Immune to Botox?

I am 53 years old and I have had Botox injections on 5 separate occasions from 5 different board certified doctors hoping that I would see results. I did not. The "eleven" lines between my brows are fine (not deep) therefore I thought Botox would be perfect.

Is it possible that I have antibodies that would prevent me from getting results from Botox? Is there an alternative to Botox that would give me the results I am searching for? Thank you so much for your time and advice!

Doctor Answers 16

Botox immunity, a growing problem

Patients who receive dilute Botox at clinics, then come in frequently for touch-ups when the weak Botox fails can, I believe, essentially develop immunity to Botox. It is actually a growing problem.

Fortunately, if all the Botox is allowed to go away for a period of 6 months, and the patient goes to a reputable doctor who uses concentrated Botox, applied to the right muscles, most patients can return to a normal Botox injection cycle every 3 or 4 months.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 117 reviews

Possible, but probably require a higher dose

Hi DW,

Of the thousands of Botox patients that I have injected, I have never encountered a patient with immunity to the effects. There have been patients that require higher dosages, sometimes twice the usual amount.

The most popular Botulinium Toxin type A in use, and the one that you probably received from your 5 injectors is Botox manufactured by Allergan. You may consider using Dysport which will soon be marketed by Medicis as Reloxin. Mentor will be putting out another alternative called PurTox. There are two other forms Xeomin in Germany, and Prosigne in China.

If you have superficial lines in your glabella, a fractionated CO2 laser resurfacing is a great alternative, and a more permanent "fix". At age 53, you (like me) are showing other signs of aging like lax skin under the eyes, face and neck, hooding of the upper eyelids, crow's feet, and general sun damage of the skin. A single treatment with Fraxel re:pair, Active/Deep FX, or Mixto will give you overall skin rejuvenation, help you look years younger, rested, and healthy. If you choose to go with the fractionated CO2 laser, make sure to choose your treating physician most carefully. Be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Try a Filler Instead

There are rare situations where a person's body may not react to Botox as expected, and you appear to be one. As an alternative, you might want to try a filler for the number 11 lines such as Restylane or Juvaderm. Without actually examining you, it's difficult to say what might be best. Also a surgical procedure could be performed to intentionally cut some of the muscles that create the #11 lines. I hope this helps. I am sorry that it did not seem to work well for you.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 22 reviews

Consider Dysport

Why not try a different type of muscle inhibitor, such as Dysport? If that doesn't work, then you an consider a different treatment such as fillers.

Botox resistance

In some rare cases, patients may not react or no longer react to botox.  Dermal fillers are a safe alternative in the hands of an experienced injector on the appropriate patient.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 26 reviews

Botox does not immediately erase lines, but it does over time!

You say that you had Botox injected by five different doctors on five different occasions. This makes me wonder if you had all of your five treatments in a row, every three months, or whether you tried every 6 to 12 months.

I ask this because you said you have fine lines between your eyebrows (frown lines) which aren't deep. But it is very possible that the Botox DID work..... to prevent you from frowning and folding the lines, but that the Botox wasn't in place long enough in a row to allow the lines to totally flatten over time.

If lines are deep enough, Botox does NOT erase them. It only prevents the underlying muscles from repeatedly folding the skin... and as the skin stays flat over months (and months)... the lines may smooth out. I am not totally surprised that you could still see visible fine lines after each Botox treatment.

If you want to try again, remember how the Botox works, and ask your board-certified dermatologist or plastic surgeon if a small amount of filler under the lines would help you with more immediate line erasure, while the Botox sits in place to prevent re-deepening. Good luck!

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
5.0 out of 5 stars 42 reviews

Immunity to Botox

Rare, but not unreasonable....however, from the wording of your question, the botulinum toxin you received never worked for you. I have had a few patients with the same issue....Recently I have treated these patients with a higher concentration of the medication and therefore a smaller volume which allows less migration of the drug and therefore has been more effective. I also think this limits the amount of effective drug needed and lowers the risk of immunity in the future...only theoretical though. 

There is also recent information, and I am awaiting scientific data, to show that vitamin supplements (Zinc) may increase the effectiveness of Botox injections. We'll see....

Hope this helps!

Dr. C

John Philip Connors III, MD, FACS
Atlanta Plastic Surgeon
5.0 out of 5 stars 32 reviews

Immune to Botox / Botox Resistance

There is about at 1 in 10,000 chance of developing antibodies to Botox.   I have seen two patients in my practice with this problem.  If you are concerned, your blood can be tested for the antibodies.  Also, there are other botulinum toxins, such as Myobloc, which can be used effectively in patients with immunity.  Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 64 reviews

Immunity to Botox

I've had a couple of patients develop immunity to Botox over the years.  They both responded very well to Dysport, which is a different type of botulinum toxin.  I would only used Dysport, however, on one of my own Botox patients.  There are a lot of injectors out there who do not inject deeply enough (especially between the brows where the muscles are deep) or who really dilute their Botox.  For patients who have not had good luck with Botox from another injector, I will  give Botox another try and it usually works. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 56 reviews

Botox immunity possible, but unlikely

It is possible to have antibodies to Botox.  If you have ever had botulism you would have antibodies.  People can also develop antibodies to Botox if they have received large doses of Botox (like for cerebral palsy treatments).  It is possible to have antibodies for no known reason, but quite unlikely.

Keep in mind, that Botox directly affects nerves (and thus muscles), not the crease.  It is more likely that Botox is working, but you are not getting the indirect affect (the wrinkle going away).  A week or so after a Botox treatment, look in the mirror and try to scowl (draw you eyebrows together).  If you can't do it, the Botox is working, it is just that your skin isn't self-repairing the crease.  Keep in mind, however, that you are still at least preventing the crease from getting worse.

If after Botox you can still scowl, then something is wrong.  Either the injection missed the target, or you are immune.  It is possible that Dysport may still work as the protein complex is a bit different and the antibodies may not recognize it.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

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.