What's the Maximum Amount for 11s?

There are several causes of your problem.

First, your corrugator muscles are broad based, i.e. .completely over the eyebrow, so those fibers will need to be relaxed as well.

Second, the wrinkles you have are very well established and it will take some filling material to fill in the wrinkle in the mean time.  Patient expect the "11's" to be gone, but Botox will not always eliminatedecades of sun damage and wrinkling.

Third, you are actually refractory to Botox, rare but possible.

I like to "nuke" the 11's for a new patient.  Using a HA filler like Juvederm or Restylane along with the Botox can give you a running start.  Fillers work for a long time when done in concert with Botox, because the muscular action isn't "milking" the filler out of the area.  Unit wise, 20 plus 15 plus 10 sounds like a lot.  Watch your brow position, as extravisated Botox can cause problems in adjacent muscles!

A dose of 50 units of Botox (Allergan produced) in the glabella should have some degree of efficacy as far as minimization of movement (assuming that you are receiving the real product, properly reconstituted, and properly administered).  Please understand that very deeply etched lines will not disappear with Botox alone.  However, I have seen an occasional patient who is poorly responsive to Botox, yet responds to Dysport (Medicis produced).

You state that you have had weekly additions to the botox number of units in the glabella. During an examination for this concern, I evaluate if the muscles are moving, not if the creases are still there!  If you are not able to move the muscle then you need no more Botox for now.  There may be continued improvement of the creases as time progresses and the muscle is no longer able to make the skin fold like an accordion.  YOu have probably develoepd these creases from years of crinkling the frown muscles and for some patients, the creaes are deep and need many months of muscle relaxation for the lines to improve. Sometimes botox takes more than two weeks to show its maximal onset of effectiveness and it may be unwise to add units before this time.  If two weeks after Botox the muscles are still moving then additional units may be needed, and for some hypertrophic muscles, mostly in men, but I have seen some women with this as well, 50 to 60 units are needed, but not much more, and again, this is not common.  If the muscles are relaxed, and you don't want to wait months for continued improvement then a filler can be added but it should only be Juvederm Ultra or Restylane.  Thicker products have compromised circulation in this area and caused complications.  

Hi Avion.  It sounds like you have more than enough to relax the muscles in this area.  Even if you had extremely developed muscles, 50 units is a lot and should have done the trick.  

If you cannot animate (move or contract) the muscles that cause the frown, then you do not need more Botox and your injector needs to think more about a dermal filler like Restylane.  If you are not able to move the muscles and your injector has not already suggested a dermal filler like Restylane, then you may need to start looking for a new injector as this is a fairly common issue.

You might need more Botox if you are a man.  Some men need up to 60 units in the glabellar ("11") area between the eyebrows.  But, you mentioned your touch-ups were only 1 week apart and it can sometimes take up to 2 weeks for all of the effect to "kick in".  So if you just had your 2nd touch up you need to wait 2 weeks afterwards to see the full effect.  That being said, if you can't move it at all but see furrows you might need some filler, such as Juvederm or Restylane, in that area in addtion to the Botox.  In my practice 95% of my patients with lines in that area can get complete smoothing with just Botox but that other 5% also needs a filler.

You also would want to see if you got Botox Cosmetic vs. Dysport.  Dysport is a botulinum toxin that is measured differently and 50 units of that equals only 16- 20 units of Botox Cosmetic.

I read your concern. In most patients, 25u Botox is adequate for treating your frown lines and reducing most of your muscle activity in that area. I like to check all of my patients around 7-10 days following their treatment so I can assess for a possible dose-adjustment.

In some male patients with strong frown muscles, 50u Botox may be necessary. I have not had to exceed this dose in any of my patients.

If your frown muscles are paralyzed and you still have wrinkles, Injectable Fillers may be helpful.

I hope this is helpful for you.

Regards from NJ:

This story sounds fishy to me.  BOTOX takes time to work.  Generally a service is have its maximum effects at 2-3 weeks after service.  Any reasonable injector would have advised you to wait before reinjecting you unless they know you were likely under-treated.  Some office fib about how much BOTOX is actually used.  Be suspiciously if your treatment was very cheap.  If the dose you have received does not get the job done and there is no evidence that the muscles are weakened, it is time to find a new office.  Look for a physician injector in one of the core specialties: dermatology, general plastic surgery, facial plastic surgery, or oculoplastic surgery.

Generally the standard dose of Botox to treat the vertical creases between the eyebrow is between 15 to 20 units.  Either you are not being injected in the correct areas or the Botox is old and and not as effective. Sounds very unusual.  

I would wait 2 weeks before adding botox after the initial injection, as it can take up to that long to see the full effects of the botox.  Usually 20-30 units is sufficient in the glabella but in a man with strong muscles (or woman), more may be needed.  However, you have had A LOT of botox added into that area.   If you cannot move those muscles, the wrinkle there is a wrinkle at rest and will not be fully corrected with the botox (which works better for the dynamic wrinkles which are more evident during movement).  Some injectors will (carefully) do a little filler in this area to help with the #11 lines if they are still present after botox but this area can be difficult to obtain perfect results with fillers as well (depending on how deep the wrinkle is).  

Some people do develop antibodies to botox and botox is not effective.  If you are getting that many units and still able to move those muscles, I would wonder about antibodies,  I would also question the injector as to why he/ she has continued to add more units without waiting the full 2 weeks to see the initial results.