3 months post op, Why Didn't my Doctor Give Me Enough Botox?

My doctor didn't seem to have given me enough botox this time because after 3 days I can't feel anything and I usually do see some result.I was very happy first time, but not impressed the last two times. He hasn't charged me this time, saying I still had enough. It's been 3 months since I had it and wasn't happy then. WHY is he doing this???

Doctor Answers 7

Was the Botox Enough?

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As the other panel members suggested, despite your previous experience, you may want to make a final judgment in the next week.  However, it would appear you are not satisfied with your treatments nor the feedback (or lack thereof) that you are receiving from your doctor.  

This might be a good time to consider finding another practitioner.


Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Many variables affect how much to inject

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First of all, it's only been 3 days - you might want to give yourself another week at least to see if you develop the effect you're looking for.  Second, I don't know how many times total you have received Botox - but all experienced injectors know that the first time is the best time - virgin muscle is exquisitely sensitive to neurotoxins, so you'll get the best "block" ever the first time any region is treated.  Knowing this, I often decrease the dose for the "virgin" treatment - and increase the dose thereafter.  We always have new botox patients come in 2 weeks after the treatment to make sure everyone is perfectly happy.  I think you should discuss this with your physician - I'm sure there is a logical explanation.  Good luck!

Laura E. Skellchock, MD (in memoriam)
Boca Raton Dermatologic Surgeon

Not enough Botox

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  There is no set number of units of Botox that will work for each patient.  The dose varies and sometimes it takes several times treating a patient before the doctor gets a handle on how many units are right for a particular patient.  Of course, this does not explain why you were most happy the first time you were treated.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

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There are always variables. It may be simply that you just need a few more units to bring you to full correction. Sometimes there may be a dilution issue, or the product has become less potent if it has been sitting on the shelf and not used in its proper shelf life. 

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Dosage is a significant issue in this field of esthetic medicine.  Unfortunately, unless the patient mixes the vial of botox themselves, it is impossible for you to know what is in the syringe.  There does exists recommended dosology for each muscle that contributes to facial lines, however, individuals do vary.  Building a rapport and allowing the physician to "get to know" how your muscles of facial expression work together to create a certain line or wrinkle is the best way to optimize your results.  Be certain to be in communication and don't hesitate to ask for a map of the number of units injected. 

Will Richardson, MD
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Botox works in 2 to 10 days

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The Botox can take 2 to 10 days to kick in for you. I find it can be different each time you have it done for you.If it isn't kicking in for you at this point you need to first find out if the Botox you are getting is fresh. Was it mixed that day or has it been saved over night? Do they save it for several days? If they save the Botox that may be your problem. If they always use fresh and it is not working then they need to increase the dose in little steps until you get the response you want. If they are not using fresh Botox then you need to go that route first before increasing the dose.

Esta Kronberg, MD
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Fine-tuning Botox dose

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Because Botox and Dysport work by relaxing hyperactive muscles of expression, they treat the underlying cause of certain wrinkles rather that filling in the wrinkle as with Juvederm or Restylane. The muscles that cause the "11" between the eyebrows for example are called the "corrugators." Muscles come in different sizes so there is no standard dose that always works unless the doctor routinely uses more than is necessary. That would of course cost more so dosing is individualized based on the response to previous injections. The there are other factors such as the body's adaptation to having muescles relaxed, which may mean that adjacent muscles become more active. I should point out too that many patients don't see a response until 4 to 5 days or more after injection.

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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.