Horizontal glabellar creases + rolling acne scars, what can I do if Botox didn't work? (photos)

In general, when properly injected, in the apprropriate locations, and in adequate concentrations, Botox typically works well for both glabellar frown (scowl, angry, "eleven") lines and for the horizontal lines shown in the photos, which are often referred to as "bunny" lines. Although true resistance to Botox is felt to be very uncommon, I have found, in the course of the 27 years I have personally been injecting Botox for aesthetic reasons, that some individuals may tend to develop a relative resistance to the product, especially if they are injected too frequently or when "touch up" treatments are performed only a week or two after actual treatment, rather than a preferable four or more weeks afterwards, which is my routine recommendation. Alternatively, you may be switched to either Dysport or Xeomin, the two existing competitive neuromodulator products currently available. Regarding the acne scars, it appears that there are several rolling and boxcar scars and many ice pick scars. For the latter TCA CROSS is an excellent, simple, quick and relatively inexpensive tried and true treatment approach. Subcision, another time-tested, quick and relatively inexpensive acne scar treatment, may be used for  the boxcar/rolling scar varieties. It is important to note that successful background treatment with Botox can actually improve the results of the actual treatments by diminishing movement in the region and allowing new collagen and elastic fibers to be lain down without interference or disruption by the excessive mechanical motion of the background musculature.   Be cautious about recommendations for this or that laser or energy-based therapie that may be pitched to you, as these are backed far more by device manufacturer supported marketing hype than hard science. Due your "due diligence."  For more information on any of the above, check out the archives of RealSelf.com, and be certain to consult with a board certified aesthetic physician with experience and expertise in  Botox injections and acne scar treatments. Best of luck.

It may be that you need more product to help with the lines that bother you.  Botox typically works well in that area.  For acne scars you can consider microneedling (Skin Pen).  It does a very nice job in improving skin tone and texture, including improving the appearance of acne scarring.

Hi SF.  For the lines you are targeting at the bridge of the nose, the muscle that controls them (the lower procerus) needs to be injected.  Perhaps your previous injector only dosed the upper portion of the procerus?  Also, the "bunny lines" at the sides of the nose contribute to this concern as well and so we would inject those lines at the same visit.  
For the acne scars, they appear very moderate.  If anything, we would suggest a glycolic acid or Retin A product to expedite the exfoliation process, which will resolve those red scars as quickly as possible.  Best of luck.