Botox help! Had furrows treated but 8 days later only having effects in middle of forehead. (photos)

Wait a few more days, sometimes it takes up to 2 weeks to see the full effect.  If it is still creasing, you just need some more Botox, either in the area that was injected or peripheral to it, as you might be moving your eyebrow muscles now to create this movement.  An experienced injector will be able to tell where you need more Botox.If the injector was not very experienced, or not very good at injecting, or used a weaker product, such as Xeomin, this could also be a reason you aren't getting the full effect.its okay to be conservative, as long as you tell your patients they might need more and they should come back if they do. 

If you still see the frown lines following your Botox treatment, either you need additional Botox injected or you need to have it placed slightly more lateral (closer to eyebrows) to stop those muscles from squeezing. I hope you find this helpful. 

Thank you for the question and sharing your photo and concerns.  Typically you would see some effect in your furrows at this point, but I would wait a full two weeks before any intervention.  People have different responses to Botox depending on the musculature, and you may require some additional units to the area to fully weaken those muscles.   "This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Results take 10-14 days to be fully apparent.  If you are unhappy after this time, please speak to your physician.  Best, Dr. Emer.

Thank you for the question and your photos. The onset of effect is generally around 5 days. Peak effect is typically at 2 weeks. If you still have unwanted movement at 2 weeks, I would recommend a little more Botox. Some patients require higher doses due to thicker/stronger muscles. Take care.

I see this frequently when patients come in for a second opinion when their Botox "doesn't work" at another office. The most common issue is that the Botox was placed too high which softens the forehead muscle but doesn't have any effect on the frown lines. This is usually because the injector is worried about placing the injections too low on the brow. I'm curious if your injection was performed by a plastic surgeon or dermatologist? Usually this is a sign of an inexperienced injector but this can happen to anyone. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Typically you might expect to see most of the results by 7-8 days although in some cases it may require a bit longer. You did not mention if this was your first injection or not. If you have been injected in the past and your response was very different than you current response then that is significant.  You also did not mention which neuromodulator you were injected with: Botox, Dysport or Xeomin.  There are some subtle differences but properly injected people typically have a nice result with any of these.If this was your first injection there are a variety of factors that could cause the response you described. It might also be that your injector was just being conservative if it was your first injection.  However it is time to call and inform them of your situation.  Clinical effects are not simply the result of the number of units injected but also a number of other factors are important including: the dilution when reconstituting neuromodulators, the location and depth of injection, your unique anatomy, and the muscle volume and distribution being injected.  Also the size of needle, the pressure of injection and  the spacing of injection sites all impact the diffusion or spread (think different sized raindrops) and thus the clinical result.  The experience of the injector and their artistic/aesthetic sense is critical and often underappreciated when people are just shopping for neuromodulator or filler injections based solely on price (of course price is also important but the variation in results can be quite significant between injectors). In short, there is no way to discern with certainty from your photos and history why you have not seen more improvement. However the neuromodulators are so popular with people because the outcomes are typically very good so you likely just need a touch-up treatment. Best wishes for a successful touch-up and final result!

Some patients have stronger muscles than others. I find this particularly in men. I would give it a full 2 weeks before going in for a touch-up.

Having performed Botox procedures now for almost 20 years, I am convinced there is not a one size fits all approach. Botox is a medication which must be tailored according to the desired appearance, the thickness of your muscle etc. When we perform Botox on someone for the first time we establish firstly what their concerns are and how dramatically they would like to be 'Botoxed'. Some desire a very paralyzed appearance with very little or no movement and others require a more natural appearance with some movement still possible with facial expression. This must also be balanced with the fact that too much Botox, can result in undesirable effects. For example in the 11's area, too much Botox can result in a very flattened appearance across this area, and also a very heavy appearance of the middle part of the brow. I would recommend that you allow a full 10-14 days for the full effect of your treatment to be established. At this time, if you are unhappy, return to your injector, or find another injector to examine you and fully analyse your individual anatomy and the placement and effect of your Botox. Recommendations can then be made for any adjustments that may be needed. We request our first time patients to routinely come back to see us about two weeks after their treatment to make sure they are satisfied with the effect and to make any adjustments that may be needed. The exact dosage and placement of the injections can then be recorded and individualized for each individual.

Botox should start to work by day 3, and by day 14 should be working to its maximum ability.  I think you should see greater improvement in the next few days.  However, if by day 14, you are not seeing better results, I would contact your physician to discuss a touch up procedure.  Likely causes of a poor result are using "old" Botox, or not injecting enough.  This is why I ask my Botox patients, especially first timers, to come back two weeks later.  Some patients just need a few more units than others.  Hope this helps and good luck!