Botox & Dysport No Longer Working as Well, Suggestions?

Question

Botox and Dysport no longer effective on brow area. I've used the same doctor for several years; lately, it's not working as well as it used to. Any suggestions?

Ron Shelton, MD · Answer

If you are finding that the glabellar muscles between the eyebrows or the crows feet muscles are not being as relaxed with the same number of units of Botox or Dysport, that is not the same as finding that the forehead muscle is drooping more or the upper eyelids are sagging.  If it is the former, then you might be developing some resistance to the injections but this is extremely rare. Changing from them to Xeomin may not make a difference as all three are seropyte A botulinum toxin. As we age, the forehead sags more and what we could have done for the horizontal creases when younger can no longer be done later because the forehead sags and brings down the upper eyelids.

Camille Cash, MD · Answer

It may be that you need to switch to a different neuromodulator.  Two others that may be effective for you are Juveau and Xeomin.  Though neuromodulators all work similarly, there are slight differences to each product that may give you the result that you are wanting.

Larry S. Nichter, MD, MS, FACS · Answer

Yes, although not very common, it is possible to develop resistance to Botox and Dysport,usually through your body making antibodies to the Botox. In those cases Xeomin  may still work and you might want to switch. Also be aware that the expertise of the injector and the number of units injected are also variables that may account for decreased response.Dysport, Xeomin and Botox are all preparations of botulinum toxin A derived protein that works at the nerve-muscle interface to relax targeted muscles. Each preparation is slightly different, for example the protein size differs.  Dysport and Xeomin have been around in Europe for a long time and more recently introduced in the USA. Note the dosage is not the same between the  drugs though each works well in my experience.

Nelson Lee Novick, MD · Answer

I have been using Botox for cosmetic reasons since 1991. Since that time, I occasionally encounter a patient who at first responded well to Botox, but after several treatment sessions, no longer responded as well or has not maintained his/her improvement for as long as previously. Some, for example, who in the past may have enjoyed six months of correction were  seeing no more than four to eight weeks of results. I have been using Dysport for about ten years already and have seen a similar phenomenon with this neuromodulator, as well. 

	One possible explanation that has been proposed for this problem is the development of antibodies to the injectables. In such cases, I have been switching these patients to Xeomin, a neuromodulator very much like Botox, but whose manufacturer has taken pains to strip all unnecessary excess proteins from the active molecule in order to reduce its potential to provoke antibody formation. So far, I have generally had success with Xeomin in cases where patients have been suspected of antibody formation to the other two approved agents. I definitely believe it is worth a try in these instances.

Kenneth D. Steinsapir, MD · Answer

Then again, perhaps you just need more treatment than you have had in the past.  Occasionally, doctors change precisely how much treatment they are giving.  You might try a different office and see if you remain "resistant."

Botox & Dysport No Longer Working as Well, Suggestions?

Answers (7)

Answer: Xeomin May Be Effective When Botox and Dysport No Longer Work As Well

Answer: Xeomin May Be Effective When Botox and Dysport No Longer Work As Well

Answer: You might be resistant.

Answer: You might be resistant.

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Everything you need to know about Botox

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Botox & Dysport No Longer Working as Well, Suggestions?

Answers (7)

Answer: Xeomin May Be Effective When Botox and Dysport No Longer Work As Well

Answer: Xeomin May Be Effective When Botox and Dysport No Longer Work As Well

Answer: You might be resistant.

Answer: You might be resistant.

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Recommended reading

Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.