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Thank you for your question.
You submitted your question with some photos.
And you describe in your question that you’re 28-years-old and you got Botox® 25 units
in your frown lines, 15 units for your forehead approximately 10 days prior and you’re asking
why you can still frown so easily and that there are these certain lines that are still
present.
Well certainly, it’s important that this type of question be addressed to the doctor
who performed the procedure but I can share with you how I discuss Botox® particularly
for the people who get it for the first time in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
In fact my specialty, oculofacial plastic surgery were amongst the first physicians
to use Botox®.
And so I’ve been using Botox® for patients since 1993.
And as far as my approach to the protocol of treating my patients with Botox® or any
injectable whether it’s a neurotoxin or injectable filler, I routinely see my patients
in two weeks after a procedure especially if they’re new to our practice.
It is always a get to know you process when you do something like these types of injectable
procedures to see how it works for the individual patient.
There is always a range when it comes to the neurotoxin of average doses that are given.
And it’s also in the context of the relative activity of different muscle groups in a given
patient.
Now essentially, it is understandable that if your goal was to have no movement in the
frown area, well if you're still able to move, I can understand why you’re concerned.
A lot of times, you can also follow whether or not your movement or determined, I should
say, what your level of movement is compared to pretreatment.
The ability to move at all is not always a bad thing.
If the frown area still moves a little bit compared to it moving a lot before the procedure
well certainly it’s within a normal range.
But if it’s unchanged at all, then there are essentially two questions that come to
mind: one is whether or not the Botox® was administered in the right places in the right
way which is typically likely since this is a very popular area.
The FDA approval of Botox® Cosmetic is actually for the frown line area.
And so the number 11 is the most popular area to do so it would be difficult to imagine
that it was technically difficult for an experienced practitioner to deliver.
And the next of course is dosage.
You might need a higher dose.
And certainly, that is conceivable.
There are always people who need more and there are people who need less.
And there are patients who come in and say to me who have had Botox® done before that
they’re extremely sensitive and that they want for me to start with very low doses.
And others would say Botox® doesn't always work for them, they need high doses.
So it is really a matter of getting to know your patient.
I think it’s reasonable for you to go back to your doctor at about 14 days as is routine
in our practice and ask this question.
And basically, what I offer is enhancement.
If someone needs enhancement, there’s no problem, we do it.
It’s part of the getting to know you process.
A lot of times, it also gives me an idea of what kind of dose they would need so the next
time we do it, we do it for them, we have a total dose that we know based on the previous
experience to apply at the first treatment.
And I still allow patients to or recommend patients to come back after two weeks for
evaluation.
So I would say that you made a choice of practitioner for your treatment that you shouldn't abandon
hopes so quickly.
Just meet with the doctor and ask about enhancement and learn from there what the right dosage
and areas work best for you so that you get the outcome you want.
So I hope that was helpful, I wish you the best of luck and thank you for your question.