Botox in the elevens. I can still see the wrinkles. Do you think it's the way she injected or the Botox she used? (Photo)

Dear Sol1234567,It takes 2 weeks to see the maximal result for Botox. 14 units is an extremely low dose for the glabellar region so I'm not surprised about your underwhelming results the first time. For very deep set 11s, it may take 2-3 treatments to completely reverse the wrinkles. Make sure your injector is reputable and experienced.Good luck,Nirmal R. Nathan, M.D.

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If your wrinkles were deep prior to Botox injections, they can take some time and sometimes multiple rounds of injections for the skin to completely relax and the wrinkles to go away.  Sometimes if the wrinkles are extremely deep they never completely go away.  You should make an appointment with your doctor to fully discuss your concerns.  

Thank You for your question.For glabellar lines (or frown lines / "11" lines), we inject Botox into the muscle, causing the muscle to weaken and improving the appearance of the lines. Botox works by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Botox takes 2 to 4 weeks to start working and lasts for up to 6 months.
For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer

After I inject a patient with Botox for the frown lines between the eyebrows in the glabella, I have them schedule a two week follow-up appointment to see if with contraction there is still some movement. If that's the case, and if the lines are present at rest without contraction, then I add more units. Some women need as low as 9 units, but many will need 20 or more to suppress the activity of these muscle groups in this one location. The injection needs to be placed deeply enough to treat the insertion of the muscle which in this location is deeper than its tail over the eyebrow. If there is no contraction and the lines or grooves are present still, we then wait for one to two more cycles or Botox ( 3-4 months apart) maintaining this relaxation of the muscle and follow to see how the creases improve. Remember the creases have been formed by years of contraction of the underlying muscle and in many cases, it takes time to have the skin bounce back to a normal appearance at rest.  In cases which the muscles don't move, and a few cycles of Botox have been used without improvement, then one can discuss the option of filler but it carries some risks in this area more than some other areas of filler injection, and the risks and benefits should be discussed with you by a board certified dermatologist or plastic surgeon.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

Thank you for your question. You don’t mention how long ago you had your treatment. Keep in mind that full results from Botox can take up to two weeks to become visible. That said, it sounds like you were given a very low dose of Botox and it is certainly possible you will need more to achieve your desired result in this area. I encourage you to schedule a follow-up with your current injector after 14 days have passed. You can also see another board-certified dermatologist if you would like a second opinion via an in-person assessment. 

Hi,Thank you for your question and sharing your photo.As others have mentioned, it takes 2 weeks for the final results of Botox/Dysport. If you are still having movement at that time, please follow up with your injector for additional units. It would also be helpful to have a "before" photo of you frowning for comparison.Hope that helps!

Thank you for your question. I would wait two weeks from your most recent treatment in this area and revisit your provider if you don't receive your desired outcome. Best of luck to you!

Thank you for sharing your question and photograph.  If it has been two weeks since your last treatment you likely require a higher dosing and correct placement of the Botox to achieve complete paralysis.

In all likelihood, you probably just need more Botox injected. It is not uncommon for me to inject 20-25 units into a patient’s glabella for complete elimination of the 11s.Hope this helps! Sam Jejurikar, MD

In general the glabella (11s) require 20 units to completely paralyze the muscles, however some patients require more.  The forehead as well,, 20 units is a good starting point.It generally takes about 7-10 days for the botox to completely paralyze the muscle in the area.  In some cases in can take affect in 3 days and others may take up to 2 weeks.  The results generally last about 4 months.  The fact that you can still animate the muscles tells me you may have needed more or perhaps the dosage that was injected was not accurately injected into the muscles.Hope that helps.