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

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.

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 works really well for frown lines, or lines of facial expression.  If someone is saying that the Botox is not working for frown lines then either the Botox has been diluted or too little has been placed.  Alternatively, the wrong placement may be responsible for these results.  It is really important to go to an experienced injector who knows what they are doing.  Botox injections is both an art and a science.

BOTOX is a muscle relaxer. It doesn’t work on lines. It reduces frown lines because they are caused by muscles. If the BOTOX relaxes the muscle and the lines are deep, the lines will still be there, but they will appear less deep. That doesn’t mean that the BOTOX isn’t working, it just means there’s still a line in the skin. Filler will often be needed in addition to BOTOX to make the line go away. A patient might be resistant to BOTOX because they have an antibody build up to the proteins in it, but this is very rare. If BOTOX doesn’t work at all, it could just mean that more needs to be injected because the patient has very strong muscles.

Frown lines form from the action of the muscles underneath your skin. If the lines are most noticable when you are animating ( contracting the muscles), then you are the ideal candidate for either Botox or Dysport. If you have them without animation then botulium toxin will soften the apperance but may not get rid of the frown line. Does that make sense?

There are several reason why Botox would not work for frown lines

1. The amount of Botox needed varies depending on the strength and size of the corrugator muscles that bring the eyebrows together to form the frown lines.  In patients with particularly strong corrugators more units may be necessary to relax them.

2. Botox treats dynamic wrinkles, meaning those that form when you make a facial expression and go away when your face is relaxed.  Botox acts by interfering with the signal the nerve sends the muscle to contract.  If the wrinkles are present at rest, Botox will not smooth them.  In that case, a filler is needed to lift the wrinkle, then Botox to relax the muscles that formed the wrinkle in the first place.  The combination of Botox and filler makes for a longer lasting result.  Caution is needed to inject filler in the glabellar area, so make sure your injecting physician is experienced with injecting this area.

3. The least likely possibility is that a patient may have neutralizing antibodies to Botox that would prevent Botox from binding to its site of action. That is extremely rare and happens primarily in patients where large amounts of Botox were used previously.

Botox is a great treatment for dynamic lines of the face such as ther frown lines. If they persist a bit because of etching, sometimes I also place a little amount of filler.