Botox, Xeomin and dysport immunity. Whats next? Will they work again if I wait for awhile?

Thanks for the question and I am sorry you are not seeing satisfactory results with your neurotoxin treatments any longer. Botox is a treatment that requires utmost precision in terms of placement of the needle and dosing amount to ensure an optimal outcome. Sometimes a higher dose of Botox is needed to treat the 11s, or laser treatment can be combined with the Botox treatment to maximize efficacy. Rarely, patients do form antibodies to Botox, Dysport, and Xeomin, but in this case, it usually would not work in all areas treated. Make sure you are working with a board-certified dermatologist who is also an expert Botox injector for the best results. An experienced doctor can make a full assessment in person and recommend the right treatment for you.

For glabellar lines (or frown lines / "11" lines), we inject Botox into the muscle, causing the muscle to weaken and improving the appearance of the lines. Botox works by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Botox takes 2 to 4 weeks to start working and lasts for up to 6 months.For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling/PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer

Immunity is an all or nothing phenomenon. If the toxin is being deactivated in one area it will be deactivated in all areas. If it continues to be effective elsewhere, the issue is not immunity but rather tolerance. You likely require a greater dose to achieve the same effect.Your options include:-a rest period to allow for down regulation of receptors-greater dosingAs always, discuss your concerns with a board certified plastic surgeon (ABPS).

In my experience, if a patient develops an immunity to Botox, Xeomin and/or Dysport, there is no response wherever the product is injected.  So, if you are responding to the injection on the forehead, I would say that you are not immune.  The reason you are not getting a response on your frown lines (11's) may be due to the dosage being too low or the placement of the injections not being ideal.  In some patients, the Botox (or Xeomin or Dysport) will relax the muscles but there may still be an indentation or furrow that can be further improved with injection of a filler.    

Resistance to botulinum toxins (such as Botox, Dysport, and Xeomin) can occur if neutralizing antibodies develop. This is noticed when a patient initially responds well to botulinum toxin for the treatment of wrinkles, but then experiences a decreased effect or no effect after subsequent treatments. It is believed that higher doses and more frequent treatments of botulinum toxin can increase the chance of forming neutralizing antibodies. However, there are reports of patients developing neutralizing antibodies even with small doses and infrequent treatments. It is also theorized that “complexing proteins” present in many botulinum toxin formulations can increase the risk of forming neutralizing antibodies. 
Xeomin is marketed as being free from complexing proteins, and there is significant evidence to suggest that Xeomin is associated with decreased risk of formation of neutralizing antibodies. However, if you have already developed antibodies to one of the botulinum toxin type A drugs, there is a likelihood the antibodies will neutralize the other botulinum toxins in this same type A family. Even so, it is reasonable to try a trial of a different botulinum toxin to truly confirm the effect. There is a botulinum toxin type B drug in the United States called MyoBloc. Although this botulinum toxin is a different serotype, studies have shown many patients that have already formed antibodies to botulinum type A can quickly form antibodies to MyoBloc. In addition, MyoBloc is approved for use in cervical dystonia and not FDA approved for cosmetic use.
It should be noted that developing antibodies to botulinum toxin is infrequent. Improper placement, too low of a dose, or over-dilution can result in decreased treatment effect. It is important to be confident that your injector is skilled and using proper products in order to achieve an effective, long-lasting result.

Best of luck, 
Allen Foulad MD 

I would first start by checking the units that are being placed in the glabella and ocular area if these are the areas that you feel they are not working.  Often times, the units administered are not enough.  I agree, it would be highly unusual for botulinum neurotoxin to work in one area but not another.  While antibodies can be formed to any of the botulinum neuromodulators, you would see the affect on all areas of your face.  Hope that helps.

There is no such thing as a product that does not work in one particular area, yet it works everywhere else. if that is indeed the case, you should try using a higher concentration or greater volume of Botox injected into the area. On the other hand if botox does not work anywhere on your facial muscles, then you should try Myoblock. Good luck from New York City

If you are not having a response from these products you might try using a greater number of units or trying a different injector.  If you still are not getting results, then it may be that you need to allow a break from using them to see if your body's receptors will recover.

Everyone has unique expressions. We move our facial muscles in a repetitive way and over time those repetitive movements cause wrinkles and fine lines. When you start to experience the signs of aging, Botox, Dysport, and Xeomin are available to diminish unwanted wrinkles and creases in your face.Botox, Dysport, and Xeomin lock the release of a chemical called acetylcholine, which triggers the muscle contractions that create wrinkles. Botox, Dysport, and Xeomin essentially paralyze the muscles and stops them from contracting. Results from these treatments are visible within 3-7 days with results that can last anywhere from 3-4 months. It is hard to determine without seeing you in person and seeing photographs. Consult with a board certified dermatologist or plastic surgeon to discuss your options and goals. Hope this helps.

Dear Arlington,The furrow 11’s typically can be relaxed with 20-30 units of properly placed neuromodulator.Other muscles of the forehead can overpower the furrow region, still causing the 11’s to persist.Massage of the forehead and conscious effort not to flex these muscles will help over time. A more comprehensive injection region of the forehead may also be helpful.Best. DrBrechtSeattle, Wa