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

I have been getting botox for a couple years for the crows feet area and it always wore off too quickly. I tried Dysport (same thing) and recently I tried the Xeomine. Non work. Within 2 weeks it looks like I had nothing done. I am 38 and very active. I know resistance to these products is very rare, could I be in that percentage? Is there an alternative?

Doctor Answers 9

Botox not working for crow's feet

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.

New York Dermatologist
5.0 out of 5 stars 76 reviews

Crow's Feet Respond Well To The Nonsurgical 3D Vectoring Crow's Feet Lift

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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Resistant to anti-wrinkle solutions

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.

Somyos Kunachak, MD
Thailand Facial Plastic Surgeon
4.7 out of 5 stars 17 reviews

Wrinkles resistant to Botox

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. 

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews


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.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Botox wears off too fast

You may be resistant to Botox and the other neurotoxins.
  • If you are getting less than 20 units around the eyes, your dose may be too low.
  • If you are getting a high enough dose, I suggest stopping for 6 months.
  • then resume with a touch-up planned with 1/2 the dose in 2 weeks,
  • But if the effect still only lasts 2 weeks - it suggests your body metabolizes neurotoxin very fast.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Botox resistance

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

George Commons, MD
Palo Alto Plastic Surgeon
4.5 out of 5 stars 36 reviews

Neuromodulators don't work for me

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."

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Botox, Dysport, Xeomin not working

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.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.