40 units of Botox on my 11s and forehead. Still not working after 10 days! Help! (Photos)

Question

I got Botox done for the first time 10 days ago. I'm 28 and don't have any deep lines. I got 25 units for my frown lines and 15 units on my forehead (a total of 40 units). I can still frown easily and still have the 3 small lines on my forehead. Is there a reason why it it isn't working yet?

Joseph J. Castellano, MD · Answer

Hello, and thank you for your question. It can take up to two weeks before the full effects of BOTOX® are noticeable, so you might want to give it a little more time before assessing your final results. If after another week or so you’re still not seeing any improvements, contact your provider. It’s likely that he or she started with a minimal dosage since this is your first time getting BOTOX. They can always add a little more to achieve the desired look. Good luck.

Amiya Prasad, MD · Answer

Thank you for your question. You submitted some photos describing you’re 28-years-old, got Botox® 25 units in your frown lines, and 15 units for your forehead approximately 10 days prior. You’re asking why you can still frown so easily, and certain lines are still present.
It’s important this type of question be addressed to the doctor who performed the procedure, but I can share with you how I discuss Botox®, particularly for people who get it for the first time in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. In fact, my specialty pf oculofacial plastic surgery were among the first physicians to administer Botox®, so I’ve been using Botox® for patients since 1993. 
My protocol for treating patients with Botox® or any injectable, whether it’s a neurotoxin or injectable filler, is I routinely see my patients two weeks after the procedure, especially if they’re new to our practice. It is always a get-to-know-you process when you do these types of injectable procedures to see how it works for the individual patient. There is always a range with the average doses of neurotoxin, and it’s also in context of the relative activity of different muscle groups in a given patient. 
If your goal was to have no movement in the frown area, and you're still able to move, I can understand why you’re concerned. Often you can also follow what your level of movement is compared to how it was pretreatment. The ability to move at all is not always a bad thing. If the frown area still moves a little compared to it moving a lot before the procedure, then it’s within a normal range. 
If it’s unchanged at all, then there are two questions that come to mind. One is if the Botox® was administered in the right places, and  in the right way, which is likely since this is a very popular area. The FDA approval of Botox® Cosmetic is actually for the frown line area so the number 11 is the most popular area to do. It is difficult to imagine that it was technically difficult for an experienced practitioner to deliver.  The second is the dosage, as you might need a higher dose. There are always people who need more, and there are people who need less. There are patients who come in and say they had Botox® done before, but they’re extremely sensitive and want me to start with very low doses. Others say Botox® doesn't always work for them, so they need high doses. It is really a matter of getting to know your patient. 
I think it’s reasonable for you to go back to your doctor at about 14 days, as is routine in our practice, and ask this question. What I offer is enhancement. If someone needs enhancement, there’s no problem, we do it as part of the getting to know you process. Often, it gives me an idea of what kind of dose they would need, so the next time we do it, we have a total dose that we know based on the previous experience. I still recommend patients to come back after two weeks for evaluation. 
You made a choice of practitioner for your treatment, so you shouldn't abandon hopes so quickly. Just meet with the doctor and ask about enhancement, and learn from there what the right dosage and areas work best for you so you get the outcome you want. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Dean P. Kane, MD, FACS · Answer

Dear Pebbles09: Thanks for sharing your photos. There are several reasons why your Botox may not be working after 10 days.Poor diagnosis of the recruiting muscles creating the glabella folds and creasesImproper injection technique; wrong site, wrong depth, too small a dose, Gray-market, weak or ineffective BotoxWhile I hear antibodies may be a cause, I have never experienced this issue in more than 30 years of injections. Based on what I see on your photos, the adjacent orbicularis muscle, a ring muscle around the eye is pulling the skin toward the middle and was not identified as the cause of your "11's" and therefore not properly injected. Please obtain a second opinion consultation from a Board Certified Plastic Surgeon with extensive experience and skills in advanced Botox techniques. I wish you the best!

Doohi Lee, MD · Answer

It takes up to 2 weeks for botox to take full affect. Give it that time and then contact the Dr's office who did your treatment and ask them to address your concerns.

Leonard Grossman, MD · Answer

There are few things that could have happened. Number one, your body does not react to Botox. Number two, not enough Botox was injected. Number 3,  not all the muscles that cause a frown were addressed. I would go back to the treating physician and I hope they're either a plastic surgeon or dermatologist, and discuss those issues with them. Otherwise get yourself another opinion. Good luck from New York City

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40 units of Botox on my 11s and forehead. Still not working after 10 days! Help! (Photos)

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