Botox didn't work on 1/2 of my forehead. Is this normal?

I have been having botox regularly done for the past 5 years. Usually my forehead is very easy to treat but 1/2 of my forehead is not 'taking' the botox I had done 3 weeks ago and the other 1/2 is. I look ridiculous! Half of my forehead is smooth and the other half is wrinkling up like a sharpe puppy! I went back almost a week ago to have touch up on the side that's still wrinkled. It still looks the same. What on earth can be the reason for this?

Doctor Answers 9

Botox Effects Different on One side of Forehead Compared to the Other

  • After three weeks, the results you see from your Botox injections are probably not going to change much. 
  • Therefore, I recommend you return to your Botox injector and be evaluated.  
  • I can't explain exactly why this has occurred, but your injector will likely be willing to inject a few additional units, at no cost, into the side of your forehead where you see little or no effect. 

Botox didn't work on 1/2 of my forehead. Is this normal?

This is not typical, and your prior good responses make me think that you need to be re-evaluated.  Give the touch up a total of 2 weeks prior to further therapy.  You might want to consider Xeomin or Dysport for future treatments because developing an immunity to Botox has been documented (though relatively rare).  Keep us updated.  I wish you well!

Parker A. Velargo, MD
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Botox is easily "tweaked"

Occasionally, the doctor under injects the forehead, and often for good reason. Injecting too much on the forehead can actually DROP the eyebrows, and that is NOT a good result. It is always easier to get more, than wait 2 months for the brow to raise up when the frontalis is over-injected. Go back and discuss with your doctor. This is fixable.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 14 reviews

Botox to the Forehead: Reliable

Botox injections to the forehead are reliable and usually require about 15 units total. The forehead treatment is designed to smooth lines and shape the brow. The injections must be done above the muscle and the creases. A predictable amount in a pattern that works for your brow should deliver results. Botox doesn't not "take" and is likely related to depth and location of injection, or amount. Its important to return to your injector and get comfortable with a predictable pattern of distribution. If it still doesn't correct, a trial of Dysport may deliver a more powerful result.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 28 reviews

Botox Worked on Only One Side of Forehead

Hi Lisa,

Not normal, try again, or see another injecting physician.  You may try one of the other neuromodulators such as Dysport or Xeomin.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

There are various variables as to why this response may happen.

There are various variables as to why this response may happen. For instance, muscle structure and the Botox that was injected. A week after your second injection you should start to notice some difference - keep in mind that Botox can take up to 2 weeks to see the full effects. 

At 2 weeks if you still have not noticed any difference speak with your injector and have them use a new bottle of Botox and technique. 

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Botox

This sounds strange because the botox should work equally on both sides if the same amount was injected.  I would ask your doctor if different batches were used on either side.  Possibly one of the batches was ineffective.

Jessica Lattman, MD
New York Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Botox isn't working on half of forehead

That's pretty weird. Injectors are trained to keep excellent records of how many units are used, and where, in order to get the desired effect. If you've been using the same person for years, perhaps it's just a bad batch of Botox. I would visit with your injector to try again.
One thing I've noticed is that when patients get relatively small amounts (say, less than 20 units) injected relatively frequently (like more frequently than every 3 months), they will have less of an effect with time. Or, we require many more units to have an effect. My theory is that patients in these conditions can form antibodies against the Botox, much like when one gets a vaccine. I have had success with other neuromodulators in these patients. You may consider Xeomin or Dysport in the future.

Robert S. Schmidt, MD
College Station Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Botox isn't working on 1/2 my forehead

Have you been seeing the same injector for all 5 years? If not, and you have a new injector, a different technique or diluting could be to blame. If I had a patient who'd I'd treated for 5 years, so about 15+ times for Botox, I'd certainly want to see you in the office and see what is happening. It's not common, and it would be less common that only 1/2 your forehead would respond and the other 1/2 not.

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