Why Didn't Botox Work for my 11's?

this is very frustrating for you as well as the doctor. I have seen patients in whom the botox wore off in six weeks but I have not seen a patient that was resistant to obtaining significant muscle relaxation with enough botox units. 25 - 35 units may be needed in the glabella and 35+ for some with unusually large muscles in this cosmetic unit.

Every patient is different in how Botox will work for them.  If you feel you did not see the results you were wanting, contact your surgeon and let them know your concerns.  In most cases it can be resolved simply by communicating your concerns. 

Dear veggieeater-

 

Your Botox may not be working because you may simply need more units.  It would be unusual to have Botox work in other parts of your face but not in the muscles between your eyebrows (the corrugator and procerus muscles).

 

There is a possibility that the Botox units were not injected in the right areas, but given your successful results elsewhere in your face and your trust in your doctor, I think that's unlikely.

 

There is a small chance that you're really straining hard with other facial muscles nearby, and that these other muscles are causing you to still have motion in the forehead area. 

 

Talk to your plastic surgeon, and I think you'll end up with the result you want.


Best Wishes,

Roy

All good feedback from the panel members.  We would not suggest that you have developed a resistance inasmuch as you have seen a response to the treatments.  However, it's concerning that it has taken three treatments in an effort to find the correct dosing and desired outcome.  The fact that these three treatments were done in a short time frame (6 weeks) is one factor in why patients do develop a resistance in some situations (ex: frequent dosing in less than 3 months).

It appears that you have a good baseline knowledge regarding realistic expectations and treatment goals.  Being that you state that you like your physician, it may be worthwhile discussing all of your concerns for a logical explanation and/or remedy. 

We have found that, in our practice, some patients choose to only treat their forehead.  They later mistakingly believe that the frown lines are the same area and should have resolved with the forehead treatment.  Having a complementary 2 week check up has proven valuable to address misunderstanding or concerns and to introduce new options.

Although your MD provided a complementary treatment, your time is valuable as well.

 

The first step is to choose an experienced and expert physician injector who can explain the treatment clearly and can implement the mutually agreed upon treatment. Some expression and movement is normal and desired. If you are in the office for the 3rd time in 6 weeks, then communication between the two of you from the outset was not clear. 

A unit of Botox is a unit of efficacy not a unit of measurement.  Every patient will need a different number of units to effectively weaken the corragator muscle to decease the vertical creases between the brows.  I   Botox is not an exact science.  Caution has to be used no the forehead where an over dosing of Botox will lead to dropping of the brows.  Sometimes it is impossible to totally eradicate any movement of the corragator muscles.  

Most neurotoxins, except for the rare person who is resistant to it, will decrease muscle function and that will help the number 11s because they are a result of muscle action.  However, if the muscle is no longer moving to any great extent, filler in combination with the neurotoxin is really the way to go.  Very often it seems as though the neurotoxin doesn’t work, but it’s because not enough product was injected.  Sometimes one can switch to Dysport or Xeomin, but generally you should be able to have a good result from any of the neurotoxins as long as a significant enough volume was produced.

It is possible that you are immune to Botox.  Go to a specialist who is experienced in the use of Dysport.  I am personally immune to Botox after 15 years of use, however Dysport works great for me.  Be sure to get treated by an expert who is familiar with the use of Dysport.

Botox works by interrupting the signal from the nerve to the muscle causing the muscle to contract.  Things that can interfere with this include:

1. dosage/amount of Botox may be insufficient.  That being said, you do not want to immobilize the face completely.  Some limited motion makes it look much more natural than a frozen look.

2. Botox may wear off earlier in people who engage in intense exercise.

3. Some people may make antibodies to Botox (usually not in cosmetic patients, but in patients in whom large doses of Botox are used for muscle spasm, etc.).  Patients with antibodies to Botox will be resistant to the action of Botox.

If your 11's disappear when your face is completely relaxed, Botox should help.  Injection of filler in the 11's must be done cautiously and by a board-certified dermatologist or plastic surgeon with proper training and experience of injecting filler in this area. 

I have seen only one patient who did not respond to Botox after multiple injectons by different doctors. Yopu may be recruiting muscle contraction from the lateral portion of your corrugator muscle. Try another cosmetic surgeon.