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

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.

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