Why is my Forehead Region Still So Mobile After Botox Injection Post 9 Days?

Question

I had my first injection of Botox 9 days ago. Unfortunately I do not remember how many units were injected. He also did a few more injections along the top of my eyebrow, but none for crow's feet. I'm 52 but the glabellar lines are really my only lines at this point. Anyhow, at 9 days I think the lines may possibly appear a little flatter, but with my forehead completely relaxed they are definitely still there, and if I frown or squint my brow folds up just like it always has. Is this normal?

Jon E. Mendelsohn, MD, FACS · Answer

While 9 days is on the longer end of how long it takes to start seeing the effects of Botox, it can take up to 14 days.  I would recommend hanging in there for another few days.

If however, there is movement after this time, I recommedn vsiting your Doctor and having it re-evaluated as you may need a "touchup."

If the Botox is working elsewhere on your forehead, my guess is that it will begin to work in the next several days.

Jeffrey J. Roth, MD, FACS · Answer

It usually takes at least 4 days to start and see results. Sometimes it takes longer. Botox can be different in individual patients. Best to contact your injector and let him/her know your concerns.

Ron Shelton, MD · Answer

Some lines go away immediately after Botox or Dysport injections in the forehead, but others can be unchanged if the muscle is not adequately relaxed with the treatment. This can be due to not enough units being used, or not enough time to allow it to work such as two or more weeks, or the physician was cautious and wanted to start off slowly and not drop your forehead which could lower your eyebrows. Furthermore, if there was adequate treatment and the muscles are relaxed, some patients creases are there from so many years of forehead contraction that the creases are very deep and the skin will take time to have the wrinkles fade now that the muscle is not making the overlying skin crease repeatedly. If the latter is the situation, then your doctor will want to reinject your Botox in about three or four months the latest, before the effect wears off and your skin creases again with the muscle movement.

Harold J. Kaplan, MD · Answer

Hi Jude.  If your glabella (the 11 lines) fold up upon frowning or squinting then you did not get a good result.  It would be great to know how many units were injected because it would be easier to tell if this is a technique issue or a dosage issue.

	If an appropriate number of units was injected (20 for glabella) then your injector may have missed the mark and you may need to find a new one.  If the area was underdosed then you should go back and find out how many units were used and see if it is just an issue of a bit more product.

	Finally, for deep frown or furrow lines, a bit or Restylane or Juvederm may be required to fill the crease.  This is in cases where Botox has taken full effect but the crease can still be seen.

Monika Soni, MD · Answer

Thank you for your question. Depending on the extent of movement you have, you may require more Botox. I recommend having a follow up with your injector for an evaluation. Best of Luck!

Martie Gidon, MD, FRCPC, FAAD · Answer

It can take up to two weeks to see the full effect of your Botox treatment.  If you still have too much of a frown, please return to your physician.  You may require more Botox for that area.

William P. Coleman III, MD · Answer

The effect of Botox peaks at about three to four weeks after treatment. The same is true of Dysport and Xeomin. This has been demonstrated in the clinical trials for each of these materials. Also some people require more Botox than others to achieve the best effect. By the way complete immobilization of the forehead and brow just looks peculiar and is not the goal of these treatments. Some 50 plus individuals also benefit from a wrinkle filler in the frown lines.

Steven Wallach, MD · Answer

Usually botox takes about a week fo rthe full effects.  The goal is not to compeltely freeze your forehead because that looks very fake.  However, certainl paitents do require more than others.

Emily Altman, MD · Answer

If the lines are still there when your forehead is completely relaxed, they are most likely static wrinkles, meaning that the creases have already changed the texture of the skin enough to appear even when the muscles are completely relaxed.  These wrinkles will not be eliminated by Botox.  Static wrinkles can be improved with a filler or laser resurfacing depending on where and how deep they are.

	If the Botox injections were placed into the glabella, it should not fold as usual.  It may not be completely immobile (and I agree with the other answer that you don't want a totally frozen look), but it should be somewhat relaxed and smoothed out.

	If the Botox was injected into the forehead, it doesn't affect the glabellar frown lines very much.  Those are relaxed by injections into the procerus and corrugators between and immediately above the glabella.

	It's also true that it takes up to 2 weeks to see the full action of Botox take place.  I recommend that you wait for another week and then return to your injecting physician to determine if other injection sites are needed.

Chris Thiagarajah, MD · Answer

There are multiple reasons why this could have occurred.

	1. Some of the lines that you have in the forehead are very deep. Remember, the botox can soften the lines but if someone has a very deep line, it wont completely efface it.  

	2. It sounds like you didn't have any botox on your forehead and thus should be able to move your forehead up and down. The botox in the glabellar area reduces the ability to bring your brows together (like when one is thinking deeply)..so in summary..totally normal

	3. If you did have botox in your forehead and you can still raise your forehead then it could be because you didn't have enough..I have rarely seen a case where enough botox was used and a patient still can raise their forehead. Lots of times patients will say.."treat the forehead but only put a few units there". I tell them I can try but if you put too few units in an area it won't work well or will tend to wear off early. Its like saying "Get rid of the crime in Las Vegas but I only want you to use one police officer". Just doesn't work that way.

	Without the units and the locations of your treatment it is difficult to say what exactly happened. If you aren't satisfied you should return and probably get more botox. One of the most common phenomenon that I see with botox is where patients in an effort to cut costs will reduce the amount of botox that they need and then be disatisfied with the results and it is due to the fact that not enough botox was used. Also, Rarely the botox just doesn't work on some people (<1%). Hope that helps.

Why is my Forehead Region Still So Mobile After Botox Injection Post 9 Days?

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