Do Some Providers Water Down Botox? I Recently Received 60 Units to Remove the 11's and Can Still See Them.

Two possibilities:

1) The botox worked to paralyze the muscle, but you are seeing the creases in your skin.  Lines that are present when the face is at rest will not go away with botox.  Botox paralyzes muscle, but it does not fill erase the creases in the skin that have resulted from years of frowning.  The paralysis will keep the creases from deepening.  Over time and serial botox injections, lines that are present at rest will often soften quite a bit.  For any remainder, a small amount of filler is an option.

2) The botox didn't work.  This would be quite unusual.  Sixty units should be enough to see a result, even in someone who has a very well-developed musculature.  

You should return to your provider to ask his or her opinion of what happened.

All providers must "water down" the botox as it arrives as a powder and must be mixed with sterile saline. The amount of dilution correlates with the amount of liquid placed in the bottle.  As the dilution (number of units of Botox per ml. of solution) varies from office to office, it is important that physicians discuss Botox treatment as number of units injected. In this way, it doesn't matter what dilution was used. If you had 60 units from one doctor who initially mixed one cc. of water in the bottle, vs. 60 units from another doctor who used 2 or 2.5ccs of water, the results should be the same as the number of units were the same.

There are certain, lets say red flags out there.

Areas vs syringes.  If the office will not tell you how many units you are getting.  This is done to keep you ignorant  about the actual dose.  However, knowing the alleged dose allows you to compare office when needed.  These products are measured in units.  BOTOX and Xeomin units are pretty comparable.  On the other hand Dysport requires about 3 times the number of units for a clinically equivalent treatment.

The advertised price per unit is less than the actual cost of the agent.  A vial of BOTOX cost the doctor about $500 give or take in the United States.  The vial contains 100 units.  So if you are being offered a unit for $5, something is up because no one gives this stuff away for their cost.  It is much more likely that the unit you are getting contains something less than a unit of agent.

In the United States, the is no independent practice of estheticians or register nurses, or medical assistants.  Physician assistants and nurse practitioners are different.  I personally believe that these treatments are best administered by the physician.  So check with your State.  If the situation is not legal, they may be cutting other corners including how much product you are getting.