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I have had 32 units of Botox injected in the glabella area without results. What could be the reason this isn't working? (Photo)

- I'm still able to use the muscles and create a deep wrinkle. - At first I was given 12 units without results, then came back and received 8 more. No results then received 12 more units! This was done by a trusted friend who is a family medicine physician over the course of two weeks. - How should I proceed? Is this the maximum dosage I should attempt for awhile? Could it be me or his technique? He assures me these are fresh vials. - 44 y.o. Female. Thank you in advance!

Doctor Answers 15

Botox in frown lines

August 1st, 2016
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Thank you for your question katklc. Botox is a purified protein used to address wrinkles associated with facial expression such as the vertical lines seen between the brows when one frowns. The pivotal studies demonstrated the most people will enjoy their results for 3-4 months when treated with 20 units between the brows. For my patients I recommend starting with 20 units. More can be added for those with larger muscles. Men, for example, generally have larger muscles than women both on the body and on the face. It is also important to understand that it could take up to two weeks to see full results after a Botox treatment, so patience is important. Please follow up with your doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
August 1st, 2016

Botox in frown lines

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question katklc. Botox is a purified protein used to address wrinkles associated with facial expression such as the vertical lines seen between the brows when one frowns. The pivotal studies demonstrated the most people will enjoy their results for 3-4 months when treated with 20 units between the brows. For my patients I recommend starting with 20 units. More can be added for those with larger muscles. Men, for example, generally have larger muscles than women both on the body and on the face. It is also important to understand that it could take up to two weeks to see full results after a Botox treatment, so patience is important. Please follow up with your doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD

Seek out an experienced injector

July 25th, 2016
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It could definitely be a case of improper
technique. I would always recommend you look for experience and skill in your
injectors, rather than choosing a physician you are friends with. Botox
injections are not a skill most physicians can just “pick up” – it requires
advanced training and a lot of experience to master the technique. Seek the
examination and opinion of an experienced Botox injector (preferably with chart
notes from your friend in hand).

Mitchell Chasin, MD

Mitchell Chasin, MD
Livingston Physician
4.9 out of 5 stars 33 reviews

July 25th, 2016

Seek out an experienced injector

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It could definitely be a case of improper
technique. I would always recommend you look for experience and skill in your
injectors, rather than choosing a physician you are friends with. Botox
injections are not a skill most physicians can just “pick up” – it requires
advanced training and a lot of experience to master the technique. Seek the
examination and opinion of an experienced Botox injector (preferably with chart
notes from your friend in hand).

Mitchell Chasin, MD
Livingston Physician

Botox

May 31st, 2016
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Thank you for your question in regards to Botox. Botox can take up to two weeks for total correction. After the two weeks, if you still have prominent movement, additional units may need to be injected. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Web reference: http://www.drjjwendel.com/botox

J. Jason Wendel, MD, FACS
May 31st, 2016

Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question in regards to Botox. Botox can take up to two weeks for total correction. After the two weeks, if you still have prominent movement, additional units may need to be injected. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Learn more: http://www.drjjwendel.com/botox

J. Jason Wendel, MD, FACS

All Botox is not created equal....

May 25th, 2016
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All Botox is not created equal.  The results really do depend on the skill of the practitioner.  They have to be able to analyze a patient's muscle activity, skin quality, and expectations and determine where and how much Botox to inject.  But this also means knowing when Botox will not be enough and educating the patient beforehand.  Fillers are sometimes needed to further soften the lines.  That being said, there is the slight possibility that someone may metabolize Botox too quickly and therefore may benefit from an alternative neuromodulator such as Xeomin, which is a purified form of Botox.  I have used that in my own patients when over time they seem to have less improvement with Botox, but I've never seen a complete Botox non-responder.  Best of luck!
Jason E. Leedy, MD
May 25th, 2016

All Botox is not created equal....

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
All Botox is not created equal.  The results really do depend on the skill of the practitioner.  They have to be able to analyze a patient's muscle activity, skin quality, and expectations and determine where and how much Botox to inject.  But this also means knowing when Botox will not be enough and educating the patient beforehand.  Fillers are sometimes needed to further soften the lines.  That being said, there is the slight possibility that someone may metabolize Botox too quickly and therefore may benefit from an alternative neuromodulator such as Xeomin, which is a purified form of Botox.  I have used that in my own patients when over time they seem to have less improvement with Botox, but I've never seen a complete Botox non-responder.  Best of luck!
Jason E. Leedy, MD

I have had 32 units of Botox injected in the global area without results. What could be the reason this isn't working?

May 24th, 2016
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Thank you for your question. Your frown appears to be strong, indicating that 12 units is not enough to smooth this area. 30 units is more realistic for the glabella area. Perhaps wait the 2 weeks for the Botox to settle and obtain another opinion. You have not reached your maximum for Botox in the glabella, not to worry. It does appear as though  you have received some results to the outer aspects of your frown. 

