Botox for Frown Lines (52 Units) Doesn't Seem to Work. Why? (photo)

Thank you for your question. The frown lines between the brows can be address two different ways:1) Botox or Dysport can be used to soften the deepening of the frown lines when making a frown expression. The treatment may even soften the lines that are present at rest. The effects typically last 3-4 months depending on the dose. I generally use between 15-40 units of Botox (30-120 units of Dysport) in the frown area depending on the strength of the muscle and the degree of frown reduction we are trying to achieve. 2) Restylane or Juvederm can be used to soften the frown lines that are present even when you don't make an expression. This can last for a year or more when used in conjuction with Botox.For someone who has concerns with both the static lines (without expression) and the dynamic lines (with expression), then using both products would work well together. I often find that patients who return after a Botox or Dysport treatment in the frown areas complaining it didn't work, is due to the confusion between the static and dynamic frown lines. They continue to see the static lines even though the dynamic lines have softened considerably.In your case, I would recommend adding Restylane or Juvederm to soften the remaining static frown lines.

Usually my upper limits of Botox in a woman has been 25 to 35 units for just the glabella (5 to 7 insertion sites) between the eyebrows. In some men with larger muscles, I have used rarely, more than 50. Your doctor, might have injected other areas other than just the glabella. If it was Botox and not Dysport, then the units you had should have reduced the frowning ability although that doesn't guarantee the lines or creases diminish right away. Some people have creases that have been present from years of contraction that they need a long time of relaxed skin overlying relaxed muscles before the lines fade. Regardless, you need to make sure that it wasn't Dysport because if it was, then the number of units can be increased.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs.

52 units to this area is very high and it's unclear to me where exactly you were injected if you aren't seeing any reduction. If you are visting a reputable office/injector, the Botox would likely have had a negative effect at this point.

It is unusual that have not seen any improvement with 52 units of Botox. Many factors can affect the results, from the dilution, how long ago the vial was open, if has been properly stored, the site where it was injected. Also you need to aks if you really got Botox, or a different botulim toxin, like Dysport, Xeomin, etc.

Did you doctor take a picture of you at rest and frowning prior to your first injection?  This would be useful to compare.  If you have no effect whatsoever, then either the Botox was bad or you have an antibody.  It would be very unusual to not have complete effect from that much Botox.  I typically inject 15u for the frowners and it is plenty for the vast majority of patients. 

Hi Gina.  If the picture of the "11" lines shows the exact area that this physician was injecting, then 52 units is a much higher dose than normally required.

I would suspect there is a problem with the product that is being injected because if the Botox was sound, it would have had some effect.  Perhaps this physician has received a batch of vials that has not been properly stored and has lost effectiveness.  

It is strange that the physician added more at the second visit though as 20 units is standard for this area and if 42 did not work, then something would be wrong.

Lastly, it's possible that the number of units this practitioner is telling you are being used is not correct.  In any event, I would try someone new and ask for a refund or partial refund.

Would you say that there was no improvement at all, or some improvement even with still being able to frown?  If there was absolutely no change, then it is possible that you have an antibody to Botox and that it would not work for you.  If there was some improvement, then most likely it is more an issue of placement and dosage.  If it turns out that you have no effect with Botox, it might be worth trying one of the other brands to see if there is any difference.  In my experience though, if a patient has absolutely no effect with Botox due an antibody, then the other types do not work also.  I would return to your treating doctor to be evaluated again.  

It appears that the Botox has minimized and relaxed your frown but you have deep creases that will not resolve with Botox alone.  Botox relaxes movement and you may not be able to completely stop all movement and still have a natural look.  You require some filler into the creases for plumping.  Please have your treatments with a certified dermatologist or plastic surgeon to obtain the best possible results.

Every person is different, and your muscles appear fairly strong, so 36-48 units would not be unreasonable. At the same time, adding a bit of filler if you have lines etched in at rest can be useful too. Would be nice to see your before & after photos, as there is likely some benefit, though not as much as you expected. The batch may have been expired or improperly reconstituted, or you may have antibodies against Botox and so it won't work in you (unlikely).

I generally do not have to use that much Botox to treat the glabella area.  It is possible that your 11's are so deep that you may need your forehead treated with Botox.  You may need a hyaluronic acid filler if the depression is very deep.  If you can still move that area then your Botox was ineffective.  You should go back to your treating physician.