No Difference After 2 Botox Injections in Frown Lines? (photo)

2 Quick question: I had never had Botox before. One month ago I went for Botox to get rid of my frown lines. After 2 weeks I saw virtually no difference. I returned and he did a touch-up. I am on Day 8 of the touch up. The first photo show my relaxed face, and the second shows when I make a scowl. Do these results look typical? Do you think it can still improve without further treatment?

Doctor Answers 14

Persistent glabellar furrows after Botox treatment

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Your results do not look typical as you still have excessive movement of your corrugators (the muscles creating your 11s).  Possible issues: poor injection technique/placement, insufficient dosage, and less likely - defective product or patient resistance to Botox.  The most likely is related to technique or insufficient dose.  

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 64 reviews

No response from Botox

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From looking at your pictures it appears as if you still have quite a bit of movement. Before you give up on Botox try a different injector.  Most of the time it is the placement and amount of the product used.  Get a copy of your treatment chart and find out how many units are being used and what injection points.  You may need more than the average client. 

I do want to caution you however on expectations. At rest you have a glabellar crease that  would be categorized as moderate on one side and  severe on the other.  At your first treatment I would expect immobility of the muscle complex but not the complete removal of the etched lines.  This will take time and additional treatment modalities like fillers or laser resurfacing.

Kenneth Janoff, MD
Portland General Surgeon

Frown line options

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Thank you for your question. The frown lines between the brows can be address two different ways:
1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve.
2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.
For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together.
I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.

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I Can Still Frown after Botox

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Hi Momof4.  You have too much movement to have had a good Botox injection.  It would be interesting to know how many units were injected as we do not know without that information whether this is a problem with the amount of product or a problem with your injector.  

If you had approximately 20 units of Botox, which is quite standard for what we see in the picture, you should have little or no muscle movement in the frown lines between the eyes.  Given that you do have a lot of movement, you could return to the same injector and ask for the job to be done correctly or try someone new.

Possible problems:

1.  Too little product

2.  Expired or bad product

3.  Bad injection technique

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Botox for Frown Lines

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Botox is very effective for treating the lines between your eyebrows when you frown. It is necessary to have the right dose and the right points of injection. The recommended dose to treat the glabellar frown lines (or 11's) which you are showing is 20 units. The dose may vary between  individuals, but if a certain dose is not met, there will not be an effect. Also, if your lines remain at rest before treatment they may require additional treatments such as fillers, laser, or repeat botox injections to completely treat them.

No change after Botox is injected in the frown lines?

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From the photos you provided, your frown lines do not appear to be an issue. But it is difficult to give you precise advice without seeing your before photos. Did you also have Botox injected to improve the appearance of your glabella, or what may also be referred to as the "11's" which are between the brow? Your result can be further enhanced by having this area treated. In general, Botox works great for the frown lines, smoker's lines above the upper lip, glabella, bunny lines, and crow's feet. I hope this helps answer your question, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Botox and frown lines

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It is unclear how many units of Botox you had injected into this area and where the specific injections were. If you are visiting a reputable, well-trained, and experience provider-they will know that there is typically a minimum amount that is effective for the glabella region. It can take up to two weeks to see the results, especially if it's your first time receiving treatment.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Botox for frown lines

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It appears that your frown has been minimized with Botox and you still have a bit of movement but you have deep creases that Botox alone will not help.  You require filler to plump up the creases and perhaps more Botox to relax the frown movement.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

No response from Botox of frown lines

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I agree with Dr. Janoff.  This is an ideal area for improvement with Botox so I would try another injector before giving up on this option.  In addition, once Botox properly takes effect you will notice the lines remaining noticeable.  I would recommend a laser resurfacing treatment to help soften these lines while Botox is in effect.  If in the end, Botox does not work for you, there are still many options available to help soften this area.  Don't give up and good luck to you.

Richard W. Maack, MD
Saint Louis Facial Plastic Surgeon
4.9 out of 5 stars 47 reviews

No Difference After 2 Botox Injections in Frown Lines? (photo)

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Thanks for the question and posting excellent photos. What comes to mind is either your galbellar/corrugator muscles are SOOO strong or the injected BOTOX was took diluted. Try another injecting doctor and ask for freshly mixed BOTOX in front of you. Try another 20 units to begin with. If there is still no response than you might consider the need for fillers and possible incisional muscle surgery. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.