Injected for the 11's (Glabella) Incorrectly? (photo)

To reduce the muscular activity in my glabella the nurse inserted 20 units in 2 injections at the bridge of my nose (right between the eyes) instead of following the recommended 'V' pattern. A month later there is no change in the muscular activity in my glabella. Instead of my glabella relaxed, my eyes are heavy & hooded. When I called the office to complain they explained I need more Botox injected for the glabella. I feel they injected me wrong as there would have been at least less movement

Doctor Answers 4

Injected for the 11's (Glabella) Incorrectly? (photo)

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I see a few issues on both sides here. The before posted photo demonstrates you already had upper eye lid hooding. The exact injection technique used can vary but 20 units should be more than enough to obtain a result. So either the BOTOX was mixed incorrectly, too diluted and you did not receive that 20 units or it was out of date is another thought. Finally, you are at 1 month post injection guess what in only a few more months the BOTOX will have "worn off"! So no foul concept. If you did not see the result after a few days you should have returned but after a month there is NO re course. 

Injection of Botox into 11 area

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There's a couple of things here. First, each injector will have their own style of injection. While some people prefer a V pattern of more small injections, sometimes it's also called a droplet technique, it's not always the preferred method for every patient. From your pre-photo you actually have naturally hooded eyes (ptosis), so yes, injecting too low on you would cause this to intensify even more. It was probably more the actual points of injection rather than a V vs. non-V injection approach. Injecting in a V pattern on you could still have caused more pronounced hooding because you naturally have this anyway. Second, nurses just don't have the same level of experience as a physician injector. I always prefer a physician injector because the level of training is just superior. Finally, when a Botox injection goes awry, I remind people that often we are very lucky Botox leaves a temporary result. It will go away, and if you wish to get Botox again, seek a more experienced physician injector and discuss beforehand what happened this time so it can be avoided in the future.

"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."

Glabella Botox technique

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It is very difficult to critique an injection done by another practitioner.

I usually recommend 25 U to treat the glabella which includes the procerus and corrugator muscles.  My typical dosing is spread over 5 injection sites. I use ice for anesthesia and an acupressure technique to minimize discomfort.  Typically the Botox begins to take effect 5 days after injection and reaches full effect at 2 weeks.

You do have very heavy upper lids on your pre-injection photos.  Botox used in your frontalis (forehead) region will make the upper eyelid hooding worse.  A blepharoplasty may be in order to rejuvenate your eyes.  

I would consider a second opinion if your primary injector does not address your concerns.


Michael Bowman, MD
Roanoke Facial Plastic Surgeon

Botox Done Incorrectly?

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Hi Atyler.  We typically use more than 2 injection points when injecting the glabella, but this is to some extent a matter of preference.  It's not necessarily "wrong" that they injected like they did unless the intended effects were not achieved.  

This goes to the second issue, contraction of the muscle.  It does not appear that you are easily contracting the muscle in your second photo.  Normally with someone in your situation, when they frown, the vertical lines are very apparent.  In your photo, the muscle activity seems limited because the contraction photo looks very much like the before and after photo, which should not be the case.  We would expect to see deeper lines in the contraction photo.  

With that said, we normally photograph patients contracting and at rest to void this very situation and show them how they look contracting in the pre-photos.]

Your eyelids look quite a bit the same as your before photos so we do not think there is ptosis (sagging eyelids) involved.  Good luck. 

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.