Botox, Dysport and Xeomine, non work for me. What is an alternative?

True resistance to neuromodulators, such as Botox, Dysport, and Xeomin are rare and true antibiody development to these products is likewise extremely unlikely. More likely, lack of response relates to overdilution of the materials, improper injection technique and placement, or both. Nonetheless, in the twenty-three years since I began injecting Botox for aesthetic reasons, I have encountered individuals who do respond as well as would be desired. For such individuals, I have found The Nonsurgical 3D Vectoring Crow's Feet Llift to be especially useful--either alone or  combined with neuromodulator treatment.Using the principles of vectoring with volumizing fillers (see the Realself archives for a more detailed discussion of The Nonsurgical 3D Vectoring Facelift, The 3D Vectoring Necklift, and the The 3D Vectoring Browlift), the region over the bone within the fixed (nonmobile) area of the cheek directly in front of the ear is used as an access point to instill "strands," "strains," or cylinders of the volumizer in a fan shape distribution over the mobile crow's feet (periorbital) area and extending onto the cheek. Requiring only a tiny amount of local anesthesia to numb the entry points, the procedure is relatively painless and takes only a few minutes on each side to perform.As a rule, immediate smoothing of the crow's feet area is seen. However, as with the other Nonsurgical 3D Vectoring Lifts, continued improvement is anticipated over the next six to eight weeks as new, native collagen is synthesized in response to the presence of the injected material (neocollagenesis). Treating both the static and dynamic components of the problem tends to prolong the results of therapy beyond that which might be obtained with either therapy alone.

Yes, wrinkles may become resistant to Botox, Dysport, or Xeomin. As other cosmetic specialists have stated, taking a Botox break is a good first option. After 6 months or more, you should be able to resume Botox (Dysport, Xeomin) and see the desired results. A topical cream is coming, but not available yet. Best,Dr. Chaboki

It is rare, but possible, to have a resistance to Botox, Dysport and Xeomin.  In my experience, if there is a resistance to one, there is a resistance to all.  Additionally, when I have seen resistance, it has been an all or none effect.  So, in your case when you say the effect is gone within in a couple of weeks, it is possible you don't have a resistance but need to alter the dosage.  

It would be highly unusual for you to be resistant for Botox, Dysport, and Xeomin.  It is more likely that the dilution or injection technique is contributing to your poor results.  Please consult a board certified dermatologist with a great deal of experience with Botox to evaluate you and inject the area.

There is a procedure that targets the nerves to the forehead that produces the 11 lines (glabellar wrinkles)  where we identify the nerves and thermally damage them so they can not give you the wrinkles. It has been approved by the FDA but is only done by a limited number of physicians at this time.

In my experience, short duration of Botox action is almost always due to inadequate dosage which may or may not be a part of resistance. I would try increasing the dosage first as the only alternative will be forehead lift or brow lift.

I have seen this resistance in some of my patients and in a family member.  I usually recommend stopping for 6 months and then trying again.  Every time the Botox etc has worked normal after 6 months and no further resistance was ever seen.  My series is not huge and contains only 6 patients so we all need to pool our experience.  RealSelf is a great resource for this activity.  My Best,  Dr C

There aren't any other FDA approved neuromodulators at this point in time. What I have found for some people though, is that they require a two-step injection approach if they have an extremely high resistance. So what I do is inject them at one sitting with a normal dosage, then have them return 10-14 days later, and inject again with a 1/2 dosage. In every case, it has worked that this then lasts for at least 3 months' time. It gives the muscles time to absorb, and then hits them again."This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."