3 wks after botox (45 units for my glabellar) , I'm still able to scowl & vertical lines appear on my forehead: Is this normal?

Question

After having so many injections, I would have thought my forehead would be "frozen" (I was a bit skeptical with the dr. recommending 45 units)? My follow up is this week and frankly, I am not happy with the results.

Marc DuPéré, MD · Answer

Thank you for your question.  One has to make sure of the anatomical regions treated.  The frown lines between the eyebrows is the glabellar region.  Anything above and on the sides is considered forehead.First and foremost, you should go back to your injector for an assessment.  In my 2 Visage Clinics, a normal dose for the glabella alone, for a woman, is 25-30 units, whereas for males, it is more 40-60 units.  Treatment takes effect within 3-5 days for most people.45 units for both glabellar AND forehead together, for a female, would be a normal dose.There are other neuro-modulator on the market and some require a higher number of units for an equivalent effect; we have Botox, Dysport and Xeomin.The injector is the one reconstituting the neuromodulator (it comes as a powder).  Make sure you see a qualified injector.  And remember, there is an art in all the injections available in Canada; neuromodulators, juvederm, restylane, Selphyl, Voluma and Volbella, Radiesse, Sculptra, etc.I hope this helped!Dr. Marc DuPere, board-certified plastic surgeon, VISAGE Clinics, Toronto and Richmond Hill, voted TOP plastic surgery Clinic in Toronto for 2013 by Consumers Choice.   416.929.9800

Martin Jugenburg, MD · Answer

45 units a strong dose.  Unless you are a man with very strong frown, you should notice a difference.  Also 45 units is something that in our clinic is used to treat the entire forehead, not just the glabellar area.It's difficult to say why it didn't work for you.  Was it a "Dr" that did your treatment?  Was it really BOTOX and not some watered down solution?

Kenneth Hughes, MD · Answer

Injecting 45 units of Botox to the glabella area is a very high dosage, your provider may have treated other areas with this amount, its best you schedule a follow-up

Martie Gidon, MD, FRCPC, FAAD · Answer

You should be assesed by your doctor to see what dynamic movement you still have.  You may require more Botox into different areas to achieve the result you would like.

Arun Rao, MD · Answer

LMV-Every patient is different and everyone's muscles in those areas are different. Usually the results of botox are known after 1-2 weeks. I would let your plastic surgeon know about your concerns. If you have had botox before some patients become resistant to it and the surgeon needs to try a different type of botox like dysport.  Good luck.

Daniel Yamini, MD, FACS · Answer

Dear LMV,You definitly have to go back to your doctor and clarify exactly what treatment you had.  You mention both your glabella and your forehead.    Injecting the glabella will not affect the forehead muscles. Those are two different regions of treatment.  Botox is FDA approved for up to 20 units in the glabella.  20 units is actually a very strong dose of Botox and should completely immobilize those muscles on virtually all patients.  Make sure your doctor was not using Dysport (an alternative to Botox) where 45 units of Dysport equates to about 15  units of Botox.Best of luck!

3 wks after botox (45 units for my glabellar) , I'm still able to scowl & vertical lines appear on my forehead: Is this normal?

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