederm Ultra (not Ultraplus) or Restylane.

Botox and Dysport are wonder drugs when itr comes to improving DYNAMIC wrinkles.  How does it work?  The doctor injects small quantities of these drugs and they work as "blockers of muscular receptors" so when the nerve attempts to make the muscle move - it can't.  When it can't move - no  dynamic wrinkle.  If you have a scar, or a very deep fold/wrinkle that is not caused by active muscle function - it will not go away completely  or maybe at all.  These are called static wrinkles.

Most wrinkles of the forehead are dynamic and do resolve with botox.