After Several Years of Botox Use Does Your Body Develop a Resistance to the Product? Botox Seems Less Effective with Time.

After Several Years of Botox Use Does Your Body Develop a Resistance to the Product? Botox Seems Less Effective with Time.

Doctor Answers 9

Botox Resistance explained

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Yes, although not very common, it is possible to develop resistance to Botox usually through your body making antibodies to the Botox. In those cases Xeomin or Dysport may still work and you might want to switch. Also be aware that the expertise of the injector and the number of units injected are also variables that may account for decreased response.
Dysport, Xeomin and Botox are all preparations of botulinum toxin A derived protein that works at the nerve-muscle interface to relax targeted muscles. Each preparation is slightly different, for example the protein size differs.  Dysport and Xeomin have been around in Europe for a long time and more recently introduced in the USA. Note the dosage is not the same between the  drugs though each works well in my experience.

Botox resistance

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While it is possible to be resistant to botox, the condition is extremely rare. Generally, patients on a regular treatment schedule will have botox results that last longer. If you go to a regular injector, ensure that he/she is injecting approximately the same time each month and ensure that you have maintained a regular schedule. Initially, that should be every 3  - 4 months. If you have not kept the same injector, then you may have a quality issue with the injector (either in terms of technique or preparation).

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 56 reviews

Is it possible to develop a resistance to Botox?

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This is possible but rare. One may develop a resistance to Botox because antibodies are formed against the protein the Botox is mixed with. Some patients that develop these antibodies may try Dysport or Xeomin.  They are a more purified form of the product and may work better if you have developed antibodies.  The products were produced to decrease the amount of “impurities” in the botox. 
Thanks and I hope this helps!

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Effects of Botox over time

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In my experience, patients have the opposite effect. That is, they seem to go longer between treatments over time, as they break the habit of making the expressions which cause the wrinkles. Also, the muscles seem to get smaller or atrophy over time. In the beginning, my patients are advised that Botox lasts around 3-4 months but over time, I have had patients come in every 6-9 months or even yearly between treatments. 

There are rare cases in which patients are resistant to the effects of Botox. For these patients, Dysport is generally effective. However, there are a few things to double check before you decide that Botox (or Dysport) is not right for you.

-First off, make sure that you are being treated by a reputable injector. Some places might try to cut costs by telling you that you are receiving more units than they are actually injecting. Make sure you are actually getting Botox Cosmetic (Allergan).

-Secondly, make sure your provider is a high-volume injector, meaning that he or she sees a large number of patients. If Botox is mixed up and left on the shelf for too long, it's efficacy could be diminished.

-Thirdly, and related to the first two, make sure that your injector is experienced and knows the anatomy of the facial muscles. Your suboptimal results could be technique-related. 

If you have been going to the same reputable and experienced provider over the years and notice the effects are not as good as when you began using Botox, try Dysport!

Best regards,

Dr. Mehta


Umang Mehta, MD
Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 52 reviews

Botox resistance does occur and can be treated by switching to Dysport in most cases.

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I am personally totally resistant to Botox, however Dysport work well for me.  I have a large number of patients who have used Botox for years.   I see a Botox resistant patient at least 4 or five times a year.  It is not super common; however it happens often enough to know that it is real.  Switching to Dysport has solved the problem for most of my patients.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Botox Resistance

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While there is no "proof" that this exists, I do believe it does happen. As with any medication, your body becomes more used to it, so it can work through it a bit faster. For patients whose Botox seems to last less, I try to switch them back and forth between Botox and Dysport. Because the products are so similar but just different enough, this seems to help it last longer.

Botox and resistance

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Some patients do eventually develop some resistance to the Botox. You can always try Dysport as an alternative.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

It is improbable to develop immunologic resistance to cosmetic botulinum toxin.

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However, it is not unusual to have more cosmetic issues over time.  This sometime requires a change in treatment strategies such as increase the dose of BOTOX, using other treatments such as surgery and fillers.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Resistance to botox

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Thank you for your question. You could call allergan helpline to get information about resistance to botox. Also consider with time and age, there is more wrinkles and you may need more botox to achieve the same results of earlier years.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

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.