47, female & Botox & others don't work on me, is there anything else I can try? (Photos)

Question

Hi! Unfortunately after trying differents Dr/providers on Botox, Jeuveau & Xeomin on my 11 lines & around my eyes went from 20/25/30 units on my frown & 10 each on my crows feets They seem never worked , effect never actually kicks in :( Im 47 female & Am I rare case where my body simply reject this type of toxins, is there anything else I can try that give me result? I'm running out of options here. Thanks in advance

Anna Chacon, MD, FAAD · Answer

I can understand how frustrating this must be, especially after trying multiple products, different providers, and increasing doses without seeing the improvement you expected.

The good news is that true resistance to botulinum toxin is uncommon, but it does happen. Before concluding that you're resistant, it's important to consider a few possibilities.

One is that your muscles may simply be stronger than average. Some people naturally require higher doses or a different injection pattern to adequately relax the muscles responsible for the frown lines and crow's feet. Technique, injection depth, and placement can also significantly influence the outcome.

Another possibility is the development of neutralizing antibodies, which can reduce the effectiveness of botulinum toxin. This is relatively rare, particularly with modern formulations, but it is more likely in people who have received frequent treatments, high cumulative doses, or treatments at short intervals over many years.

Since you've tried Botox, Jeuveau, and Xeomin without noticeable benefit, it raises the question of whether you're experiencing true treatment resistance or whether another factor is contributing. One option that may be worth discussing with your physician is trying Daxxify, which has a different peptide stabilizer than the other available products. Although it still works by targeting the same nerve pathway, some patients who have had suboptimal responses to other neuromodulators do report improvement with it. While the evidence is still evolving, it can be a reasonable alternative in selected cases.

It's also important to look closely at the wrinkles themselves. If your "11 lines" have been present for many years, they may have become static wrinkles, meaning they remain visible even when the muscles are fully relaxed. In that situation, neuromodulators alone won't erase them. Treatments such as fractional laser resurfacing, microneedling, chemical peels, collagen-stimulating therapies, or carefully selected fillers may help soften those etched-in lines.

Looking at your photos, there appears to be a combination of dynamic muscle movement and some established skin creasing, which is very common at 47. That means the best results often come from addressing both the muscle activity and the quality of the skin rather than relying on toxin alone.

If you truly have resistance, you're certainly not alone, but it is uncommon. Fortunately, there are still several effective approaches to facial rejuvenation that don't depend solely on botulinum toxin. A thoughtful treatment plan that combines the right techniques for both muscle movement and skin texture can often achieve meaningful improvement, even when neuromodulators haven't met your expectations.

Lisa Vuich, MD · Answer

Thanks for your question. There are rare cases of individuals who do have 'neutralizing antibodies'- meaning that their immune system has produced antibodies which inactivate botulinum toxin used for cosmetic or therapeutic injections. Again, this is extremely rare. I've been injecting since 2005 and have only come across 2 individuals in all that time. There is no easily available 'test' for this. And, if you have these antibodies then no brand of tox will work for you because the active ingredient is the same in all of them. A dose of 10 units around your eyes based on your photo is likely too light a dose to give an adequate relaxation- so dose can definitley be part of the problem here. Xeomin in particular has the lowest amount of active ingredient fyi. You may want to consider trying the newest tox- Daxxify- it has a special peptide which helps it to bind better and have a stronger effect/longer duration of effect. Daxxify units are not interchangeable with the other toxin units, it is really unique. The recommended dose of Daxxify between the brows is 40 daxxify units, and around the eyes is 24 daxxify units per side. Many doctors, including myself, charge "by the area" for Daxxify because the units are so different from the other tox brands. I hope that helps.

Parag Patel, MD · Answer

Botox and other neuromodulator resistance is rare but real. PDO threads for wrinkle control/reduction is a great option is this case whether you have natural or induced resistance.

Camille Cash, MD · Answer

Begin by ensuring that you are being treated by an expert injector.  Discuss your previous results, or lack thereof, and ensure that you aren't being undertreated.  You may want to try Dysport.  (Just a note that one Botox unit equates to approximately three Dysport units). Follow up with your injector two weeks after your treatment to review your results.  Your injector should take "before" photos to refer to at your follow up appointment.

Anna Avaliani, MD · Answer

If you trust your provider, then you both should have a plan in place. I would advise to try Dysport and I think it may have to do with the product placement as well. The right muscles need to be targeted and also the neighboring muscles too. Your crows feet are actually considered very difficult to target for a beginner injector and 10 units on each side is super underdosing you. You need more. Your glabella region requires a very low injection on the nose to fully immobilize. I would advise you seek an expert injector who is familiar with all the toxins and different injection techniques. Have the same person inject you with different toxins .
Hope this helps.

47, female & Botox & others don't work on me, is there anything else I can try? (Photos)

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