I have had 40 units of Botox in my glabella in the last 3 ish weeks and still have full movement. (Photo)

Question

my practitioner said the first time she maybe didn't go deep enough so injected another 20 units. Is it possible to have not gotten "deep enough" again or maybe does Botox become less potent after a certain amount of time? The picture attached is prior to my very first injection on June 5th of 20 units then received another 20 on June 19th ...I feel like 40 units over the course of a month should have done something?

Gregg Kennedy, MD · Answer

Thanks for this good question.  Only a single photo is available to me for examination, so I will speak in generalities.  If the best explanation offered to you by the injector is that the Botox may have been injected incorrectly, this may be an indication that a second attempt by another injector may be beneficial.  I suggest that you find a competent physician, and tell your story, so that you can achieve your goals.

Christopher Dannaker, DO, MPH, FAAD · Answer

I am assuming your 'practitioner' is not a board certified dermatologist, plastic surgeon or head and neck surgeon.  You need to see a specialist before you assume anything.  There are many possibilities such as:
Your movement is actually much less than you think (photos would help) and thus your expectations are not reasonable
You were not injected with 40 units of Botox.  This needs to be clarified.  A board certified physician should have some answers for you.
The depth of injection will not account for 'no response' with so many units being used, and presumably charged for.  
You have blocking antibodies interfering with the Botox effect.  Some patients have such antibodies,  which can be tested for at least in the academic environment, yet paradoxically  still respond well to Botox.  Therefore, it is not a perfect test.  If a patient is documented not to respond at all to 40 units of Botox which was properly placed and injected by a reliable physician then such a test might be useful.
Changing products from Botox to Xeomin or Dysport might sometimes help a bit but a no response to 40 units of Botox is so rare that there is likely another explanation. 
There are many fine board certified and academically oriented dermatologists and plastic surgeons in your area, including the academic departments of the many respected universities near you.

Jessica H. Kim, MD, FAAD · Answer

For frown lines, 20 units of botox is the standard dose.  I may do a little more for my male patients who have stronger muscles but 40 units seem excessive.  In terms of placement, botox does not require "deep" injections as it selectively targets the muscles in the area.  Consult with a board-certified and experienced cosmetic dermatologist.

Shaun Patel, MD · Answer

The typical dosing for treating frown lines using Botox injection into the glabella is 20 units. 40 units for the glabella is a lot and a dose usually reserved for men who have much stronger muscles. I recommend you see another injector for a  second opinion. Good luck.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photograph lynn5115. I understand
your concern. Botox is a purified protein used to address wrinkles associated
with facial expression. It is difficult to make an assessment in the absence of an after photograph and in the absence of photographs while frowning.One of the most common areas treated with Botox is the glabella, the area between the brows. When injected into the skin in the area Botox will relax the muscle group and smoothen out the overlying wrinkles. The wrinkles seen here are typically vertical in orientation and get deeper when frowning. When we perform such treatments in our office we take photographs of our patients frowning before a treatment and two week later to assess the results, when the final results are expected.The pivotal studies demonstrated that when 20 units of Botox is used in the glabella, the peak effects are seen 14 days after a treatment and most people enjoy their results for 3-4 months. At that point a maintenance treatment is recommended. In practice I find that some patients require a higher dose. This frequently occurs in mature patients, in those with stronger muscles, and in men.In rare circumstances a batch of product is not effective. In this case the treatment can be repeated using product with a different lot number. Alternatively a different neuromodulator such as Dysport or Xeomin can be used. In other rare cases, some people are resistant to a certain neuromodulator such as Botox. In these cases other neuromodulators can be tried as well.
Please consult with a doctor for specific
recommendations. Good luck!

Melvin Elson, MD · Answer

The standard dose for the glabella is 20 units.  it is very unlikely that the injection was not deep enough as it is to be into the muscle and in that area there is nowhere else to go.  Be sure you see a board certiified dermatologist

Robert L. Kraft, MD, FACS · Answer

If Botox is properly performed, it should not restrict movement in the forehead, thereby creating a natural result rather than a frozen one.

I have had 40 units of Botox in my glabella in the last 3 ish weeks and still have full movement. (Photo)

Answers (7)

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