Botox Not Working for 11s After 10-14 Days? (photo)

I have considerable experience using Botox for aesthetic purposes, having started doing so in 1991, eleven years prior to its official FDA-approval for this purpose. Throughout that time, from time to time, I have encountered individuals who had at first responded well to treatment, but who, after two or more prior treatments, demonstrated either no response, weaker response or shorter duration of response.

The medical literature estimates the development of antibodies in the range of 3%-13%. However, it seems that  even among those with proven antibody formation few actually demonstrate any significant loss of responsivity to further treatments. This of course does not rule out that some may indeed do so and this fits my own experience in twenty-one years of injecting Botox for dynamic wrinkles.

An increased chance for promoting antibody formation may also be related to the routine practice of bringing patients back after just two weeks to touch up any areas that may not have completely responded to treatment. For this reason, it is currently deemed wiser to bring patients back no sooner than a month following treatment for touch ups.

When there exists no other obvious explanation for lack or response or loss of response or shortening of duration of response (such as changes in dosing or concentration, etc.), and antibody formation is suspected, a trial of Xeomin, another bolulinum neuromodulator would be reasonable.

Xeomin is essentially a naked  Botox, stripped of the proteins that come attached to Botox that are believed responsible for triggering the development of antibodies. I have found Xeomin to helpful among the few patients I have had recently  in whom I have suspected antibody-related resistance, In such instances I have seen full responsivity restored.

Although Dysport, the third approved botulinum neuromodulator available in the U.S. market, does contain additional proteins, I have nonetheless also found this product to be useful as an alternative in patients who appear to have grown resistant after several successful prior treatments.

Finally, persistent "etching" of the skin, a result of years of folding the skin with expression, can be further improved with the use of fillers, such as Belotero Balance or Restylane L. As a side benefit, the combination of neuromodulators with fillers, particularly in this region, has been associated with signficant prolongation of the results--upwards of a year, as opposed to only several months when the neuromodulator is used alone. 

Botulinum toxin usually works well when administered by experienced artistic clinicians.

Why would Botox not work?  Here are the Top Five:

1.  Not enough Botox was placed.  

2.  The Botox was not placed in the right areas

3.  The Botox cannot quickly eliminate established wrinkle lines.  This takes time.

4.  The patient expected no movement whatsoever.  This frozen appearance is widely ridiculed and most top doctors avoid that look.

5.  My brows came down.  Too much Botox in certain areas causes the muscles to relax.  This is very predictable.  If the patient is at the borderline of needing their brows and upper eyelids done (or lower eyelids, but that is another conversation), even a small amount of Botox can bring on sleepy brows for three months.

There are many other reasons Botox doesn't work properly, but these are 5 common ones.