Glabellar Botox isn’t flattening the area between my eyebrows: quite the opposite. Why does this keep happening? (photo)

if you are getting botox from an experienced injector and you are doing it regularly then might be its time for the filler in the area to clean up the deep wrinkle and then continue with botox. 

If you can still make some muscle movement and bring the eyebrows together or see contraction of the muscle bulges getting bigger in the mirror then you know you haven't had enough units of Botox for your specific muscle thickness.  If however, the muscles are quiet when you try hard to contract, then it means that Botox is not enough for you. Some people do have filler injected there but there is a risk of blood flow compromise and worse even blindness from fillers injected into the glabella (and other facial areas). I often find that those people who have such an issue do not keep up their Botox treatments regularly enough and with time that lapses after the Botox wears off, the muscles start contracting again so that there isn't a chance for the muscles to remain flat and have less of a groove between them. There are people whose Botox wears off at 8 weeks and in those cases, I would recommend every 8 week Botox for several sessions to keep the muscles quiet and see over a year if there is flattening before considering a filler. Also some cases won't look good with a filler trying to fill in the groove between the muscles as it may only serve to raise the groove and create more of an unnatural fullness in between the eyebrows.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

I would recommend using a filler in addition to the Botox to treat your glabellar region.  Botox will help to relax the muscle, but you also have some depressions in the area.  A filler could be injected to help with this issue.  I would discuss this option with your plastic surgeon.

It would be helpful to see before treatment photos as well as photos of your glabella at rest and with animation. It is possible that you require a higher dose of Botox or Dysport. Alternatively, you may now need add filler to the glabella, in addition to the Botox, to get the result you are looking. 

Thank you for your question and for sharing your photograph Lauren_23. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment in the absence of consistent photographs before and after in the same lighting and angles for comparison. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. 
Although 20 units is a good standard dose to start with, some people require a higher dose because of higher muscle volume. This is common in mature patients, in those with large bulges from expressive faces, and in men. I find that Botox still works in these cases, just a higher dose is required. I have used up to 40 units in the glabella.
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.
In rare cases, some people are resistant to a certain neuromodulator such as Botox. In this case the treatment can be repeated using a different neuromodulator such as Dysport or Xeomin.
Botox (onabolutimun toxin) is what we call a neuromodulator. This means that it controls nerves to relax the muscles by preventing them from contracting. Botox is the most popular neuromodulator available, has been the most studied, and is cleared for the most number of indications. Other neuromodulators available in the United States include Dysport (abobolutimun toxin), Xeomin (incobolutimun toxin), and Mybloc (rimabolutimun toxin). Botox, Dysport, and Xeomin are type A toxins while Myobloc is a type B toxin. This means the structure of the protein is slightly different. Overseas many others are also available. Dysport is the most commonly used neuromodulator other than Botox in the United States. The dosing for Dysport is different than that for Botox. Approximately 2.5 to 3 units of Dysport are required for every unit of Botox. For example, in the glabella 20 units of Botox is most commonly used. If Dysport were to be used in this area 50 to 60 units of Dysport would be required. The investment per unit of Dysport is approximately 2.5 to 3 times less than that of Botox. While the manufacturer states that the units of Xeomin are a one to one equivalent of Botox, many doctors find that a higher dose of Xeomin is required to produce the same effects as Botox. Each product has slight differences, but all of them work. Dysport, for example, is known to spread more than Botox. This makes it useful in places like the underarms where it can be used for excessive sweating. However, if it spreads near the eyes it can lead to side effects such as a droopy eyelid. Xeomin is also called a naked protein, because it does not contain the accessory proteins that are included with Botox or Dysport. It is thought to have a slightly faster onset (by one to two days faster) than Botox or Dysport. It is also thought to have a decreased likelihood for allergic reactions, although allergic reactions to Botox and Dysport are incredibly rare. In the United States Myobloc is not FDA cleared for cosmetic use and is primarily used for muscle pain in those with cervical dystonia. The majority of our patients find that they like the results of Botox the best. Additionally, Allergan, the maker of Botox, offers the Brilliant Distinctions Program. This is a rewards program where patients receive points from their Botox treatments which can be used toward discounts at subsequent treatments. Points are also received when patients purchase other treatments in the Allergan portfolio including Juvederm Ultra, Juvederm Ultra Plus, Voluma, Volbella, Vollure, and Kybella or products such as Latisse or Skin Medica products.
If I had a patient with the concern described here I would want to know the dose and placement of the product. Sometimes a higher dose will correct the results. Alternatively there may be resistance as described above, in which case trying a different neuromodulator may be of help.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Please consult with a doctor for specific recommendations. Good luck!

Over time you do develop antibodies to Botox ..Xeomin is incobotulinumtoxin A that is more concentrated and you do not form antibodies to it therefore better results

Dear Ontario,Your post op swelling may be partially injector dependent.Try another skilled injector and see if you experience is different.Best. Dr Brecht Seattle, Wa