If I have Botox resistance will I still see results from dermal filler?

Question

I seem quite resistant to botox. It works nowhere near like it used to and does not last long at all, despite injecting a much higher amount of units. I'm wondering if given that my body seems to reject the botox, would my chances of rejecting filler be much higher now too? I'm feeling depressed about this and hoping to find some options! Thank you for your time.

Lexie Wang, MD · Answer

Hi! So sorry you are depressed about this. First and foremost, botox and filler are not the same at all. So just because your body seems to "reject" botox does not mean that it will "reject" filler. The thought process behind "rejection" of botox is that your body has somehow built up immunity against the toxin so it eats away the toxin and doesn't allow it to do its job. One thing I might suggest is switching toxins (example: if you started with botox, try xeomin) because they are all compounded and formulated differently. But even if that doesn't work for you, just because you cannot have botox does not mean you cannot have filler. However, also remember that they work differently, so filler is not necessarily the best option for certain concerns. Good luck!

Nima Shemirani, MD · Answer

Hi @little.mermaid.xo. I recommend switching to a different neurotoxin like Xeomin if you've developed true Botox resistance. It is very unlikely that since you developed Botox resistance you will also experience resistance to dermal fillers. They have completely different mechanisms of action.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Aaron Gilson, DO · Answer

I'm sorry to hear your botox treatments are not working as well as you'd like. Sometimes switching to a different brand can help. As far as fillers go, most fillers today are made from hyaluronic acid. While fillers and botox do different things through different mechanisms, if you've built up an resistance response to botox, its unlikely that you've done so to fillers if you're filler naive. Best of luck!

Joshua T Halka, MD · Answer

Hello,
Some people have been known to see less and less effect from botox over time and often they switch to a different neurotoxin and end up with great results, such as switching from botox cosmetic to dysport. 
Fillers are a very different injectable from neurotoxins as they are made of compounds that take up space and don't cause your body to react to them, most of them dissolve slowly over time. Neurotoxins weaken or paralyze muscles temporarily and the injected compounds aren't designed to stay were they were injected after they have taken effect. You should still be able to get good results from filler. You should also try a different neurotoxin such as xeomin or dysport.
Hope this helps!
-Dr. Halka

Jason Emer, MD · Answer

If Botox is not an option for you, Dysport or Xeomin are the next options. I suggest dermarolling at home to give the skin Botox-like effects with at-home treatment. See an expert. Best, Dr. Emer

Eric M. Joseph, MD · Answer

Generally, dermal fillers are not a substitute for a neurotoxin. We have seen some people develop resistance to a neurotoxin, however, when that happens we may suggest using another one like Xeomin or Dysport. Hope this helps! Sincerely, Dr Joseph

Nelson Lee Novick, MD · Answer

I have been injecting Botox for aesthetic purposes since 1991 and injecting fillers since 1982. So, I have enormous personal experience with these injectables. Botox, which works on the muscles of facial expression and fillers, which are used for elevating and smoothing wrinkles and folds, as well lifting, contouring and volumizing purposes, are entirely chemically unrelated. Therefore, lack of response to Botox in no way precludes the use of fillers or presages failure with fillers. As an aside, you might wish to discuss with your injector the trial of alternative neurotoxins manufactured somewhat differently from Botox, such as Xeomin, to which you may prove responsive. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Matthew Zeiderman, MD · Answer

Thank you for the question. Your body should not be resistant to the filler like it has become to the botox. they are different substances that your body will react to differently.If you're now botox resistant, you could consider trying a different brand similar to botox like Dysport, Xeomin, Daxxify, etc. Each brand of what we call neuromodulators acts a bit differently.

Karyn Grossman, MD · Answer

Dear Little.Mermaid.Xo,What you’re describing sounds like you’ve built up resistance to Botox. This is not uncommon, particularly with patients who’ve been using the product for many years. It’s not that your body is rejecting it, your tolerance is causing you to need more to get the same effect. Keep in mind that as we age, we tend to need more to get the same results we would get 5 or 10 years ago. I recommend trying a different brand like Dysport, Xeomin, or Daxxify. We offer all of these at Grossman Dermatology.Alternatively, some patients tend to metabolize the product faster. However, if this was the case for you, you would have likely experienced issues with duration from the beginning. Tolerance of neurotoxins should not effect how your body responds to filler. Filler and neurotoxins like Disport and Botox work in completely different ways. Toxins paralyze the muscles therefore decreasing movement and wrinkling, fillers add volume to refill the fat that’s lost as we age or to augment. Hope that helps!

Michael Plastini, MD · Answer

"Botox resistance" is a term used to describe a situation in which a person appears to have reduced responsiveness to the effects of Botox (Botulinum toxin) injections over time. This phenomenon can occur in some individuals but sometimes can be just a result of natural age-related changes such as loss of skin turgor and increased elasticity. 
Filler works via adding volume so there is no increased risk of "rejecting" filler if you have developed botox resistance, but overall there may be better solutions to address your concerns such as Laser or even surgery. 
I recommend you schedule a consultation with a board-certified plastic surgeon. Often injectors who are not appropriately trained do not have the appropriate knowledge base, training, or privileges to recommend or administer more advanced treatments for facial aging.