Why Isn't my Botox Working As It Has in the Past?

Presumably you have gone to a new injector than you have in the past.  Two different injectors can use identical treatment dosages and have two very different treatments.  Further complicating this is that one does not always get what one pays for and treatment response is inherently subjective.  What are your recourses?  I would speak to the injector.  If there is any funny business, these types of office are often happy to provide additional "free treatment."  I personal feel this is a red flag.  An experienced injector using an appropriate amount of agent knows what type of treatment results they get.  In my office, treatment results are so consistent that we simply charge more money if you want more treatment effect.  I have never had a patient for whom the before and after photos did not show a difference.  40 units is a significant number of units of BOTOX or Xeomin for the gabellar area.  Beyond that it is very difficult to "prove" the doctor is not giving you what you paid for.  See if the office will provide more treatment and consider finding a new office for service in the future.  Board certification is not a guarantee of results.

Please return to your surgeon to express your concern.  I'm certain he would want to know  and would try his best to give you a good result.  He can reinject you since it is possible the Botox you had was inactive (it can rarely happen) or you may need to be switched to another neuromodulator if Botox is no longer working for you.  Give him a chance and if you are still unhappy, see another specialist.