What would cause my glabella to look worse after botox? (Photo)

Question

I received 40units of Botox on my forehead and glabella (usually amount for me) a week ago. My doctor will not disclose dilution ratios. I have not have treatment in 2.5 years due to pregnancy and breastfeeding. I would normally see full effects after 3-4 days so the likelihood of this treatment working is not good in my opinion. What should I do and how to i approach this with my doctor. I feel like I was slided out of a good amount of money.

Jason Emer, MD · Answer

Botox takes 2 weeks to take full effect, have some patience.  If you are not happy at that point, go back to your treating physician.  Best, Dr. Emer.

Brian M. Harmych, MD, FACS · Answer

There are many factors that could effect the result that you are seeing after Botox treatment to the glabella and forehead. After only one week, I would suggest trying to be patient. After two weeks, if you still do not have the desired effect I would recommend scheduling a follow up appointment with your plastic surgeon. Occasionally, patients will require a "touch up" dose. I hope this answer helps! Good Luck,Dr. Harmych

Stephen Prendiville, MD · Answer

The before and after photos shown are not representative of a result one would normally expect after being treated with 40 units of Botox 7 days ago. However, I encourage patients to wait two weeks prior to rendering judgment. Botox, when stored and administered appropriately, is very consistent in terms of duration and quality of results.  If the Botox was not fresh or if not refrigerated properly, the toxin could have been rendered inactive.  However, this is an issue that is best taken up with your injecting Doctor.

Dean P. Kane, MD, FACS · Answer

Dear Botoxbeauty2014:Thanks for sharing your photos and this experience.According to the captions, your photos are in reverse order and I am presuming, 1 week apart according to your comments. I find that dilution is important from the perspective of the diffusion of the Botox undesirably relaxing adjacent muscles. I do not see diffusion effects in the after photo. Your before photo note an arrangement of active lines like: >> ! << Your after photos appears with these lines:>>>\!!/<<< .Without seeing you in person, I see only a little effect at all and this may be attributed to the following.1. You receive minimal Botox in the "glabella region of muscles" including the corregators, depressor, and procerus muscles. 2. It is too early to see your final results. It takes 10 to 14 days.3. The corregators pull the medial brow inward creating the double lines("11s") above the beginning of the brow. On occasion, it may create a single central line but rarely, all 3. The minor downward pull lines across the nose are relaxed. A small effect on the nasal portion of the corregators with no change in the forehead body of the corregator at the time of this photo, allows for the recruitment of the orbicularis muscle to deepen the middle line and "push the glabella complex" inward and upward and create a deeper "!", the "11s" and the chevron-like dimples above the brow. This is in contrast to desired result where the 3 lines are relaxed and the medial brow separates and lifts. (I hope you could follow this.)4. If you did indeed receive 40 in the upper lateral crows feet and forehead, I am unable to visualize the effect due to the cropped photos.All in all, it is time to return to your injector and re-evaluate your results after 14 days. You may need a touch up to rebalance your muscles of expression. Of course, you have the option to seek the advice of a well experience, Board Certified Plastic Surgeon, Facial ENT or Dermatologist.Good luck!

Sean Maguire, MD · Answer

It looks like you still have significant muscle contraction. I would wait a week and see if this improves. If not, you should ask for a touch-up/re treatment. I typically do not charge for a touch-up in such circumstances.

Adrian M. Guevara, MD · Answer

I have definitely seen some patients require increasing amounts of Botox to stay corrected.  However, there are multiple variables including actual amount of product, dilution rates, and injector skill.  If you really don't trust the injector, I would go to someone who will explain things to your satisfaction.  Also, it never hurts to talk it over with the injector, because most injectors want satisfied patients.

Stephen M. Davis, MD, FACS · Answer

You simply need to ask your physician about what he thinks is going on. Who actually injected you?I would ask for new / fresh Botox to be re-injected ( at no additional cost) and based on his / her response, find a new physician or return in the future.Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

Michael L. Schwartz, MD · Answer

Have you contacted your doctor? I always instruct all my patients to call us if after a week they are not seeing the expected response. we have them come back in to be seen. If they need additional Botox they are only charged for the units they receive.

Darryl J. Blinski, MD · Answer

Appears there was NO response. Either too old BOTOX, to diluted, poorly injected, or a combination of all. I might ask for this doctors response...Than either try to get a touch up or move on to another more expert injector...

Mark Mandell-Brown, MD · Answer

It appears that you need Soft Tissue Fillers like Perlane or Juvaderm     The Botox relaxes the muscle movement but some patients still require filling out the furrow itself.   So Botox and Perlane work together to help that deep crease

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