Why do I still have motion 11 days after Botox follow-up? (Photos)

Hi Casamama,

Thank you for your question and photos.  Botox is commonly used for treatment to the dynamic rhytids in the glabella and forehead region.  There are multiple other uses and locations for administration of Botox.  Botox usually takes 7-10 days to take effect and last for 3-4 months.  I feel that there is a mild cumulative effect of Botox over time that may in fact further resolve your current persistent animation as you continue to receive treatments at 3-4 month intervals.  Patients with significant creases may additionally benefit the use of a hyaluronic acid filler.  I would discuss your concerns with your providing physician. 

Best,

Dr. Mooty

Hello and thank you for your question.  There are a few things that may be the cause of your concern; there may not have been enough Botox injected to achieve full correction, you may have developed antibodies to Botox which does not allow it to work on you, or the last follow-up dose that was given hasn't taken effect yet.  If after 2 weeks from your last visit there is still no improvement, it would be a good idea to talk to your provider about other options.  If the muscle movement has diminished but the indents are still prevalent, filler can also be a good option for you.  With precise and careful injections, fillers such as Juvederm, Restylane, or Belotero can be used to soften those deeper lines that Botox cannot improve.  Be sure to seek an experienced injector who specializes in facial aesthetics for best results. Good luck!

Thank you for sharing your question and photograph.  Though your pictures do not show your forehead in order to offer advice it appears that you still have some motion in the corrugator muscle of your glabella.  This can be treated with an additional injection over the outer aspect of the brow.  The corrugator is shaped like a comma sign and often needs treatment to the central head and tail.  Hope this helps.

I would wait a full two weeks for final results. After that you can assess whether you need a touch-up. Deeper wrinkles need a combination approach with Botox and lasers, microneedling/prp and fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hi Casmama.  The 20u dose in the area between the eyes is the right amount, but it appears that you have some pull on an area we call the tail of the corrugators.  When you look at your right eyebrow, there is a small indentation in it right above the pupil area.  Some patients pull from the tail of the corrugator muscle farther from the midline of the eyes and need to be injected as such.  This should have been corrected with your touchup. 

It looks like you may have some activity at the tail end of muscle. Please see your injector for a small tweak or just leave as is if you are going for a more natural look.

Thank you for your question and for sharing your photographs casamama. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. Although 20 units is a good standard dose to start with, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.Some people have lines at rest (that is without facial expression) which get deeper with facial expression. In these cases, the wrinkles often do not go away completely. However, I find that if patients continue treatments every three months as recommended the wrinkles smoothen out after approximately one year.If I had a patient with the concern described here I would advise that it is normal to have motion after a Botox treatment. The results should be natural with the wrinkles softened. I would recommend following up to compare before and after pictures is before pictures were taken. Often times this comparison makes the results look noticeable.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

Thank you for your question! I would wait a full two weeks for final results. After that you can assess whether you need a touch-up. Deeper wrinkles need a combination approach with Botox and lasers, microneedling/prp and fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best of luck!

While it is difficult to see much on your photo it is likely that you have lines at rest.  While Botox will improve the look of such no amount of Botox will completely correct any deep lines at rest.  For such lines it may be that you would benefit from filler.  I would discuss with your provider the desired results you seek and determine if filler would help.

Hi casamama, Thanks for your question and for sharing photos. I would wait a few more days and maybe revisit the physician 3 weeks post your follow-up to make sure the full effect can be assessed. As you asked for a natural result, your injector may be more cautious with regards to the amount of units injected. The good news is that you can always add more to relax the muscles further. You may just need an adjustment. Hope this helps! Best wishes, Manish Khanna MD,FRCPC