Day 5 After Botox....absolutely No Difference in Glabella!

I read your concern, and you should notice at least some improvement in your appearance. and weakening of your frown muscles by now. The full effect of your Botox will be seen in another 5 days. If it's not working, you should visit your physician for evaluation.

Normally, Botox can take 3-7 days to start seeing results. It can take up to 2 weeks. Assuming you had 16 units injected at your glabella, that sounds conservative, but the amount injected can vary from patient to patient depending on how strong your muscle movement is. Usually 20 units are injected into the glabella region with no problems. The good news is that you can get a touch up and have more units injected if you do not see results by 2 weeks.

BoTox, and all forms of Botulinum Toxin A, work by blocking the reuptake of acetylcholine at the neuromuscular junction. By doing so, it inhibits transmission of signals from one neuron to the next at whichever junction it is working on (e.g., neuro junction, sweat gland junction, etc.) The duration of BoTox is typically 3-4 months on average. It can take up to 7 days for it to take effect. If after that time, I would return to see your injector.  Thank you for the question! Hope this helps!

Hang in there...some people take up to 7-10 days to show the effect, after Botox injections.  If you haven't seen any effect by two weeks post injection, then return to see your injecting physician.

 

All the best,

You may want to contact your physican's office to notifyt them. Some have a policy of waitng 2 weeks but you might as well schedule an appointment  

Hi Teaneck.  Although you should see results after 5 days, we do not bring our first time patients back for a checkup until 14 days.  

In addition to waiting a bit longer, it sounds like you may not have enough product.  Usually at least 20 units (not cc's) are used in the glabella.  

Finally, for deep creases, it may be required to use a dermal filler like Restylane.  If you have this sort of crease in your forehead it should have been discussed with you before treatment.  Call your injector back for a checkup and discuss all these issues with him/her.  Good luck.

peak effect of botox injections may only be seen as long as two weeks or more after treatment. It is possible that the muscles will start to be inhibited from moving in the next week or more. The variable to judge Botox's effect is not the crease but the muscle movement. Some people will demonstrate that the Botox worked by full immobilization of the muscle but the crease may take months of this muscle inactivity to fade. It is possible, that you require more units. You mentioned ccs, but possibly you had 16 units, not ccs. You may need more units if your muscle groups of the glabella are strong. 25 units are not uncommon in this area and I have injected in women up to 35 units of Botox in the glabella and more in some men.

Though Botox can take up to two weeks to see full effect, most patients see some changes by 5 days, and if additional time does not give you the results you wished, this may have been due to a number of causes. First, as others have stated, you didn't have 16cc, you may have had 16 units, or 1.6cc of a particular dilution yielding a specific unit dose. This may be inadequate; if you have had this exact amount here before with good results, then it's not an "amount" issue. If this is your first Botox session, check the amount with your injector. More may be necessary.

But there are other possibilities as well. One is that the Botox was warm, agitated, "old," or incorrectly reconstituted. Rare in an office that uses Botox on a regular basis, but all possible. You could even have had a "bad batch" which may be another name for all of the above. I have had occasion to see this, with all the patients I injected from one bottle having "NO results." whatever the cause, it wasn't because I injected it inaccurately or in too-small doses, so it had to be one of the other reasons. Of course, I graciously re-injected these patients without additional charge, and they had fine results, making a case for one of these reasons for Botox "failure."  Rest assured, Botox is manufactured under the strictest guidelines, so if your doctor is using real Botox (or Dysport, the botulinum toxin form another manufacturer), and doing all of the other important things listed above, you should indeed see results in several days or up to two weeks.

BTW, clinics or spas that advertise "Botox days" generally are trying to "use up" the rest of their reconstituted Botox so it doesn't sit over the weekend and lose potency. Beware the Friday Botox days, or the Monday morning Botox deal!

Also, working out after Botox is not recommended for a day or so, to prevent Botox migration from the desired location to areas where it's not wanted or needed, and away from the treatment site(s).

Thank you for your question Swirlmommy. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary.Although 20 units is a good standard dose to start with, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.Despite having a natural appearance when performed correctly, many people are afraid of the results of their Botox treatment, in particular before their first treatment, which is natural. In these cases, a lower dose can be used. For example, sometimes I use 10 units in the glabella region instead of the recommended 20 units. In these cases, I advise my patients that the full results will be seen approximately two weeks after the treatment and have them return at that time to take after photographs. At this point, more Botox can be added if further enhancement is desired. I find that when lower doses are used, patients do not enjoy their results for as long; six to eight weeks as compared to three to four months. Therefore maintenance treatments must be performed more frequently.If I had a patient with the  concern described here I would recommend being patient and waiting a full two weeks, then assessing the results with before and after pictures.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

A unit of Botox is a unit of efficacy not a unit of measurement.  Every patient will need a different number of units to effectively weaken the corragator muscle to decease the vertical creases between the brows.  If you get no result at 14 days then you will need a dose adjustment.  Botox is not an exact science.