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Botox Resistance - Why Doesn't Botox Work for Me?

I had Botox injections between the brow. The frown line was still present a few weeks later so I returned for another injection. I am starting to think that I am crazy. I can feel the other muscles in my forehead "fighting" the paralysis. The line is still there and it seems that from the point of the arch of the brow the muscles are furrowing inward. If I lift my brows the line goes away but when I relax the forehead the furrow is back. The MD who did my injections said he gave me a lot of Botox. I went to him because he is a friend of one of my friends so I don't think he is using inferior product. But I am so disappointed. Is it possible that Botox just doesn't work for me?

Asked 44 months ago by Julianna

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failure

Resistant to Botox

We're wondering whether you are resistant to Botox or if Botox is not the right tool for the problem. Every once in a while, we see a patient with ONE vertical line in the area between the eyes that is so deep that Botox will not fix the problem. In these cases, it is possible to use Botox and/or a dermal filler such as Restylane to solve the problem. While this injection technique is not that common, it can be very effective when used by an experienced injector.

Doctor's Website

Harold J. Kaplan, MD

Los Angeles Facial Plastic Surgeon

Botox resistance rare, but possible

It is possible to develop a resistance to Botox, but this is extremely uncommon. Other reasons for failure of treatment can be related to injection technique or inadequate number of units. The dilution technique is not relevant, but the total number of units injected is the key. Another reason for "failure" may be when the corrugator/procerus muscles are immobilized there is recruitment of orbicularis oculi muscles. What this means is that the eyelid squeezing muscles can create... more

Brett S. Kotlus, MD

Rochester Oculoplastic Surgeon

Botox Resistance

There are rare but documented cases of Botox resistance. If the Botox was stored properly, freshly opened and mixed properly, you may need additional units to obtain optimal results. You just need to ensure that you are not receiving too many units in order to avoid possible side effects. If a photo was taken prior to treatment, you may want to see if any improvement occured. If you did receive some improvement, you may need to repeat the treatment after a few months. The muscle is... more

Kris M. Reddy, MD

West Palm Beach Plastic Surgeon

ASAPS

I would agree with Dr. Sinclair's bulleted list...

I would agree with Dr. Sinclair's bulleted list completely; however, I do not agree with his assessment that all failures are due to the injector and not the Botox. There are case reports of failure of Botox, even in the cosmetic realm after its reformulation. The most recent of these reports of failure of Botox Cosmetic was provided in the facial plastic surgery clinics of North America in 2007. Several other case reports of Botox Cosmetic have been published as well as several case... more

D.J. Verret, MD

Dallas Facial Plastic Surgeon

Botox Resistance if Very Rare, Need for Filler is More Common

Julianna, Resistance to Botox is very rare (1:10,000) and the cause is not completely known. What is known is that your body forms an antibody response to the Botox. If you do have resistance, there are other forms of Botulinum toxin that can be used. That said, it is unlikely that you are resistant. From your description, it seems more likely that you need a dermal filler in addition to the Botox. Botox works on dynamic wrinkles - that is, wrinkles that appear when the muscle... more

Doctor's Website

David Shafer, MD

New York Plastic Surgeon

ASPS

Botox "resistance"

Sometimes the muscles between the brows (the corrugators) are bigger and more hyperactive in some people. For this reason, one patient may require a little more of the product than another patient to gain the same amount of paralysis of the muscles. The muscle also spans from the top, or root, of the nose all the way over to the lower forehead just above the inner third of the bony orbit of the eye, so the expanse of the muscle belly needs to be injected in order for it to be completely... more

Jennifer Walden, MD

Austin Plastic Surgeon

ASAPS ASPS

Botox resistance

There are occasional cases of true Botox resistance. If you are indeed resistant to Botox (botulinum toxin type A), which is very rare, you might be more susceptible to botulinum toxin type B, which will be coming on the market soon. In these cases, treatment with Restylane can provide enough volume support to improve your appearance significantly. Often it is helpful for patients who respond well to Botox, but have really deep creases, and need additional correction. Sometimes, the... more

Stella Desyatnikova, MD

Seattle Facial Plastic Surgeon

Why Botox doesn't work for some

"Why doesn't Botox work FOR ME?" and "What is wrong WITH ME?" are the most commonly heard self-directed complaints we hear from patients coming to us from other offices or spas thinking that somehow they are to blame for inferior or non-existent Botox results. Let's cover the causes of "Botox work for me"RAREST cause - your body has formed a resistance to Botox by forming antibodies to it. It is known as TACHYPHYLAXIS (take notes - this would sound great at a... more

Peter A. Aldea, MD

Memphis Plastic Surgeon

ASPS

Botox issues

It is unusual for a patient to be immune to Botox. However, there are some patients that develop resisitance and newer products not yet available may be helpful( Reloxin). Reloxin is derived from a different strian of botulinum toxin than Botox. If the muscle are paralyzed and theline is still there, then it is most likely a dermal deficiency crease which may benefit from undermining surgically or a filler or the combination of the two to soften its appearance.