How Come After Botox on my Frown Lines, It Helped a Little,but Did Not Make It All Go Away?

Botox can help relax the muscles in the glabella region to help soften the facial expression as the action of the muscles become less apparent.  However vertical lines between the eyebrows can become permanently etched into the skin. This is the result of years of muscles contractions between the brows which crease the skin.  If this is the case, a dermal filler can help fill in the creases to help them become less noticeable.

 

 

If your muscles are larger than average in the glabella then you may need more units of Botox than average.  The muscles could still contract after the Botox was injected initially then the doctor determines how many more units were needed..  Other patients may say that the Botox didn't work but the muscles are proven to be 100% relaxed and the lines couldn't fade any further from Botox but they could improve with a mild fillers.       

Botox relaxes movement but may not totally stop all frowning.  If the lines are still deep, you may require filler to plump up the creases.  Botox treatments are usually about 4 months apart but the filler can last for 6 months or longer.  Please see a board certified dermatologist or plastic surgeon to ensure the best possible results.

If your frown lines are deeper or if the injector was overly conservative, you may need additional units. For particularly deep creases, a filler such as juvederm or restylane can help.  To perfectly flatten your frown lines is not a reasonable expectation.

Botox won't erase lines that have been etched in to the skin.  Botox keeps muscles from contracting and increasing the depth or severity of the lines.  Imagine your skin is like a piece of paper...once you fold it and create a crease in the paper even when you unfold it and lay it flat you can still see the impression of the line on the paper.  If the groove is quite deep you may consider a filler in addition to Botox and possibly a laser procedure like Pearl Fractional to help soften the line further.

Good luck~

Dr. Grant Stevens

It is likely that you need more units injected to get the best result.  In our practice, we offer a courtesy (no extra charge) follow up at 1-2 weeks after initial treatment to every patient.  This gives us the opportunity to check the results for the patient and to add a little more, if necessary.  In my opinion, it is better to be conservative and go back and add a little more than be too aggressive and cause undesired side effects. I recommend you follow up with the physician who did your injections. Click on the link below to see before and afters of good botox results. 

Every patient responds differently to Botox. Sometimes physicians are more conservative with Botox injections, and this is not necessarily a bad thing. In our practice, if a touch up is needed after 10 - 12 days, we will be glad to do a free touch up to obtain optimal results.

Botox works on the musculature to prevent movement of the brows toward the midline. It does not erudite wrinkles. You might consider fillers for the lines; this would reduce the deep creases but fine lines will remain at the superficial level. No such thing as perfect here-only improvement.

There are two things that may have happened with your recent treatment. First, you may have been underdosed, meaning you may need more Botox to completely relax your muscles. Sometimes I have patients with very strong muscles that need a little bit higher doses. Second, if you have a wrinkle that is there at rest, meaning even if you don't squint or frown the wrinkle is present, botox may never completely make those wrinkles disappear. While getting the injections on a regular basis will help over time you may need to consider having a dermal filler like Juvederm or Restylane placed in the remaining wrinkles. Make sure you use an experienced injector as there can be some complications from using fillers in this area.

If your frown lines are etched in (they are present even after stretching the skin tight), they will not go away with a single treatment of Botox.  I tell these patients that over time, these lines will gradually improve WITH MULTIPLE Botox treatments.  If you don't keep up with the treatments regularly, they will not improve at all.  After about 1 year, you will probably see a difference.  Placing filler can help as well, but there are risks associated will placing filler there..