Why after I had Botox injected at my Glabella and forehead does it tighten at my Glabella after I massage my head?

Question

I had 12 units injected at my forehead and 18 units injected at my Glablla. Two weeks later I could see some results on my forehead, but not as much at my Glabella AND I had arrow-like wrinkles right above each brow. When I phoned my injector she said I needed to come in for a touchup and was injected w/12 more units of Botox above my brows and on my forehead. Two weeks later the arrow-like wrinkles had indeed dissipated, but were still there with no significant change to my Glabella.

Jose Barrera, MD · Answer

Botox for the forehead and glabella can be very effective when injected in the right quantity, location, and concentration. By what you mention, you did the receive the right amount to relax the muscles of the forehead and labella. The location may be an issue as to why you wrinkled afterwards. Also, check with your injector and make sure you are receiving the correct concentration when injected.

Jason Emer, MD · Answer

This is tough to answer without pictures. It may be that not enough Botox was used. I recommend following up with your injector. You could also try Xeomin or Dysport as an alternatvie. Best, Dr. Emer

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry to hear of your Botox dosing issues.  Typically when Botox administration results in good results to one area of treatment but not another it is because the dosing to the unaffected site is too low.  You may have glabellar muscles that are large enough that more Botox needs to be administered to achieve paralysis.  Hope this helps.

Hardik Soni, MD · Answer

Thank you for your question. You may have strong glabella muscles that require a higher dosing. Typically when you have good results to one area but not another it is usually because the dosing to the unaffected area is too low. I recommend having a consultation with your injector. Best of Luck!

Shaun Patel, MD · Answer

It appears that you had a "spock" appearance to the eyebrows after your first Botox injection which was treated during the "touchup". As for the glabella, if you still have motion, you may require more Botox. Remember, it is natural to have some movement in this region. It is hard to tell exactly what is going on without seeing some photos or evaluating you in person. Followup with your injector and discuss your concerns.

Alex Eshaghian, MD, PhD · Answer

Thank you for
your question mierab. I am sorry to hear about your situation. Botox is
a purified protein used to address wrinkles associated with facial expression. The dosage and placement of Botox is variable from one person to another. Sometimes additional units are required and sometimes treatment of a slightly different area is required. I encourage my patients to provide their feedback in order to correct such issues two weeks after the treatment. Please consult with
a doctor for specific recommendations. Good luck!

Steven F. Weiner, MD · Answer

It sounds like you had a "spock" problem with your brows and the follow up injections were only to correct that. The glabella typically needs more than 18 units. My dosing in 20-30 units. I would discuss with your provider and see if you need more in the glabella. Sometimes I get patients who have minimal movement in their glabella and still want more Botox. In very strong glabellar patients, complete loss of movement isn't always possible. Botox can take movement down 2 grades typically, so a 4 grade to a 2 grade, a 3 to a 1. A 4 to a zero doesn't happen, but over serial treatments, the starting point will gradually fall and the end result will be closer to zero. In my practice, I try to not go completely to zero, having a small amount of movement is more natural.

Why after I had Botox injected at my Glabella and forehead does it tighten at my Glabella after I massage my head?

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