Had Botox for frown lines. I had 2 injections above my eyebrows. No results. Is it possible my frown muscles cannot be relaxed?

I was told I would not be able to frown 1 week after injections. I waited 2 wks, called, went back in and got 2 more injections, again above my eyebrows (i could see the tiny red spots). The Dr was defensive and said it was squinting not frowning. No problem frowning whatsoever. It's been 6 weeks. My forehead lines improved a bit but that was not I went for. My frown lines are deep. I was never told how much Botox was used. Should I call the office again? Should I request a refund?

Doctor Answers 11

Botox an Frown lines

Without an in office consultation or photos it is impossible to tell how deep your wrinkles are and what type of correction yo can expect.  I suggest you return to your treating physician for examination.  If you are still unhappy please consult a board certified dermatologist with expertise in cosmetic injections.

Botox

Thank you for your question.

Without photos it is difficult to make a suggestion, although you may have not received enough botox due to the muscle being to strong or that your frown lines are to deep to help achieve the desired goal. 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.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 150 reviews

Botox for Frown Lines

It's not really possible to explain your lack of response to Botox without knowing more about your treatment.  I would recommend that you return to see your injector for an in person evaluation.  If you are not satisfied with your current injector, you could let the Botox wear off and then start fresh with another doctor.  In my hands treatment of frown lines with Botox usually provides a "home run" result.  I charge for Botox by the unit and I always tell my patients exactly how many units I am injecting.  I tell all my patients to return to see me in 1-2 weeks if they are not 100% satisfied.

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

When you have unsatisfactory results from Botox

Patients experience a range of muscle immobility, from complete inability to create those "frowning lines" to hardly any effect at all.  The full effect is seen within two weeks of the injection.  

It is quite uncommon for patients to see little or no effect after Botox injection - these rare cases may have better results with a different product such as Dysport.  More commonly, it is an issue of needing higher doses of Botox than the average patient, or a series of multiple injections to achieve the desired result.

Jill C. Fichtel, MD
Columbus Dermatologic Surgeon
5.0 out of 5 stars 16 reviews

Botox for Frown Lines

You may need higher doses or more injection points if you do not have the results you are looking for. Often fillers are needed as well. I suggest seeing a cosmetic dermatologist with experience.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Frown lines not improved after Botox

The normal injection for frown lines is a series of 5 injections. There is usually some decrease in movement. Don't expect total lack of mobility if you have very strong muscles. In a female, dosing is 15 to 30 units. Men are up to 100% more. The lines that are present without movement are called static lines and aren't affected much with Botox. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Had Botox for frown lines. I had 2 injections above my eyebrows. No results. Is it possible my frown muscles cannot be relaxed?

There are several possible explanations for your current concern.

First, this is rare, but sometimes people just don't get the typical level of muscle relaxation that comes with Botox treatment. In some cases, Dysport or Xeomin will work better. Again, this is not common.

Second, some with severe frown lines have imprinted those lines on their skin. Botox can relax the muscles but will not remove those etched in lines. Patients return with the same etched in lines but absolutely no ability to frown and say that their Botox didn't work.

Third, some patients describe their Botox not working when in fact it has worked but they're using the muscles around the eye to recruit an unnatural amount of movement that pulls the eyebrows downward and can mimic that frowning look.

It's impossible to tell which scenario is accurate having never met you nor seeing any photos of what you describe. I would recommend that you return to your injector for re-evaluation. If you've lost confidence in their skills you should seek a second opinion. Best of luck.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Non response to Botox

You state that the injections were above the eybrows and that is not where injections are made to correct the frown line. if it was done in the correct spots it is possible it was old or too dilute but more likely it is the injector.  See a board certified dermatologist or plastic surgeon who is expereinced in the use of Botox. Since there was some improvement in the forehead you are not a non-responder

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Frown Lines After Botox

Hi Jan. Without before and after photos, it's difficult to say for sure, but there are a couple possibilities.

It's possible that the Botox was bad or that the injector was not skilled.  It's also possible that the Botox was diluted and that you did not receive enough units.  

An alternative explanation is that your creases are deep enough that even though the muscles are relaxed, you still have not lost the lines.  In this case we typically follow on with a dermal filler injection like the one you see at the link below.  

If you are still moving the muscles, you need to find a different injector.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

BOTOX® Cosmetic does relax the frown lines.

Relaxing the muscles that cause frowning require: 1. the right dose for your muscles, 2. the correct site of injection and technique, 3. proper dilution of the BOTOX in a physiologic liquid (overly diluted could lead to an insufficient dose). I do not have the before and after photos, however, one possibility is that your frown lines were already visible at rest and so may have required some dermal filler to 'fill in' the lines as well the correct amount of BOTOX to prevent the further deepening of the lines. Over time, if you are consistent with the recommended interval between treatments, you may not need more dermal filler as the lines will start to fade due to the lack of movement between your eyebrows. Hope this was helpful!

Manish Khanna, MD, FRCP(C)
Montreal Dermatologic Surgeon
4.5 out of 5 stars 15 reviews

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.