My frown lines are slightly worse after botox even though I am barely able to frown. What could be the problem?

Question

I had botox 11 days ago and since that time I have noticed that my frown lines are slightly worse. I am barely able to frown, so I know that the botox has mostly paralyzed the muscle. Is it possible that the way the doctor injected the botox made them worse? How can this be corrected?

Martin Jugenburg, MD · Answer

Thank you for your question. It is difficult to assess without a photo or in person evaluation. Botox is administered to relax the muscle. If your frown lines are deep, you may require a small amount of filler to assist in smoothing the line. Follow up with your injecting physician at 14 days post injection to discuss treatment options. Best,

Asif Pirani, MD, FRCS(C) · Answer

This sounds unusual. Can you post pictures to illustrate what you are describing?  Full results are seen at 14 days.

Harold J. Kaplan, MD · Answer

Hi HB.  If the muscles that cause frown lines are not contracting, then the Botox has done it's job.  If the creases were very deep to begin with, it's possible that a second step that involves placing a small amount of Restylane in the creases will be required for best results.  You should review this with your injector to talk about follow up options to improve your results.  To see an example of a patient that needed both Botox and filler, click the link below.

Jason Emer, MD · Answer

If you are concerned or unhappy after your treatment you should speak to your treating physician about it.  If the muscle isnt moving/contracting, the botox is working and what was done was done correctly.  You likely need a more in depth consultation which would require possibly adding filler and/or laser treatments to really give you the ultimate improvements you are looking for.  Best, Dr. Emer.

Daniel Brown, MD, FACS · Answer

Thank you for your question.  If your frown lines appear worse than prior to your treatment and your truly have minimal muscle movement, you may require a filler under these deep lines.  Expert placement of filler, such as hyaluronic acid (Juvederm Ultra, Restylane) under deep lines can "pop them out like a dent in a car fender".  I find that what works well in patients like yourself is adding filler 2 weeks after an optimal Botox treatment in which the muscles have minimal active motion, but deep wrinkles remain.  Regular Botox treatments every 4-6 months will stop the deep wrinkles from reforming and you may only need additional filler every 1.5-2 years.  Please mention this to your injecting physician, or seek consultation with an expert injector board certified plastic surgeon or dermatologist in your area.  Best wishes!

Katrinka L. Heher, MD · Answer

If you are unable to frown that means the botox is working. When first starting botox the frown lines won't improve much at rest, they just won't deepen with a frown effort.  If you continue botox every three months or so you will notice gradual improvement as your body remodels the lines with collagen. Its very unlikely your lines are worse but check in with your injector to make sure you don't need a touch up. Good luck.

Christopher Dannaker, DO, MPH, FAAD · Answer

Look at your pre-treatment pictures.  Often the lines around the area soften and you simply notice the deep, but improved lines between the eyes more.  If these lines were very deep, Botox with filler such as restylane is typically necessary to restore volume loss.

W. Bryant Walker, MD · Answer

I have never seen frown lines worsen following Botox injection.  But I have seen people who perceive a worsening of other lines.  For instance, on one patient I injected the glabella for frown lines and at follow up she asked if the botox had caused her to have bunny lines on her nose.  The answer is no.  But improvement in some areas may make others appear more prominent.  Pre and post procedure photographs are very helpful to point this out.Another possibility is that you may have been expecting static frown lines (lines present without frowning) to go away with botox injection.  This is a very common misconception.  Botox may soften those static lines with time but filler may be a better choice for your static lines.  Botox is best for dynamic lines (lines that appear with facial animation such as frowning).  I would recommend seeing your physician and if photographs were taken, review them with him/her.  There is most likely another option that will help you achieve your goals.  Good luck!

Heather J. Furnas, MD · Answer

Check with your doctor. If the muscles are mostly paralyzed, make sure you describe what aspect of your frown lines you feel were made worse. Generally paralysis of the frown muscles results in improvement of the frown lines. Click on the link below to see what I mean. Your doctor will need to examine you to give you an assessment.All the best.

My frown lines are slightly worse after botox even though I am barely able to frown. What could be the problem?

Answers (9)

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