Why Won't My Wrinkle Go Away After Botox?

You've had Botox and there's a line that just won't disappear. What's going on? There are a few different things that could be happening.

First question: is the muscle in that area paralyzed enough? If you have a forehead line and the area is still moving, it's hard to get complete resolution of the wrinkle. You may want to consider:

• Increasing the dose
• Changing how it's injected

If the muscle is still active, the wrinkle can persist simply because the treatment isn't strong enough in that specific area.

There are wrinkles in certain areas of the face that are unlikely to completely go away with Botox alone. It's important to have good expectations going into the procedure and know exactly what to expect. That residual wrinkle may be something that simply won't completely resolve with neurotoxin treatment by itself.

Here's a totally different scenario: the muscle is completely paralyzed, but the wrinkle is still there. This is called a wrinkle at rest — a deep line in your 11s or forehead that doesn't go away even with zero movement of the muscle.

This is really common in people with very strong muscles who didn't get treatment for many years. The repeated folding of that skin causes the area to permanently change and become different from the surrounding skin. Even when the muscle isn't functioning, you'll still see an indentation.

For patients with etched-in wrinkles, depending on how deep the line is, we have several options:

• Skin resurfacing — laser, microneedling, or even a chemical peel to smooth the texture
• Filler — adding a small amount of volume directly into the line to bring it level with surrounding skin

If you have a wrinkle that doesn't go away with Botox, your provider should 100% be able to tell you why. Call the person who injected you, show them what bothers you, and they'll examine you and figure out the next step — whether that's adjusting your dose or adding a complementary treatment.