Hope this helped, 

Web reference: http://torontosurgery.com/non-surgical/botox-cosmetic-clinic/

Martin Jugenburg, MD
May 24th, 2016

I have had 32 units of Botox injected in the global area without results. What could be the reason this isn't working?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. Your frown appears to be strong, indicating that 12 units is not enough to smooth this area. 30 units is more realistic for the glabella area. Perhaps wait the 2 weeks for the Botox to settle and obtain another opinion. You have not reached your maximum for Botox in the glabella, not to worry. It does appear as though  you have received some results to the outer aspects of your frown. 

Hope this helped, 

Learn more: http://torontosurgery.com/non-surgical/botox-cosmetic-clinic/

Martin Jugenburg, MD

Botox and Glabella

May 23rd, 2016
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Botox give reduction not always full resolution of lines and you may need higher dose or fillers to this area to get improvement.  Please see an expert.  Best, Dr. Emer.
Jason Emer, MD

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

May 23rd, 2016

Botox and Glabella

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Botox give reduction not always full resolution of lines and you may need higher dose or fillers to this area to get improvement.  Please see an expert.  Best, Dr. Emer.
Jason Emer, MD

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Botox not working...probably injector

May 23rd, 2016
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I would question the skill of the injector. One red flag is the initial 12 units for the glabella. That is not an appropriate dosage. 32 should have an effect for most people. Seek out another opinion before you get complications from additional injections. Resting glabellar creases won't necessarily improve with Botox and might need filler or multiple treatments over time to improve with Botox.

Web reference: https://stevenfweinermd.wordpress.com/2014/10/12/all-botox-providers-are-not-the-same-choose-carefully/

Steven F. Weiner, MD

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.8 out of 5 stars 45 reviews

May 23rd, 2016

Botox not working...probably injector

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would question the skill of the injector. One red flag is the initial 12 units for the glabella. That is not an appropriate dosage. 32 should have an effect for most people. Seek out another opinion before you get complications from additional injections. Resting glabellar creases won't necessarily improve with Botox and might need filler or multiple treatments over time to improve with Botox.

Learn more: https://stevenfweinermd.wordpress.com/2014/10/12/all-botox-providers-are-not-the-same-choose-carefully/

Steven F. Weiner, MD

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.8 out of 5 stars 45 reviews

Botox not working for frown lines

May 23rd, 2016
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I would suggest seeing a cosmetic dermatologist rather than a family medicine doctor.  In my hands it would be very unusual not to see results after 32 units of Botox.  Botox and fillers represent about 50% of my practice.  Like anything else, the more you do of something, the better you will be at it.
Regards,
Dr. Ort
Richard Ort, MD

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 27 reviews

May 23rd, 2016

Botox not working for frown lines

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I would suggest seeing a cosmetic dermatologist rather than a family medicine doctor.  In my hands it would be very unusual not to see results after 32 units of Botox.  Botox and fillers represent about 50% of my practice.  Like anything else, the more you do of something, the better you will be at it.
Regards,
Dr. Ort
Richard Ort, MD

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 27 reviews

Problems with Botox

May 23rd, 2016
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This seems a little strange. I'm not sure why only 12 units would be injected into that area to start with. However, the reasons that Botox might not be working would include injecting it into the wrong area, too low of a dose, or "old" Botox that has essentially expired (that would be unlikely). I'd recommend you see an experienced injector.

Realize that the wrinkles may not go away with the injection, but that the muscle motion should be greatly reduced or eliminated.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa

Web reference: http://www.quintessamedicalspa.com/botox

Andrew Campbell, MD

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

May 23rd, 2016

Problems with Botox

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
This seems a little strange. I'm not sure why only 12 units would be injected into that area to start with. However, the reasons that Botox might not be working would include injecting it into the wrong area, too low of a dose, or "old" Botox that has essentially expired (that would be unlikely). I'd recommend you see an experienced injector.

Realize that the wrinkles may not go away with the injection, but that the muscle motion should be greatly reduced or eliminated.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa

Learn more: http://www.quintessamedicalspa.com/botox

Andrew Campbell, MD

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 25 reviews

Botox in Glabella

May 23rd, 2016
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Not sure why you are not seeing any results. Typically the glabella area takes approximately 20 units. Some people prefer a different brand such as Dysport over Botox. I would maybe go to an experienced injector.
Lawrence Bundrick, MD
May 23rd, 2016

Botox in Glabella

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Not sure why you are not seeing any results. Typically the glabella area takes approximately 20 units. Some people prefer a different brand such as Dysport over Botox. I would maybe go to an experienced injector.
Lawrence Bundrick, MD

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.