Why Botox not working on my 11 lines? (photos)

It often requires more units in some people and remember it is a "reduction" not permanent paralysis. Sometimes fillers are needed as well.  I suggest seeing a cosmetic dermatologist with experience in neurotoxins and fillers.  Thermi is a permanent solution or trying dysport or xeomin as alternatives.  Best, Dr. Emer.

When wrinkles are present during dynamic facial expressions, such as the deep frown lines in the glabella, then Botox will be very effective at treating them.  However, if those lines are still present at rest then Botox alone will not fully eliminate those lines.  Using a fine-line filler such as Restylane Silk or Belotero will help to soften those lines even more.  

If you have not seen an improvement with Botox on the deep lines between your eyebrows, you will benefit from a filler like Juvederm or Restylane, to improve the area. The lines in between your eyebrows are too deep, and Botox alone may not be the best treatment.

Hi Elle.  It appears that the lines you have are very deep.  In most cases with these types of lines, we take a two step approach.  First we use Dysport (Botox) and once the muscle is relaxed, if the lines are still present, we then use Restylane for further smoothing.  To see an example of before and after photos for an Irvine, CA patient just like your case where we had to use both Dysport (Botox) and Restylane (a dermal filler) to resolve the patient's concerns, click on the link below.  An in person evaluation may help, but in your case, it may be unrealistic to get complete resolution of the lines because they are so deep.

You appear to have fairly severe imprinted frown lines. This means that those lines are present even when your face is totally relaxed. If I'm misinterpreting your photo my apologies. With imprinted lines, it is possible that Botox can completely eliminate the muscle movement but will not fill in or eliminate the lines that are folded into the skin. If that is the case, you're likely a good candidate for placement of a small amount of filler in those imprinted lines to plump them up and eliminate them for up to one year. This is a higher risk injection area so it is best if you seek out a highly experienced physician injector who understands the anatomy there like the back of their hand. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

I would say there are three possible reasons why Botox would not work.  First, the dose could be too low.  Second, the placement could be incorrect.  And the third reason is that the patient could be immune to Botox (botulinum toxin).  Assuming that your Botox was placed correctly, I would think that you should see some change with 30 units, so you may be immune.  Did the Botox ever give you improvement or has it always not worked on you?  You might consider trying a filler instead of Botox for your 11's.   

Sorry to hear you are not happy with your Botox treatments.  Perhaps you are an underresponder to Botox.  You could try a different product such as Dysport or Xeomin because the chemical structures are slightly different.  Hopefully one of these will work.  Good luck.

elle50,I would recommend that you use both Botox as well as a filler such as Juvederm.  Your 11s are relatively deep and have not softened with neurotoxin treatment alone.  I would recommend fillers to decrease the depth of the wrinkles.  However, if you just inject filler than the repeated contraction of the muscle in that area will lead to a short term result.  If filler is needed to improve these lines in my patients I always recommend that they do Botox as well for a longer lasting result.  Best Wishes,Cody Koch

I recommend using Botox/Dysport/Xeomin to relax the muscles as much as possible and then using a filler to smooth and fill the creases completely. Thank you for your question and for sharing your picture!Kate Ross, MD

Botox is a muscle-relaxing medication which relaxes dynamic lines, or lines in the skin which appear with expression or muscle contraction. Skin lines present at rest--lines etched into the skin--typically require fillers to fill in or pop out the crease. In my experience, etched-in lines at the glabella (the area between the brows) tend to do best with fillers (to fill in the lines) and Botox (to prevent the muscles from making the lines even deeper). At times, I see some young people with etched-in lines get significant improvement from repeated Botox treatments alone, usually over the course of a year. If you are able to form/ deepen frown lines with effort, you may require a greater dose of Botox or a different injector.  Botox resistance is a possibility as well, in which case I would recommend trying Dysport or Xeomin, which are muscle-relaxing cousins of Botox.  If you are unable to deepen your frown lines with effort, this means that the Botox is indeed working; in this situation, you would benefit from the off-label use of filler to plump the etched-in lines from the inside out.  Discuss your concerns with your treating physician, and best of luck.