No change in 11s after re-injection of Botox. Could it be that they are using old Botox?

At Quintessa, we say that patients don't buy Botox, they buy what Botox does for their lives. We also discuss the fact that Botox just relaxes the muscles that cause a wrinkle, they don't necessarily treat the wrinkle directly. For those with deep 11's, they will see an improvement with Botox, but to really get rid of the lines, we may need to add filler to that area as well. From your history, it appears that maybe the first treatment was placed a little too high and caused the area above your brows to smooth out, but not the 11's. If you could still pull the brows together, then that would be the case. After your second treatment, there are a few possibilities. One is that the Botox was not placed in the correct location, the second is that not enough Botox was placed to give you the effect you desired, and the third is that the Botox is working well, but the wrinkle is too deep and won't immediately improve with just Botox.Ultimately, I would discuss your concerns with your injector. Botox should never be considered a "waste of money".Andrew Campbell, M.D.Facial Plastic SurgeonQuintessa Aesthetic Centers

Thank you for your
question.It is likely that your glabella muscles are very strong and you may require a higher dose of botox than normal. 

To be sure, 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.

Thanks for sharing.  Botox may affect patients differently.  What is important is using the proper concentration and storage of the botox as these my change how botox works.  I like to use very "fresh" botox and use the standard concentration.  You may inquire what concentration is being used and how long the botox has been stored after reconstitution. Experience also matters There are other substitutes for botox such as xeomin and disport.

I suggest trying another toxin such as dysport or xeomin.  Some people also need much higher doses (2-3x normal) to get results. I see this a lot in my male patients or those who are very expressive.  Best, Dr. Emer.

Thank you for your question. Every patient is different from a presentation standpoint, as well as the results obtained from Botox. Several factors come into play. Anatomy of the musculature being treated, dilution quotients, injection technique, amount of drug used, patient health, and patient expectations. Botox is meant to soften your appearance, not rid you of your expression.Voice your concerns with your doctor. Compare your post-injection photo with your pre-injection photo.Your doctor wants you to have a meticulous result as do you. Establish a plan with your doctor so you can be realistic as to what to expect.Best wishes.

There are some people who develop antibodies to Botox and fail to respond to treatment.  I switch these patients to Dysport and they then do well.  Try the switch.

If the Botox worked on your crow's feet area then it would seem that it was most likely not old Botox that was being used for your 11's, which did not respond.  It is more likely that the dose needs to be increased and/or the location of the injections needs to be altered.  

Most of the patients will notice definitive results after botox injections and are usually very happy with botox-induced relaxation of facial features. As you know, botox is just a tool and you need to ensure that you are using an expert injector who has full understanding of facial anatomy. This allows the choice of optimal botox dosing, injection points and reduces likelihood of complications. 

Botox often can help 11 lines. Sometimes the lines are so etched in, that filler is sometimes required to soften them.  Best of luck.

Dear transient123:Botox is a injectable muscle relaxer. In thousands of injections, I have yet to see it not work but there are non-responders. These include:A patient whose muscle of expression has had multiple
injections  and atrophied to a point where no contraction occurs. If a muscle elsewhere showed relaxation or less movement, then the non-responding muscle is due to its atrophy. All other reasons:antibodies against the neuromodulatorold Botoxpoor techniqueuse of medication or non-medication not a neuromodulatorinadequate number of units or over dilution of the neuromodulatorThe continuous use of a muscle of expression in the face, like any muscle wrinkling skin elsewhere on the body will thin the fat directly under the crease and thin the dermis which forms the visual line in the skin. In between the eyebrows, this can form the appearance of an "11". You may need filler at various levels to assist the skin to repair the dermal damage and fill the fat loss. This is an advanced technique in this area due to a added risk of problems. Consult with a well experienced, Board Certified Plastic Surgeon, ENT Facial Surgeon and / or Dermatologist for evaluation and your best results.