I have 41 units of Botox in my forehead and the lines never disappeared. I having been getting Botox for 8 years. What do I do?

41 Units seems like a lot of Botox to have in your forehead. Especially if it only lasts you 1.5 months. I would question whether you are actually getting the Botox dosage you have been told you are getting. You might be getting Botox that has been overdiluted and that's why its only lasting 1.5 months. Botox when given properly should last about 3-4 months. It's important to understand that very deep wrinkles and lines may not completely disappear with Botox, although they can be significantly decreased. Sometimes a little filler may be required to smooth out any lines that remain after the Botox has reached its full effect. If you continue to be unhappy with your injector and results then you should consider finding a new injector. Hope this helps.

Schedule a follow up and express your concerns with the original injector. If you lose confidence seek out a reputable experienced injector and start over again with a consultation. Ensure you are waiting 2 weeks at least between Botox injections. Hope this helps. 

By forehead do you mean the 11 lines (glabella) and the lines above (forehead)?  If that is the case, that is a resonable amount and you may need to try switching to a different filler such as Dysport or Xeomin.  I suggest speaking to the injecting physician about what they can do for you.  I have had some patients who need to switch toxins after some time.  Best, Dr. Emer.

While I agree that starting with the correct dose is standard of care and there are some practitioners who may over  dilute the product thus administering less than an effective dose, some patients simply require a higher dose than others. Therefore increasing the dose may be required. Still other patients have lines that are too etched in and are non-dynamic. These patients do well with additional filler to treat the static rhitides. A product such as Restalyn or Belotero would be appropriate. 

Hi SJS.  The first question we have is "are you going to the same injector?"  Although Botox is a product, it's also a service and if you have proper results with your initial injector you may want to return there.  We hear this often from our patients that "cheated" on us.  They go somewhere else and then come back when they experience a lower level of service or subpar results.If it's the same injector, it could be a bad vial of Botox.  It could also be that you are growing resistant to the Botox (happens rarely, but does happen) or finally, that you are at an age where you need a bit of filler in the area between the eyes to completely resolve the frown lines.  Take a look at the before and after photos at the link below to see a Los Angeles patient that had very pronounced frown lines and needed both Dysport and filler to completely resolve her lines.

Typically, if you are using the same injector repeatedly, you should get predictable results similar to what you experienced in the past. If you change injectors you may see a difference in the result. I suggest that you find an experienced injector that you trust and like and try and stick with that person. 

Generally speaking , a patient who is receiving the appropriate dose should not experience this issue. If the dose of BOTOX® Cosmetic is too low to relax the muscles in the treatment area the results will be compromised. If the BOTOX® Cosmetic is not injected into the correct muscle, the treatment could be inefficient.  Another factor to consider is the dilution of the product. I suggest doing some research as to who is a reliable, experienced and reputable cosmetic dermatologist in your area.

This is a difficult question. The lines often take more time and repeated injections over time. Also , you may want to consult a plastic surgeon

I have been using Botox since before 1997 for the frown and never have had seen it not work. The original injection pattern was 20 Units in 5 places  and I would combine it with 1/2 a forehead of 9-12 units. Bigger people needed slightly higher doses and at times I combined it with fillers but it always worked. This is about you being treated with to few units----go elsewhere.Dysport diffuses more than Botox and the 3:1 ratio does not always work. Also it does not last as long. While Xeomin diffuses like Botox it has a shorter duration of Action. AWK

My assumption from your question is very much along the line with Dr. Kaplan. I assume that you went to a different or perhaps "cheaper" injector? If your Botox has always worked before for 6-9 months, then I would assume it would be the same if you went to the same injector. If not, you results may not be as good.... because it's not that the Botox isn't working (unless it was a bad vial but I've had 2 bad vials in over 20 years!), it's that you went to someone else who dilutes differently, uses a different injection technique or unit amount, or who simply may not be as experienced. Remember that Botox has no idea what to do on it's own - it is injector-dependent!"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."