Botox not working well after long hiatus from it. Could it be resistance?

Question

I had Botox for first time since a 3 year break due to pregnancy. I had Botox in May and I am 1.5 years' postpartum. I am still lactating but no longer breastfeeding. I had Botox in my forehead horizontal lines, crows feet, lip flip, chin. Lip flip and the crows feet seemed effective (I have minimal movement between brows), but I had to return 3x for horizontal lines and I still have quite a bit of movement there (I now have 20 units there). Could it be resistance even though some areas work?

Anil R. Shah, MD · Answer

Hello little.mermaid.xo! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. There are several reasons as to why the Botox is potentially not as effective. I recommend monitoring for any changes over the next few weeks. If after a few weeks you believe that the Botox is still not as effective and you are still maintaining muscle movement, I recommend trying a different neuromodulator. I hope this helps and best of luck!

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Larry Thiesen, MD · Answer

Although Botox resistance is possible, I doubt that this is a reason for the lack of effect in the forehead area. The fact that you had a 3 year hiatus and that the Botox was effective in other areas of the face argue against resistance as a potential cause. A more likely explanation would appear to be underdosing in the forehead region.
Best,Dr. Larry Thiesen

Camille Cash, MD · Answer

You may require a higher dose of Botox to certain areas to attain the same effect as you had three years ago.  If even a higher dose isn't working, you may want to try a different neuromodulator such as Dysport.

Douglas Taranow, DO, FACOS · Answer

It could be resistance which would require higher dosing in resistant areas.  Some patients have resistance after Covid infections (this is just a personal observation of mine).
Best wishes,
Dr. Taranow

Botox not working well after long hiatus from it. Could it be resistance?

Answers (5)

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