Should I get a refund? (Photo)

I have long experience with the use of Botox for aesthetic purposes, having begun injecting it in 1991. In all that time, I have perhaps encountered only a handful of patients whom I  have judged to be truly resistant to Botox--meaning they persisted in having noadequate response after repeating the treatment.  Since antibody testing to Botox is not routinely performed or available, true resistance was not proven in any of these cases. More recently I have found that some of these "resistant" patients do respond to Xeomin (another neuromodulator with less likelihood of engendering antibody production to itself)..From the looks of the photo provided, there appears to be a suggestion of the  "surprised" Mephisto or Mr. Spock look to the lateral eyebrows, implying inadequate or improper treatment of that area, and also evidence of a bit too much movement slightly medial to that area--again indicating the need for more and proper treatment.It would be prudent and reasonable to return to your injector to permit him/her to attempt to rectify these problems and to rediscuss the money issue. Going forward, be sure that whomever who consult with should be a board certified aesthetic physician with extensive experience in the use of neuromodulators for cosmetic use.  

The fact is, Botox did work on you.  The depression of your central brow relative to the lateral brows is a result of your Botox injection.  Similarly, the central forehead shows the effects of Botox injection as well. Your appearance is certainly consistent with focused treatment, and should respond well to lateral forehead injections. 

I agree that it would be helpful to know which areas of your face were treated.  From the picture you provided, it appears that perhaps the center portion of your forehead is not moving while there is still movement on the sides.  If this is the case, I would say that the Botox did work on you but that you may need some areas on the sides treated to decrease the movement there.  

There are some people who are resistant to Botox, however this is extremely rare.  I would make sure your provider is well trained and experienced.  I would also try another provider or Dysport.  It would also be helpful to know which 2 areas that they injected, to better discuss whether the dosing was adequate or not.

Botox is a muscle relaxer and will relax the muscles into
which it was injected. Sometimes the
muscle is not injected completely evenly or the Botox doesn't take evenly and
other muscle movements become more evident. A touch up treatment can usually solve this issue and most doctors will
do it at no additional charge. It appears from your photo that you have Botox on board as well as some
movement in the forehead. It may be
because you’re not getting enough product or because you have a resistance to
Botox (but that’s pretty rare). Xeomin,
the newest neuromodulator, may be more effective in some patients who don’t
respond well to Botox, but it may also be the injection technique and Botox reconstitution. Your
options are changing the dose, finding a different injector, switching to
Dysport or Xeomin, trying filler instead (sometimes using filler along with
BOTOX can make results last longer). Hope it’s helpful.

In very rare cases, some patients are resistant to Botox.  It would be useful to know which two injection sites were treated and the qualifications and experience of your Doctor.  You should consider having another treatment with a fully qualified plastic surgeon and discuss your concerns and previous treatment outcomes.

Thanks for your question and for including a great photo.There are some patients who are resistant to Botox.  It is quite rare though.  Have you had successful Botox treatments in the past?  It appears that some areas are paralyzed while much of your forehead has motion.  I would consider further Botox to the areas unaffected, or switching to Xeomin or Dysport.Best of luck.Dr. T

From the picture, it seems that there are some Botox effects in the middle of the frontalis muscle and perhaps in the glabellar complex.  I can't tell for sure from the picture since it is only on activation of the frontalis muscle.  If the forehead lines are your #1 priority then you might possibly need 20-40 units in that muscle itself.  That is just one area.  I have had patients who need close to 40 units for satisfactory results in the frontalis muscle.  And then I have some patients where 6 units works perfectly.  Thus some patients need what seems to be very high doses.  The human body, being so magnificently diverse, makes it very hard to predict reactions to medications.Thank you for your question.
Without having seen you in person, I'm answering the best I can without
physical examination info. My comments
are meant for a general public discussion to help others who may have similar
concerns. I'm also using my answers to
build up library of information for my own patients and also to see how my
answers compare with other doctors.
There is always much for us to learn from each other. My answers are generalized medical
information only, not directed medical advice.
For medical advice please see your doctor/surgeon in person.Calvin Lee, MDModesto, California

There are rare people who are resistant to Botox, and some patients develop antibodies to it after repeated treatments. In those patients, I recommend trying a different form of botulinum toxin such as Xeomin or Dysport.The placement of the Botox is also important. If a physician places it too superficial, above the muscle, it may not have as much of an effect. After 55 units, most people should see at least diminished movement, depending on how those units were distributed. I would recommend

it would be helpful to know what areas were treated. Some patients can be resistant, but it is also injector dependent too.