Are There Different Techniques when It Comes to Injecting Botox? And is There Any Reason It May Have Worked Before but Not Now?

I have had injections in my forehead and glabella by 2 very qualified plastic surgeons, the first was a facial specialist, the 2nd (current doctor) a generalist. The 1st doctor was able to completely freeze my 11 lines, the 2nd has been unable to do so. If I remember correctly, the facial plastics guy used fewer injection sites. Between the 2 regions of my forehead I get 50+ units, which is a lot. My forehead responds better than my glabella. I am a fit, active 36 year old female. Thoughts?

Doctor Answers 11

Are there different techniques for injecting Botox?

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Different doctors may have different techniques for injecting Botox, so it is possible you could get different results from different physicians.  The amount used and placement of the Botox are both important in achieving good results.  The number of injection sites is not really important, as some doctors can distribute to a treatment area with fewer injections than others.  The important issue is that the Botox is placed throughout the proper region.  My advice would be to return to the physician who treated you when you got the better results.  

San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

MICHELE KOO, MD,FACS Board Certified Plastic Surgeon on Botox Injection Results

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Botox injections can vary significantly between different doctors and even between sessions by the same doctor. Sometimes a certain lot number (batch) of Botox vials may not be as effective for whatever reason. The number of injections is not as important as the concentration of the Botox per injection and the actual location of the injection. For the best results you should followup and repeat your injections with the same doctor for at least 2 or 3 times. This will allow your doctor to see your muscles response to the amount and location of the injections. I always see my first time Botox patients 2 weeks after the injection to access the results, draw the exact pattern of my injections and the results. This ensures that you will have consistent results each time. You can have additional injections if needed to paralyze any remaining activity. The important take home message...go to a plastic surgeon that is meticulous about the injections and follows up him or herself on the results!

Michele Koo, MD, FACS
Saint Louis Plastic Surgeon

Are There Different Techniques when It Comes to Injecting Botox? And is There Any Reason It May Have Worked Before but Not Now?

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Every provider has their own technique of injecting Botox or fillers, you may have been under-dosed the 2nd time and will require more units to see full correction.

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Different techniques for Botox injections

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Anyone can inject neurotoxins such as Botox, Dysport or Xeomin but doing it safely and correctly requires a comprehensive understanding of functional anatomy to maximize outcomes. Each patient needs to be thoroughly assessed and have a specific treatment plan developed based on patient desires and a comprehensive aesthetic evaluation. It is as much an art as it is a science. And there is no substitute for experience.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
4.4 out of 5 stars 13 reviews

Botox and antibodies

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There are people who are reported to have developed antibodies to Botox in which case it would not work.  It is extremely rare to have this problem.  If Botox is not working, you need to go back to the provider and discuss it with them, and if you are not satisfied, then get a second opinion from a very experienced injector who is board certified in an appropriate specialty such as Dermatology or Plastic Surgery. 

Rebecca Baxt, MD
Paramus Dermatologic Surgeon
4.8 out of 5 stars 29 reviews

Botox injection techniques

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Just as their are chefs and then real chefs, there are injectors and then Real INJECTORS that understand facial dynamics, symmetries, muscle normalcy, anatomy and technical skills.  Not all injectors, doctors, specialists are created equal.  Generally, those of us that have a few gray hairs have "been there and done that" and especially if the injectors has a surgical practice: for example, a Dermatologic Surgeon, a Plastic Surgeon, a Faical Plastic Surgeon, a Oculoplastic Surgeon.  We are the Physicians that "handle" tissue and are able to think on our feet so to speak because of our surgical training.You, the consumer, will be in a better place if you adhere to my advice and not try to find the best "deal".  To get consistent results you need a consistent technical professional.  You get what you pay for! 

Steven Pedro, MD
Fort Worth Dermatologic Surgeon

Varying Botox results

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As with any procedure, your result can vary with different doctors, or even different visits to the same doctor.  In general, specialists familiar with facial anatomy should have better results wit their injections of Botox.  For facial injectables, one must be able to understand the balance of the muscles which helps treat the specific issues a patient has.

Results may be affected by the units administered, their locations treated, and your level of animation (motion of your muscles) prior to treatment.  While giving botox injections may seem easy enough, there is enough skill involved that results will be affected by one's experience and knowledge.

Roxanne Sylora, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 19 reviews

Botox Not Working Now

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Hi YTT.  It's likely that it's either the injection technique or the second MD is not placing the same number of units.  Most consumers view Botox as a commodity that can be injected the same by anyone using it.  This couldn't be farther from the truth as advanced techniques are not known to many lesser injectors.  That's not necessarily what's going on here, but better injectors are going to command higher prices because they get better results.

A couple other points to consider.  This could be a "bad batch" that was stored improperly, purchased illegally from overseas, or for some other reason is not working well.  If the second MD wants to keep you as a patient, he would remedy the situation by trying again.  If you have not asked for that, you might try.  Good luck.

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

Botox in forehead

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Injecting Botox is an art as much as it is a science and needs to be customized for each patient. If you had good results with the first doctor, is there a reason you went to someone else?

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

Botox worked before, and is less effective now

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There are techniques used that can be slightly different, sure, but more it would depend on the concentration of the Botox, the placement of the injections, and now many units are injected per site. It's not the number of actual injections that would matter. If you liked your first injector, I would recommend going back there.

"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."

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.