What causes Botox failure? Can your muscles "overpower" the Botox once it's set and push it out?

IThe last two times I had Botox in my 11s (different injectors, both PS's) it failed after about a month. After the 20 units froze that area, I had a bad dream, and apparently squeezed my eyebrows together bc I had red lines on my 11s in the morning and the effect of Botox was completely gone. The PS couldn't explain why it happened. He added 10 more units, but those never "took". Last year, a total of 10 units in that same area held up for 6-7 months. What's happening now?

Doctor Answers 8

Botox results

Thank you for your question TinyLip. Botox is a purified protein used to address wrinkles associated with facial expression such as the vertical lines seen between the brows when one frowns. … SHOW MOREMost people enjoy the results of their Botox treatment for 3-4 months. But some people metabolize it more quickly and in such people it could last only 6-8 weeks. Some people become resistant to Botox over time, this is rare. In these cases alternative neuromodulators can be used. The pivotal studies demonstrated that 20 units of Botox in the glabella allow patients to enjoy their results for 3-4 months. But some patients benefit from higher doses. Please consult with a doctor for specific recommendations. Good luck!


Encino Physician
5.0 out of 5 stars 1 review

Botox failure

Thank you for your question.  This is most likely technique dependent.  Please switch to another product and have them inject your glabellar for your unique needs rather than a cookie cutter 20 unit approach.  Regards, Dr. Matt Elias

Matthew Elias, DO, FAAD
Fort Lauderdale Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Botox "failures" what happened?

its very rare for botox to fail you likely just need higher doses or should consider trying another product such as dysport or xeomin.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 168 reviews

Botox failure

Thank you for your question. And for sharing your experience. One of the most common reasons that Botox fails for the 11s is the individual anatomy of the patient. Using the same technique for different patients anatomies can result in sub optimal results.  This is more likely since you've had a very good response in one setting a very poor response and another. I would recommend revisiting your plastic surgeon that you had a good response with. It is more likely that he was able to read the surface anatomy correctly.

What causes Botox failure? = possibly technique issues #botox # #botoxfailure #injectiontechnique

Sub-optional results with Botox could be secondary to multiple reasons. One of the most common causes is technique failure. 
Failure in Botox technique application could be secondary to amount of botox injected, location where the Botox is injected, inadequate Botox dilution for the area treated , etc.

Botox is scientifically know for lasting NO more than 4 months. Botox results for up to 10 months are unrealistic. Since Botox effects last for 3 to 4 months, patients require serial injections at least 3 times a year to maintain their results.

Patients with suboptimal Botox treatment result should get a "touch' up by their licensed Botox injector

John Mesa, MD
New York Plastic Surgeon
4.9 out of 5 stars 111 reviews

Botox Must be Done Correctly

Thanks for your botox question   Yes, it is possible for your botox experience to not be all that you hoped.  This could be for the following reasons:

- Your provider might have used botox that was incorrectly diluted (and gave you less than they believed you were getting)
- The person injecting your botox is utilizing old botox that has lost its effectiveness 
- The person injecting your Botox is not correctly trained to understand placement and dosing 
- Your body is resistant to the toxin
- Your muscles are actually overly active or hyperactive. 


Always remember: 

1. Select a board certified plastic surgeon that you can communicate with comfortably to establish your desired look.

2. Establish that your plastic surgeon has your best interest in mind and make sure that they can explain your procedure to you in a way that makes sense and makes you comfortable. I want my patients to walk out of my consults and feel like they “get it” with respect to their surgical or injection plan. 

Wishing you the best!  Steven Camp MD  # HappyCamperMD 

Steven M. Camp, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 87 reviews

What causes Botox failure? Can your muscles "overpower" the Botox once it's set and push it out?

Your timeline and amounts written are a bit confusing. But the reasons for BOTOX failure are: under treated in dose/units, old mixed/diluted Botox, hyperactive muscles, resistance to the toxin, poorly trained injecting doctor. 

Botox failure

it is not very likely that you "pushed" the Botox out by frowning.  If you massaged the area that could account for the problem. Although the standard dose for the glabella is 20 units some patients may require more so i would increase the dose and see what happens

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