Alternative for Someone Allergic to Botox?

Question

I am terribly allergic to Botox and have deep furrows in my forehead. What can I do? I have tried Botox 5+ times each with a different doctor so I am allergic but need help with forehead, glabella lines, etc. Are there any alternatives?

David Shafer, MD, FACS · Answer

You say that you have an "allergy to Botox," but you do not state what your allergy is. What symptoms do you experience. It is very unusual for someone to be allergic to Botox. There are other botulinum toxins that you can try such as Dysport. Also, you may want to look into dermal fillers as an alternative or supplement to Botox treatments. Good luck.

Jerome Edelstein, MD · Answer

It is possible to have a good improvement of forehead lines from fillers, if the lines are visible when your face is in a neutral expression. You can also consider laser treatments.

David Hansen, MD · Answer

I doubt you are allergic to Botox since 5 doctors injected you with it and you probably never ended up in the hospital with breathing problems or a bad itchy rash. If the Botox doesn't work on you, then that is not an allergy. Dysport ($300-500) is another type of botox like material that is worth trying as long as you didn't breakout in hives or rashes. Fillers like Restylane and Juvederm ($550-600 per syringe) are great for filling in forehead and glabellar creases. Some patients need both fillers and Botox/Dysport to get the grooves filled in well on the forehead.

Richard Baxter, MD · Answer

There is another product called Dysport which works the same way. Whether or not it is suitable for you depends upon the nature of your allergic reaction; some people use that term when it is a lack of response. In rare cases, the body does form antibodies that neutralize the product. Normally an allergic reaction means hives, itching, things like that. If that is the case then it might be risky since the products are very similar. I would suggest that you contact someone who does Dysport and have a detailed discussion.

Kenneth D. Steinsapir, MD · Answer

It is worth emphasizing that allergies to Botox are rare but not unheard of. It is worth knowing how you are terribly allergic to BOTOX. Do you develop a rash?

	Generally, immunological reaction to BOTOX that is seen is blocking antibodies to BOTOX rendering the BOTOX ineffective. However, if you are developing a rash, it is possible that you are allergic to something other than the BOTOX itself. BOTOX also contains human albumin. The saline used to reconstitute the product may contain preservatives that can cause a rare allergy. Because other products also contain these types of additives, it is essential that it be established which of the components of the product you are allergic to before recommending an alternative treatment.

Camille Cash, MD · Answer

Botox allergies are quite uncommon.  You can try alternative neuromodulators such as Dysport and Juveau.  They produce a similar result to Botox treatments.

Robert S. Bader, MD, FAAD · Answer

True "allergic" reactions are not generally seen with Botox. Some patients will develop antibodies to a protein in Botox that will stop the product from working properly. This is generally after several treatments and is not common. If one does develop antibodies, he/she can be treated with an alternative to Botox, including Dysport and Xeomin.

Cameron Rokhsar, MD, FAAD · Answer

A true allergic reaction means symptoms like facial and tongue swelling, difficulty breathing, hives, etc. Allergic reactions also get worse each time the body exposed to the offending agent, meaning if you had Botox 5x and were truly allergic you'd likely have been in the hospital. Perhaps you are sensitive to the numbing cream? If you feel like this is the case, you could try injections without the cream or use a different numbing agent. You could also try other neurotoxins like Dysport, or GFX "No-Tox."

Anifat Balogun, MD - Account Suspended · Answer

You did not explain the nature of your "terrible" allergy to Botox. Did you develop a rash or did the Botox not help relax the furrows? A true allergy to Botox is quite rare. It may be beneficial to skin test you to see if you are reacting to components in the saline or if you have a true allergy to Botox.

	Another thing to note is that if you indeed have deep forehead furrows, the Botox alone may not have made the furrows go away but just softened them a little. Typically, for effective smoothing out of deep furrows, you would need a combination of Botox to relax the muscle and a dermal filler like Juvederm, Radiesse or Artefil to fill the remaining wrinkle.

	Another option for smoothing your forehead furrows is TotalFX fractional laser resurfacing. The DeepFX component of the treatment is very good for deep wrinkles, scars and skin folds and facilitates skin plumping through collagen stimulation.

	Good Luck!

Arnold R. Oppenheim, MD (retired) · Answer

One possiblity is that you might be allergic to the benzyl alcohol which is in the preservative based normal saline. If you break out to other injections in which saline might be used, this possiblity looms greater.
   Allergy to Botox itself is very rare. It would seem to me that the Botox molecule is so similar to the Dysport molecule that if you broke out to one you would break out to the other. If you are truly allergic and you problem does not stem from the preserved saline, then you will probably have to wait for some of those neurotoxins they are using in Europe to be FDA approved.

Alternative for Someone Allergic to Botox?

Answers (10)

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