Over 130 cc of Botox and still movement in my forehead, advice?

Question

Hello , I have been receiving botox injections in my forehead and crows feet for over a year now . I go to the specialist every 6 weeks for my injections which is not normal my last treatment was 8 weeks ago I received 85 units and he added 15 units 2 weeks later followed by 25 units the following two weeks follows by another 15 units and nothing changed . I paid over 15000$ of Botox injection just for my forehead in the last year . This is a reputable clinic with a dermatologist Thank you

Aldo Guerra, MD · Answer

I suggest you try a different injectable neuromodulator like Xeonim or Dysport. Alternatives sometimes work better and may be even consider changing to another injector. In general, Dysport is thought to work faster and last a few weeks longer. Best wishes, Dr. ALDO

Jeffrey Horowitz, MD · Answer

With respect to your injector, that is quite a lot of Botox for the forehead alone.  Perhaps you are miscommunicating (?).

If those numbers are correct, I would consider either changing providers or trying Dysport to see if you have a better response.

Good Luck!

Jeffrey Horowitz, MD

Andrew Campbell, MD · Answer

Something doesn't seem right to me. The amount of Botox is excessive as is the frequency of treatment. The overall cost seems ridiculous for forehead Botox. Most patients only need 12-20 units of Botox to adequately treat the forehead, and the result should last around 3 months, sometimes much longer. I'd see someone else to see if it's a problem with the injector. If you still have problems getting a result from another location, consider trying dysport or xeomin.Andrew Campbell, M.D.

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

Facial Rejuvenation Specialist

Quintessa Aesthetic Centers

Hardik Soni, MD · Answer

Thank you for your
question. 130cc of Botox is a lot. I suggest seeking out another expert
injector to evaluate you. It could be that the clinic is over diluting there
Botox. It can also be that you metabolize the product very quickly and may need
to try a product without complexing proteins, such as Xeomin. The typical
dosing for the forehead is 10-12 units. Best of Luck!

Ravi Jain, MBBS · Answer

So it is hard to say how much active ingredient you have been given as Botox doses are usually measured in  Units and not cc. You can have 10 units in 1cc or 100cc. It is the number of units that counts and produces the effect, to the number of cc.

If one brand of botulinum toxin isn't working for you, ask your doctor to consider and alternative brand such as Dysport. I've used that for years with very happy patients.

Jack Berdy, MD · Answer

You have spent a small fortune trying to achieve the benefit of relaxed muscles. On average this area requires only 16-30 units depending on the density of the patient’s skin. Once the effect is achieved it should take 3-4 months for it to wear off. You noted that you received a 130 cc’s which is not a measure of how much Botox you are getting since it would depend on the dilution per cc. I can only assume you meant units since that would tell you how much you are getting and the number of units doesn’t change with dilution, but with the volume of what is injected. You should confirm with your provider what is the actual number of units you are receiving. If you verify that you are getting the correct number of units then you may have to consider resistance which is possible albeit rare. If that is the case, then you may benefit form either Dysport or Xeomin which are competitive products with a slightly different chemical structure. Thanks for the question and good luck.

Dr. Berdy

Dr. Berdy

Melvin Elson, MD · Answer

There is of course no way you got 130 cc but 130 units and it may be that the muscles are getting a bit tired but the 15000 cost is too much. Let everything settle down and go away and then restart either with your doctor or another qualified one

Ram Chandra, MD · Answer

I am sorry about your situation. $15000 is way too much to spend on Botox in one year just for forehead, though typically results last for 3-5 months. You  might have developed resistance to it ( rare, but possible). Consider other options (other neurotoxins) or try a different provider. Also please keep in mind if you have static lines, and lines from general laxity of the skin due to collagen loss, then any amount of Botox or any other neurotoxins will not help. These only help with the dynamic expression lines produced by the muscles. Botox or Xeomin or Dysport will not address the skin and collagen issues.

Alex Eshaghian, MD, PhD · Answer

Thank you for
your question nadine2005joey. I am sorry to hear about your situation. Botox is
a purified protein used to address wrinkles associated with facial expression. In rare occasions some people develop a resistance to Botox. In these cases other neuromodulators such as Dysport and Xeomin can be used. Please consult with
a doctor for specific recommendations. Good luck!

Steven F. Weiner, MD · Answer

I think it is time to see another provider. $15K is excessive for a year's worth of Botox just for the forehead. I would try Xeomin or Dysport. You might have a resistance to the Botox.

Over 130 cc of Botox and still movement in my forehead, advice?

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