Botox Resistance After 6 Treatments?

I've had botox to crows feet approx 5 - 6 times with no treatments lasting much beyond 2 months, approx 20 units each time. First results were great, last time it took a long time (and I had a top up of two units per side) to see with far less improvement.

Am I getting botox resistant? I can't afford to not have results - I save up for these treatments. Are there any worthwhile/affordable alternatives for crows feet? Help!!!!

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10 Doctor Answers | Asked by Learning in New Zealand

Doctor Answers (10)
Community Comments (0)

Botox Resistant in Crows Feet is a Misnomer

Aha, I am so happy to see this question. I spent many years getting frustrated with a few patients where I could not get the crows feet to respond, no matter how many units I put in. Finally, one day I was watching a physician's webinar when she mentioned the same problem and stated that 'IT IS CAUSED BY THIN SKIN AROND THAT AREA WITH YEARS OF LOSS OF COLLAGEN. WHEN ONE SMILES THE CHEEK IS PUSHED UPWARDS AND YOU SEE WRINKIES CAUSED BY PRESSING THIN SKIN BETWEEN CHEEK TISSUES AND THE... more

Botox resistance

In theory, you could be resistant to Botox through the development of specific antibodies that neutralize it's effect. However, this is rarely seen and may be related to technique. If this is the case, then you may want to ask your doctor about newer different alternatives such as Dysport.

Steven Hacker, MD

3 reviews

West Palm Beach Dermatologic Surgeon

Botox resistance.

There are some patients that have Botox resistance. Fortunately other forms of Botulinum toxin are now available that work a bit differently. Dysport is one new form that is Botulinum A and should be effective if you are resistant to Botox.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Change practitioners

I don't think it's possible to be Botox resistant. However, are you really getting 20 units? I use new Botox each time and 25 units per side. My patients are paralyzed for up to 5 months. Also, is the injector getting it deep enough? If he/she is only putting it under the skin it won't do much. It must get into the muscle. This is evident by the "crunch" that is felt during injection. I would try a new physician, not nurse or spa or traveling salesman, a physician who... more

I have never seen Botox resistance.

Hi. In New York, we have done thousands of Botox injections, and we have never seen resistance. Try another doctor, and maybe you need 30 or 40 units, but I believe you can expect a good result for 4 months. Technique is very important.

I need to know a few things

You did not state your age or sex. While 20 units is fine for a female in her 20's and maybe 30's, it is totally inadequate for someone older because of skin laxity, and it is not enough for men because their muscle mass is bigger. That is why we recommend patients start Botox (and now Dysport) younger in order to prevent those deeply etched lines that Botox alone can't handle efficiently. The major sign of inadequate dosing is short duration of effect. You certainly might want to try... more

BOTOX resistance is rare

Dear Learning, Before you declare yourself BOTOX resistant, ask yourself a few questions: Have you been getting treatment by the same injector? Does the office do before and after pictures and show these images to you so you understand what the treatment is doing for you. In Los Angeles, some offices sell BOTOX at a price per unit that is less than the cost of the service. Generally these offices have a generous "top off policy." I think the reality is that many of these offices... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Botox resistance: consider Dysport

If you are Botox resistant, you may want to consider using Dysport as an alternative. This recently became available and may be a good option to test if you are resistant to Botox or the basic product : Botulinum toxin A.

Otto Joseph Placik, MD

33 reviews

Chicago Plastic Surgeon

Botox resistance

True Botox resistance with total absence of response to injections is rare. Partial resistance is more common. You might need to have a higher dose to achieve the same response. You might consider trying a different doctor for treatment to see if slightly different technique might give you better results. If these don't work,different medications, such as Dysport (same Botulinum Toxin A) or Myoblock (different toxin - Botulinum Toxin B), might give you the results you are looking for.... more

Antibodies; Add superficial filler

If your physician is injecting the same amount of Botox and you are getting less and less of an effect, you may be developing blocking antibodies to the Botox. Usually, Botox will last somewhat longer between injections in someone who has received multiple Botox visits as the body has difficulty re-establishing new nerve-muscle connections. However, if you are finding that Botox is working less and less, and you are receiving the same or increaed dosages, you may be developing antibodies.... more