My 11s just won't go away! The issue is a pucker. The 11s are not etched into the skin as of yet

Its necessary in some instances to to first try Botox /Dysport and if that's not enough to supplement with fillers. That will usually do the trick. Good luck!

Thank you for sharing your question about Botox. It sounds like you have strong muscles in the area between the brows (collectively known as the glabella). While 18 units is a decent dose of Botox for this area, you may require more units for a complete treatment. For some patients, a small amount of dermal fillers directly into the 11’s can go a long way in softening these lines. For best results, Botox should be repeated every 3-4 months in order to sustain results and prevent lines from worsening. For more information, I recommend following up with your injector to discuss your concerns about the 11’s. Best, Dr. Kian. 

The strength of the muscles that create the 11s can vary among individuals and sexes.  This is one reason why we use different units for both men and women.   One thing that I would suggest is to follow up with the injector and ask them about their touch up policy.  Botox’s effect does vary in individuals with some people losing its effectiveness in a shorter period of time.  In addition, some people use different dilutions that they could alter for your next injection.  Botox does take close to 2 weeks to reach maximum effectiveness.  One thing to note is that if botox is not improving the lines may consider using lasers for resurfacing (DeepFx or Fraxel Repair) or rhytidectomy.  If you prefer to go that route I would recommend seeing a dermatologist with laser training. If you are considering filler injectables in the area I would recommend someone who is very knowledgeable as there is many risks with injecting in this area. Make sure you visit a board certified physician (e.g Dermatologist, Ophtalmologist, Plastic Surgeon, or Facial Plastics) who either completed additional Cosmetic training or does this on a regular frequency.

There are three frequently used neuromodulators.  Botox, Xeomin and Dysport. All three work about the same for most people but for 10- 15% of people the Botox doesnt work as well.  For those 10-15% of people Dysport works much better.  I recommend you give the Dysport a try. 

I would go back to your injector to address your concerns, I would wait a whole 14 days to see the results of the treatment. Extra botox might be needed or some filler to help the area if the wrinkle is very deep. 

Good question. For the glabellar area if the wrinkles are now static and in skin I recommend using regular botox- inject botox when even slightest of muscle action comes back. Try that for few times and if it still doesn't soften the wrinkles then add filler and that should do the trick rigth away. Just make sure you follow up with botox regularly so it doesn't come back.

Thank you for your question. 
It is always difficult to diagnose a problem on the description alone, without a photo, however, you may just need to be patient. 
The average starting dose for Botox in the glabellar complex is anywhere from 25 to 30 units. And it takes Botox 3-4 days to kick in and start working and up to 14 days before it peaks (or is at it's strongest). So with that being said, I would wait until you are 2 week post this last injection, before you can evaluate its effect. If after then , it is still not working, I would revisit with your injector. 

The average dose of Botox that I use in my clinic for frown lines ranges from 16-24 units. Males and patients with stronger muscles may require a higher dose. You should certainly be seeing some effect with 20 units of Botox. I would followup with your injector to discuss your concerns and to review your before and after photos. 

Thanks for your question.  A pic would have been helpful.  I have had a couple of patients with this problem.  On one the muscle was very relaxed after two separate injections with Botox but it exposed a skull indention.  On the other the patient was just resistant.  I used a small amount of filler on both patients which helped with the problem.  I would not advise too much filler in that region however as complications can occur.  Hope this helped.
Dr. ODell

The 11’s or glabella frown lines may require a more significant dose than you have received in the past.  I generally start with a dose of 20-24 units and occasionally it has taken over 40 units to see a result.  Without knowing the placement of injections, it is impossible to suggest what can be changed to obtain your desired outcome.  I don’t quite understand why you were receiving injections high in the forehead since this is generally not the target area for your problem.  Also, I would be cautious before adding filler to the area since you noted that you don’t have any etching, you would then still have the movement that causes the 11’s.  Filler would be beneficial if you had etched in lines. You should follow up with a physician who is expert with cosmetic Botox treatments.  Good luck.
Dr. Berdy