Botox Not Working for 11s After 10-14 Days? (photo)

Based on the photo's you've provided, you are having some relief in this area treated. You're probably a good candidate for more product. Dosing should be based on size and strength of muscles and isn't the same for everyone. Visit with your provider closer to two weeks post-treatment for a full assessment and possibly to add more Botox to the areas of residual activity.

you have deep 11's. there is some mild improvement but the skin creasing will not disappear after just one treatment. The skin has been used to creasing for years due to underlying muscle movement. Just because the muscles no longer move does not mean the creases will go straight away. I have had several patients in my 15 years injecting botox who have required sequential doses over a period of a year to eradicate the lines that have taken decades to form. I suggest you persevere!

It does appear your lines & movement have improved. Although those lines in the "11" area are created from years of making that expression. The lines are deep and may take multiple treatments of Botox. If the multiple treatments does not seem to make a difference, you may need a filler like Juvederm  or Restylane to fill those deep lines.

I have considerable experience using Botox for aesthetic purposes, having started doing so in 1991, eleven years prior to its official FDA-approval for this purpose. Throughout that time, from time to time, I have encountered individuals who had at first responded well to treatment, but who, after two or more prior treatments, demonstrated either no response, weaker response or shorter duration of response.

The medical literature estimates the development of antibodies in the range of 3%-13%. However, it seems that  even among those with proven antibody formation few actually demonstrate any significant loss of responsivity to further treatments. This of course does not rule out that some may indeed do so and this fits my own experience in twenty-one years of injecting Botox for dynamic wrinkles.

An increased chance for promoting antibody formation may also be related to the routine practice of bringing patients back after just two weeks to touch up any areas that may not have completely responded to treatment. For this reason, it is currently deemed wiser to bring patients back no sooner than a month following treatment for touch ups.

When there exists no other obvious explanation for lack or response or loss of response or shortening of duration of response (such as changes in dosing or concentration, etc.), and antibody formation is suspected, a trial of Xeomin, another bolulinum neuromodulator would be reasonable.

Xeomin is essentially a naked  Botox, stripped of the proteins that come attached to Botox that are believed responsible for triggering the development of antibodies. I have found Xeomin to helpful among the few patients I have had recently  in whom I have suspected antibody-related resistance, In such instances I have seen full responsivity restored.

Although Dysport, the third approved botulinum neuromodulator available in the U.S. market, does contain additional proteins, I have nonetheless also found this product to be useful as an alternative in patients who appear to have grown resistant after several successful prior treatments.

Finally, persistent "etching" of the skin, a result of years of folding the skin with expression, can be further improved with the use of fillers, such as Belotero Balance or Restylane L. As a side benefit, the combination of neuromodulators with fillers, particularly in this region, has been associated with signficant prolongation of the results--upwards of a year, as opposed to only several months when the neuromodulator is used alone. 

Botulinum toxin usually works well when administered by experienced artistic clinicians.

Why would Botox not work?  Here are the Top Five:

1.  Not enough Botox was placed.  

2.  The Botox was not placed in the right areas

3.  The Botox cannot quickly eliminate established wrinkle lines.  This takes time.

4.  The patient expected no movement whatsoever.  This frozen appearance is widely ridiculed and most top doctors avoid that look.

5.  My brows came down.  Too much Botox in certain areas causes the muscles to relax.  This is very predictable.  If the patient is at the borderline of needing their brows and upper eyelids done (or lower eyelids, but that is another conversation), even a small amount of Botox can bring on sleepy brows for three months.

There are many other reasons Botox doesn't work properly, but these are 5 common ones.

It takes 2 weeks to see the full results from Botox.  If at that point you still want there to be less movement, then more Botox can be injected.  Based on your pictures, it does seem like you have had some improvement.

Be sure to see a board certified physician with experience with Botox.

Best,

From your pictures, it does appear that you did get some improvement with the Botox to your frown lines.  It's possible that you may just need some more to get a better result.  Another option would be to also use a filler under the lines to help soften them more.  

Presuming you were treated properly by a highly trained and experienced injector such as a dermatologist, it is most likely that you would require a higher dose of Botox to achieve no movement. That said, it is possible that you could be losing some response to Botox (forming antibodies to it), and so you may want to try another form of botulinum toxin such as Xeomin or Dysport. ~ Dr. Benjamin Barankin, Toronto Dermatology Centre.

There are 3 likely reasons that you did not get the result you were looking for. First- it may be that not enough Botox was used (the muscle is weakened but still moving). The fix is more Botox into the same area. Second- Botox may have been injected into part of the muscle, but not all of it (part of the muscle isn't moving at all and another part of the muscle is moving fully). The fix is to inject more Botox into the part of the muscle that didn't get it before. Third- The muscle may be fully relaxed but your wrinkles are deep enough that you are going to have a wrinkle even when there is no muscle movement at all. The skin does have "memory" and if your wrinkles were present AT REST prior to Botox, they will be softened, but not eliminated after Botox. When we inject Botox into a patient for the first time, we are guessing (am educated one- but a guess none the less) as to the exact extent of the muscles that we are trying to weaken. Some time s we don't get a perfect result that first time, but by seeing your response we can learn from that to get a near perfect result the next time. Go back and show your injector what has happened. Explain your concerns. This way you will get a much more satisfactory result next time. Good luck.

Ten to fourteen days is adequate time for botox to take effect. When people have very strong glabellar muscles, higher doses of neuromodulator should be used. I have had to use double the standard dose for some of my patients with large muscles. Despite this, botox can only relax the muscles underneath the wrinkles. Once the lines are etched, adjunct fillers and/or laser resurfacing can further soften the lines. Any filler in this area should be performed by a board certified physician with significant experience in injecting glabellar lines. This is a very high risk area, and if performed incorrectly, can lead to significant complications.