Why is filler and Botox not working for me? Deep frown lines between eyebrows? Options? (photos)

Question

I've had Botox injections twice within the last two and a half months, 45 units in the glabellar area only and 10 more units on top of the forehead. Also three syringes of Juvederm Ultra Plus to fill in the lines in three sessions. The first three or four days the lines looks better, but after a week the lines still come back. Botox has created bulges between my frown lines and a new line on top of my eyebrow. I did the second dose of Botox a week ago, 45 units again and I still frown, lines still deep.

Jason Emer, MD · Answer

If Botox is not an option for you, Dysport or Xeomin are the next options. I suggest dermarolling at home to give the skin Botox-like effects with at-home treatment. See an expert. Best, Dr. Emer

Misbah Khan MD, FAAD, FACMS · Answer

Botox takes time to soften the lines esp if they are very active muscles. best is to do it consistently for alike a yr or so then eventually the lines will soften up.

Camille Cash, MD · Answer

Ninety units of Botox is quite a high dose for the glabella area.  It can take up to two weeks for Botox to be in full effect so you will want to wait another week before determining the effectiveness of the treatment.  If you are not seeing improvement after ninety units you may be resistant.

Anshul Gambhir, MD · Answer

Thank you for your message and I am so sorry you are dealing with this! It is possible you are resistant to Botox. That being said, I would give it some time for everything to settle. Over time, the more consistent you are with neuromodulators such as Botox, the more your resting lines will soften. It is possible you had too much filler in that area as usually a syringe or less is needed. I would give it some time and then potentially seek out another provider to get their opinion!

Michele S. Green, MD · Answer

From your photos it seems that you may be resistant to Botox and it seems that you may have had too much filler in this area.  It should not take 3 syringes to fill the glabella area.  I would wait a few months to have this dissipate and then consult another expert injector in regards to this area. A better combination could be Dysport and Restylane.  Please consult an expert in cosmetic injections for the best cosmetic results.  Best, Dr. Green

Mayli Davis, MD · Answer

Hi,
I think you need to give it more time.  Many people think one treatment with Botox will make all the lines disappear, but it doesn’t work that way.  The lines will soften with time after not being forced into that shape by the muscle.  It often requires several treatments (3 months in between) so it may several months.  I agree the filler may be responsible for more bulges, so hold off on any more filler for now.  Be patient! We all want a quick fix but it’s not possible.

Richard Ort, MD · Answer

I would let things settle down for a while and then would get an opinion from another injector. You might want to try an alternative neuromodulator such as Xeomin, which is similar to Botox but has less risk of immunologic reaction or antibody formation. You need to be very careful with filler injection in the glabella as this is a high risk area and needs to be done very carefully. Regards,Dr. Ort

Drew Varano, MD · Answer

First you need to give Botox 2 full weeks to take final effect . If at that point there is still movement  then It is possible to have natural immunity or develop immunity to Botox . 2-3% of individuals can have some immunity. You can try an alternate neurotoxin but there is no guarantee you will not be resistant to others . 3 syringes of Filler injected into the glabellar region is a significant amount , this will not prevent a dynamic wrinkle ( wrinkles that occur with action such as frowning) but are better used when there are static wrinkles. Also the initial improvement 3-4 days after a filler are due to swelling which limits muscle movement , which will return once the swelling subsided  . If your problem is dynamic wrinkling and your injector is injecting 3 syringes of filler in the glabellar area to help the issue  , I would suggest trying another injector and using a different neurotoxin like Dysport

Lamia Wassef, MD · Answer

Thanks for your questions 
Sometimes your body will produce antibodies against Botox so if you had Botox for long time you need to change it to Dysport or xeomin.
Try another injector, it depends how they dilute the Botox.
Go to somebody professional and certified.
Good luck
Dr Lamia WASSEF,
Ottawa

Robinson Facial Plastic Surgery - Alpharetta · Answer

Hello! It appears that your treatment has been at least partially effective! Botox has a predictable and consistent outcome. Having 45 units should be more than sufficient to immobilize the glabella. The key factor is how it is injected. According to the photo, your corrugators are still active and need to be directly injected into the areas of continued movement.  This means that your pattern will extend beyond the “approved” dosing pattern. It should only take a few units to accomplish this, as long as it is placed appropriately. All the best!
Michelle Giglio, PA-C, MMS

Why is filler and Botox not working for me? Deep frown lines between eyebrows? Options? (photos)

Answers (10)