What can I do for wrinkles when Botox, Dysport and Xeomin don't work?

I have been getting botox and dysport for around 15 years and both stopped working completely. I was given 150 units of dysport (from a very experienced injector) for forehead lines, crows feet and frown lines. I went back as this had produced no result, so the injector used 180 units of dysport over the 3 areas. This also did not work. She then tried botox and this did not work. I then found a clinic that used Xeomin, tried that but this hasn't worked either. I am assuming I have developed antibodies.

Doctor Answers 7

Botox not working

Thank you for your question dazzee38. I am sorry to hear about your situation. Botox, Dysport, and Xeomin are purified proteins used to address wrinkles associated with facial expressions. In rare cases resistance to one of these proteins may develop. In such cases a different neuromodulator is used. If none of them work energy- based treatments may help, depending on the area. Please consult with a doctor for specific recommendations. Good luck!


Encino Physician
5.0 out of 5 stars 1 review

Wrinkle Dilemma

It is quite possible that you have developed antibodies to botulinum. But first, did any factors surrounding your  routine change? New doctor injecting? Do you know if the botulinum toxin was freshly reconstituted and not old? If you truly are now immune to the effects, depending on on how much, if any, ptosis/sagging you have of the brow, a brow lift/forehead lift may help improve the appearance of lines.

Millicent Odunze-Geers, MD, MPH
Sacramento Physician
4.6 out of 5 stars 5 reviews

What can I do for wrinkles when Botox, Dysport and Xeomin don't work?

Hello and thank you for your question!

Perhaps you want to send us photos so we can better evaluate your case. Based on what you are telling us, however, your case might be a surgical case. Maybe a SMAS face-lift would be the most recommendable treatment for you. 

Sometimes the surgical treatment might not give you a result 100%, because some of the wrinkles are quite difficult to treat. Please send us some photos so we can further advise you.

Please consult a board certified plastic surgeon for further advice and the best, safest results.

Good luck!

Enriquillo Clime Rivera, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 5 reviews

Skin Rejuvenation (non-surgical) - Combination of Treatments Needed

The best treatment for skin rejuvenation and prevention depends upon an individual’s skin type, age, ethnicity, sun exposure, and overall health. In order to give you an accurate treatment plan, a consultation is required to properly assess your skin. I recommend  a healthy lifestyle: a diet high in fruits, vegetables, nuts, legumes and fish; eight to ten hours of sleep nightly; limiting alcohol intake other than the occasional glass of red wine; and regular exercise. An important step for all skin types is sun protection including the use of daily sunscreen, sun hats and sunglasses, all of which help prevent aging and sunburns.  When it comes to rejuvenating and prevention treatments, a combination of treatments are available including cosmeceuticals (skin care products including ZO® Skin Health or ZO® Medical, Skinceuticals® or Glo-Minerals®), neurotoxins (Botox®, Xeomin®), dermal fillers (Restylane®, Juvederm®, Esthelis®, Belotero®, Emervel®, Radiesse®), skin resurfacing procedures (laser resurfacing with CO2 laser, Er:YAG laser, Fraxel DUAL®, PicoSure® FOCUS Lens Array or OBAGI® controlled depth chemical peel) and other devices such as Ultherapy® can be used.  These are advanced techniques so be sure to get an experienced dermatologist or plastic surgeon consultation for recommendations and treatment options. 

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
5.0 out of 5 stars 10 reviews

Botox nonresponder

It is extremely uncommon, but some patients do develop antibodies and a resistance to Botox. Given your history, long use of toxin, and high doses with no response, it does seem this is the case for you. I would recommend combination treatments with fillers and energy/non-energy based devices such as Fraxel and microneedling combined with topical skincare including sunscreen, antioxidant, and retinoids. There are many treatment approaches, just see an expert in aesthetics. 

Botox non-response

there are patients who do not eventually respond to botulinum toxin but they are very rare. you can have fillers or laser or chemical peels depending on the areas you want treated. Be sure you are seeing a board certified dermatologist or plastic surgeon

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Botox not working

There are rare cases of Botox not working.  In this case I would consider lasers and fillers to have the best cosmetic results.  Please consult an expert.  Best, Dr. Green

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.