Is it possible for Botox to be effective in one area, but not another? (photos)

I had my glabella (12 units) and forehead (20 units) treated. Forehead was very responsive, but still had full movement in my glabella. Went back for a follow up appt and got 20 units of Botox in the glabella. It has been 12 days since the follow up, and I see no difference in area that was retreated. Is it possible that my glabella is just unresponsive, or could it have been a bad batch?

Doctor Answers 11

"11" Lines -- Botox, Fillers, Lasers, Microneedling/PRP

Botox, fillers and lasers work in combination for this area. Skin improvement with microneedling/PRP and lasers also help. The additional 20 units should have given great improvement, I suggest returning to your injector and discussing your concerns. If Botox remains unsuccessful, I would try dysport or xeomin. Best, Dr. Emer


Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

Variable Botox Results

  • Botox is a medication.  Much like with other medication groups such as antibiotics or chemotherapy, individual patient responses to Botox treatment can vary widely and for a multitude of reasons. 
  • Rather than any knee jerk response like "the injection was done wrong" or "it was a bad batch of Botox", I prefer an objective and evidence based approach to these patient concerns.  The best first move is being evaluated where you were treated unless you have lost confidence.  Beware of other practitioners who are rapidly critical of their competitors.  Are there objective assessment tools available to you such as before and after photos?  Patients often see more pronounced improvement when doing a side by side comparison.  Is the treatment a repeat of a previously successful treatment (same dose, same injector, same site)?  All of these factors can be relevant. 
  • Given a thorough review and evaluation, most offices and the Botox reps themselves will do whatever they can to get a patient to their happy place and desired result.  Our office finds that being honest, kind, and fair is usually reciprocated.  Hope that helps!

Steven L. Garner, MD, FACS
Santa Cruz Plastic Surgeon

Botox always works

If Botox is injected properly into a muscle, that muscle will relax. Period.

The initial 12 units was not enough, and now with a second chance, you still didn't get a good result. I would recommend you discuss this with your injector. Or, better yet, I'd consider finding a different injector. Go to someone with extensive experience.

Andrew Campbell, M.D.
Facial Plastic Specialist
Quintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Effectively treating the glabella (11s) with Botox

The glabella or 11s or worry lines between the eyebrows was the first area to be approved for Botox Cosmetic. 

A typical starting dose for the glabellar region is 20 Units. The glabella consist of a group of muscles, not just one. To get an effective result, each muscle needs to be treated. And the stronger muscles need more. 

I like to photograph my patients before their first Botox injection to closely evaluate the facial muscles. I have my patients frown and squint before each injection, so I can target each muscles contributing to the wrinkles. Each patient is different and one side may be pulling harder than the other. A pair of the corrugator muscles may be far from the midline. All of these nuances can effect the result, so it's important to consult with a trained physician on your first injection and to start conservatively. Safety comes first. 

Victor Chung, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Botox Ineffective In Some Areas?

You have very strong muscle movement in the area of the glabella. 20 units is the standard starting dose. You can always add on from there. Some individuals may need up to 35 units to start with in the area of the glabella. 32 units total should have made more of a difference for you. A number of things could have occurred. Old Botox, poorly injected Botox, or you just need more perhaps? Since 12 days have passed, I'd recommend returning to your doctor for further assessment and treatment. 

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 reviews

Botox to glabella

Botox would be expected to work well to reduce the muscle movement in your glabella.  I would go back to see your injector.  If you are not satisfied, see another injector.  Injection technique is the most important variable with Botox and filler injections.  Normally I would start with 20 units for the glabella but some people with strong muscles need more for best results.
Regards,
Dr. Ort

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

Botox to glabella

In most cases, when I see a patient who does not see the results he/she expected after Botox injection, it is because of under-dosing. Based on your photos, you would need more than 12 units to see a significant improvement in your frown lines. While photos do not replace an in-person consultation, in my hands you would probably have received around 20-24 units to the glabella. Hope this helps. 

Ineffective Botox

Botox is effective in all areas if effective in one. there are many reasons that this did not work for you--too diluted, too old, inexperienced injector. Go back and discuss this and be sure you are seeing a board certified dermatologist or plastic surgeon

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

Botox to the glabella

I am sorry to hear about your result.  I would say that 25 units is a good starting point for treating the glabellar region, especially in a patient with a relatively active muscle.  Everyone responds a little differently to dosages of botox, and your first session is typically a starting point, with some minor adjustments made as needed at future visits.  Some patients with quite strong/active facial muscles will require quite a bit more than others.  Did you receive 20 units total or 20 more units after the 12? Generally 12 days should be long enough to appreciate some inactivity of the muscle, so you may need some further treatments (especially if it has only been 20 units total).  Good luck.

John Harbison, MD
Omaha Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Botox not working

12 units is way inadequate to treat the glabella, especially with the strength you have. I'm not sure if you got 8 more units in the area or 20 more. 20 more should be more effective than what is seen. I would go back and discuss with your injector.

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