Filler not working. Is this normal?

Hi, I had botox on my 11s back in June with 27 units I also had 24 units on my crow's feet but I still was not happy with the results I wanted to achieve. So last week I had some filler injected into my 11s. But still you can see these horrible line's. They do look a bit smoother but I thought after botox and filler they would completely go. Could you please tell me if this is normal. It is my first time with botox and filler.

Doctor Answers 9

Filler not working, is this normal?

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Thank you for your question. It is difficult to give you advice without seeing a photo or examining you in person. However, Botox and filler when combined are typically very effective in the glabella region. It may be possible that your wrinkle(s) are very deep and this is why it is not fully corrected. I recommend having a follow up with your injector for and evaluation. Best of Luck!

Summit Emergency Medicine Physician

Botox and Filler not erasing wrinkles; consider proper Skin Rejuvenation

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Dear gem 123:

Yes, Botox and fillers are 2 of many improvements in wrinkle improvement.

  1. Botox will relax the muscles that create the wrinkle but do not "erase" a wrinkle. 
  2. Fillers (generally, HA's (hyaluronic acid gels), are used to elevate or project or plump the depression of a wrinkle 
Re-evaluation of proper diagnosis and injection technique should be your next step but they are only part of the answer.

What is a wrinkle?
The wrinkle is made from:
  • accumulation of dead cells of the epidermis on either side of a wrinkle line giving the appearance of greater depth and shadowing.
  • thinning and therefore less resistance to folding of the dermis
  • thinning and therefore less projection of fat under the line
  • increased thickening due to unbalanced use of the muscle (typically) perpendicular to the crease.

Depending on the age and the cause of the wrinkle will determine which option(s) are best.
So, in addition to 1 and 2 above, you may consider properly evaluated therapies to:
   3. exfoliate the epidermis with microdermabrasion, epidermal peels, exfoliating laser therpies, retinoids
  4. dermal stimulation of cellular regeneration and structural proteins for strength, hydration, firming and thickening with retinoids, dermal laser, IPL, Sculptra and deeper dermal peels. 

I recommend you return to your injector or another physician certified in the evaluation and use of the ZO Obagi Therapeutic Skin Health Management System to improve, rejuvenate and protect your skin.

All the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Filler and Botox for Glabella area

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Botox and filler is usually very effective in the glabella area as a combination treatment.  It is possible that your glabella wrinkle is very deep and that is why it is not fully corrected.  Without a photo it is difficult to determine. I suggest you return to your treating physician for discussion and evaluation.  

Filler not working, is this normal?

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It sounds like your filler is working the way it should. It was your first time with Botox and filler so, it may take some time for your Botox to soften the lines more. The filler works instantly and you may just need a bit more to completely soften. Follow up with your injector to address your concerns.

Thank you for your question and good luck!

Kate Ross, MD

Kate Ross, MD
Bradenton Dermatologic Surgeon

Botox and filler not working

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Without seeing any photos, it is difficult to answer your question.  Occasionally, neurotoxins - like Botox - may not work, and the treatment will need to be repeated.   I would call your provider and discuss that you are not pleased with the results.  

Joseph Franklin, MD
Durham Plastic Surgeon
5.0 out of 5 stars 8 reviews

Filler and Botox for the 11's

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There are many factors that could contribute to the lines not going away. The first thing to consider is how deep was the line to start with. If you have deep lines, it will take many botox injections over the year to soften the line. In terms of the filler, what type of filler was used? The filler placement is also important. Overall, I think your expectation was likely to high for the first treatment. It takes years to develop those 11's and will take months to years to get rid of them or soften them to your desired level. All the best!

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
4.9 out of 5 stars 16 reviews

Botox and Fillers

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Your combination of Botox and fillers should have accomplished more than you say your results show. Perhaps you were not given enough Botox or it was not injected properly. On the other hand, it is possible that your frown lines are just too deep to treat. Please share photographs for better evaluation. You should see your doctor again as well. Good luck.

Botox and filler for 11's

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Was this treatment performed by a physician? a qualified and experienced physician? How many years did it take for the glabellar furrow's to deepen as much as they had prior to your treatment? why were you under the impression that one treatment of Botox would resolve the wrinkles? Botox will only minimize progression of active wrinkles. If your 11's are deep at rest, Botox can only keep them from getting worse. Filler in this area should be approached carefully and only by experienced physicians to avoid intra-vascular infiltration and skin loss. The most important part of a cosmetic consultation is to set realistic expectations for the patient with the treatment they have chosen. This was clearly not done in this case.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Filler not working. Is this normal?

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Hi and thank you for your question. I usually advice patients with more pronounced wrinkling that they will see improvement after the first treatment however, long term use of the product whether it be Botox, Xeomin, or Dysport will help soften the lines over time and overall you will be happier with the results. Generally, we set a patient up with a follow up muscle paralytic injection right around the 10 week mark and I will take pictures to reference their improvement with continued treatments. It could be at this point that you might require slightly more product or you could require a different product all together. If you noticed some improvement with the filler, it could be that the lines were slightly more pronounced. My best advice would be to continue to follow up with your plastic surgeon/nurse that did the injections for you, so that they can recommend based on the results that you are looking to achieve a treatment plan. I hope this information helps you and good luck. 

Fadi Chahin MD, FACS
Plastic and Reconstructive Surgery
Diplomat-American Board of Surgery
Diplomat-American Board of Plastic Surgery

Fadi Chahin, MD, FACS
Beverly Hills Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.