Botox didn't work on 11's - is it possibly because of the placement? (Photo)

Question

I have had anti wrinkle injections numerous times with great results. I decided to try a new practitioner in my area as it the clinic is doctor lead as opposed to a home salon aesthetician. The treatment has work really well on my forehead but not on my 11/glabella. I've seen no difference even after a top up treatment. The injector says that the Botox brand she used probably wasn't strong enough and I would need to t try a different brand. Is it possible that it was poor placement? It seems strange it worked so well in the other treated areas and had little to no effect on the 11s. I'm hesitant to return as it was a lot of money for little result.

Kally Papantoniou, MD, FAAD · Answer

Yes, placement could definitely be part of it, but it is not the only possibility.

The 11 lines can be a stubborn area because they involve stronger muscles between the brows. If the Botox was placed too high, too low, or not enough product was used, you may see little improvement even if the forehead responded well.

It is also possible that the lines are more “etched in” at rest, meaning Botox may soften movement but not erase the crease on its own. In that case, you may need a different treatment plan, not necessarily a different brand.

I would follow up with the injector if it has been about 2 weeks. A small adjustment may be all that is needed. If you are not comfortable returning, see an experienced injector for an in-person assessment

Laurie A. Casas, MD, FACS · Answer

Hi there, 
Based on your description, it doesn’t necessarily mean the product itself was the issue. If the forehead responded well but the glabellar (“11”) lines showed little improvement—even after a touch-up—there are several possibilities.

The glabellar complex is one of the strongest muscle groups in the face and often requires precise placement, appropriate dosing, and occasionally a different injection pattern based on an individual’s anatomy. In some patients, untreated accessory muscles can also continue to pull, making it seem like the treatment didn’t work.

While true resistance to botulinum toxin is possible, it’s relatively uncommon, especially if other areas treated during the same session responded as expected. If you’ve had good results with the same product in the past, it’s less likely that the brand itself was the problem.

Before switching products, I would recommend seeking an evaluation from an experienced injector who can assess your muscle movement in person. They can determine whether the issue was related to anatomy, dosing, or injection technique, and discuss the best approach moving forward.

Nelson Lee Novick, MD · Answer

The situation described is quite unusual. Since the Botox worked well for the forehead, ( and did not work well for the glabella) the problem is unlikely one in which you have developed resistance to Botox. 
The possibilities for such a disparity in response suggest either improper technique was used, an insufficient amount was used,  or a change in concentration for the glabella was perhaps used. You would be wise to consult with an experienced, board certified cosmetic dermatologist injector expert and best of luck going forward.

Anna Chacon, MD, FAAD · Answer

This is a great question—and honestly, your instincts are right to question this.

When Botox works well in the forehead but not at all in the 11s, it almost always comes down to technique rather than the product.

The glabella is actually one of the most technically sensitive areas to treat. The muscles there (corrugator and procerus) are deeper, stronger, and vary quite a bit from person to person. If the injections are:

- placed too high
- too superficial
- or not far enough laterally

you can completely miss the muscle that’s causing the lines. In that case, you’ll see exactly what you described—no effect, even after a top-up.

Regarding what your injector said about the “brand not being strong enough”—that’s not typically how this works. All FDA-approved neurotoxins are effective when used correctly. Differences between brands are subtle and would not explain zero response in one area but good response in another.

The fact that:

- your forehead responded well
- you’ve had good results in the past
- and even the top-up didn’t help

strongly suggests this was a placement issue rather than resistance or product choice.

Bottom line:

Yes—this is very likely due to injection placement (and possibly dosing), not the Botox brand.

If you decide to treat again, I would recommend seeing an experienced injector who:

- assesses your muscle movement at rest and during frowning
- tailors injection points (not just a standard pattern)

You should absolutely be able to get a good result in this area with the right technique.

Camille Cash, MD · Answer

There is only one Botox brand.  If you are unsure what product is being used ask to see the vial.  There are other neuromodulators that work similarly to Botox but have slight variations.  They include Dysport, Jeuveau, Xeomin and others.  If another neuromodulator was used this may account for the differences.
You are correct though in noting the placement.  It too can affect your results.

Skin Social · Answer

It could be related to placement, dosing, or the brand used. The glabella is one of the strongest muscle groups in the face, meaning it needs precise placement and an adequate dose. While some patients respond better to one brand than another, if your forehead responded well but your 11s did not&mdash;even after a touch-up&mdash;technique or dosing may also be factors. If you're unsure, seeking an in person second opinion is reasonable. I hope this helps!

Botox didn't work on 11's - is it possibly because of the placement? (Photo)

Answers (6)

More Botox Questions

28 year old, female. Prominent neck muscles - would Botox fix this?

How can I fix a 3 year old forehead bump from botox? (Photos)

Is serious long term injury from Botox possible?

Will Botox fix the bulging muscles in my forehead? (Photos)

Can Botox or a surgical procedure remove my long cheek dimples? (Photos)

55 - how can I treat the deep lines under my eyebrows? (Photos)

WE SEND PRETTY
EMAILS