My Botox didn't work for the third time. Is it because my wrinkles are too deep?

Question

Done my first botox in January (between the eyes). After 3 weeks and no results, I went to see my dr. Got a new dose but still no results. Yesterday i went to see a new doctor and he told me that my wrinkes are too deep and botox wont work. Only fillers. Is that possible and why? Im 35 years old.

Jason Emer, MD · Answer

you may need higher dose or a different version of botulinum toxin (like dysport).  Sometimes you get improvement but still have lines and this would require filler as well.  I have never had a patient who did not get some result from the botox.  I suggest seeing an expert for an evaluation.  Best, Dr. Emer.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.Botox paralyzes the muscle to stop the movement which created the wrinkle. If your wrinkles are already too deep, fillers may be used to help soften those lines. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment.I hope this helps.

Benjamin Barankin, MD, FRCPC · Answer

Botox is a terrific treatment for dynamic/movement wrinkles, but if the lines or wrinkles are too deep, then adding a filler along with Botox is a good idea. A tiny percentage of people don't or stop responding to Botox, and so a different botulinum toxin such as Dysport can be tried. Sometimes the dose is wrong, or the injection points or depth of injection, so make sure your injector is a highly trained cosmetic physician expert such as a dermatologist.

Adam L. Basner, MD · Answer

BOTOX is not the solution for everyone.  You could be resistant to the toxin...but most likely you need a different treatment to address your wrinkles.  Fillers may be more beneficial... it is hard to say without examining you, but BOTOX is not always the answer.

Martie Gidon, MD, FRCPC, FAAD · Answer

Botox stops dynamic movement that causes wrinkles.  If the wrinkles are already deep, volume needs to be replaced and this is done with a filler such as Restylane.  "Before" photos showing you at rest and then with frowning would determine if the Botox really had no effect, which would be very rare.  A cosmetic dermatologist or plastic surgeon would be able to help you.

Nissan Pilest, MD · Answer

It may not be a matter of the efficacy of your
Botox treatment, but a miscommunication of expectations between you and your
physician. Take a look in a mirror and attempt to frown; you will most likely
not be able to fully contract your muscles as you would before treatment. It is
possible you need more units of Botox, but it is more likely that your wrinkles
are “static lines” that require filler.

Static lines are the wrinkles that are present
even when your face is at rest, and cannot always be “erased” through Botox
alone. Botox WILL however minimize contraction of the treated muscles, avoiding
creating an even deeper wrinkle. In my practice, I like to have patients return
in two weeks after a Botox treatment to evaluate their results. If deeper
static lines have not been resolved to the patient’s satisfaction through
Botox, I may add a small amount of filler to diminish the appearance further.

Be sure to consult with a board certified
Dermatologist for any future injectable treatments. Best of luck!

Todd C. Miller, MD · Answer

Hi Daniela, Botox is very effective at softening dynamic wrinkles. These are wrinkles caused by movement of the muscles of facial expression. It is not effective at addressing static wrinkle lines. An off label use of a dermal filler may be beneficial. Follow up with an experienced injector who can give you options.

Mark Mandell-Brown, MD · Answer

I have had a few patients who just don't respond to Botox.   After different vials -- they still have full muscle movement.  Try Dysport another Botox - like drug to paralyze or weaken muscle movement. Surgically , the muscles can be weakened through a forehead lift or coronal approach Hope that helps!

Sean Paul, MD · Answer

Deep lines can be difficult to manage at times. Depending on where they are, Botox may be able help with softening these lines but not fully flatten them.  Filler, as an off-label tool may help with this problem.  Additionally, laser resurfacing may be option for you. Good luck!

F. Victor Rueckl, MD (in memoriam) · Answer

If you have static lines (those that are persistent even when you are not trying to move your facial muscles) then Botox is not your answer. Or is not entirely your answer. Botox works to inhibit dynamic muscle movement. So we often use a combination of treatments when people have significant static lines. Botox to stop the lines from forming more, and filler to actually fill in the lines already there. "This
answer has been solicited without seeing this patient and cannot be
held as true medical advice, but only opinion. Seek in-person treatment
with a trained medical professional for appropriate care."

My Botox didn't work for the third time. Is it because my wrinkles are too deep?

Answers (10)

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