I've been getting Botox for 15 years. Why is it less effective now?

Question

I've been having Botox for 15 years (I'm now in my 60's) & noticed the last few times that Botox hasn't improved my crows feet. It also seems less effective around my forehead. I go to an injector with 18 years experience who is also a Dr. When I discussed my concerns last time with her, she advised that the Botox won't fix my crows feet and I need filler to correct it. She's conservative & I get 22-30 units for around eyes/forehead. Is it possible that Botox stops working after long term use?

Jose Telich, MD · Answer

Dear Youbeauty,
It's not uncommon for some individuals to experience a decrease in the effectiveness of Botox after using it for an extended period of time. There are several reasons why this may occur, including:
- Immunity: Your body may develop an immune response to the Botox, making it less effective over time.- Tolerance: Your body may become tolerant to the effects of Botox, which can cause it to be less effective.- Changes in dosage: Over time, your healthcare provider may adjust the dosage of Botox that you receive. This could potentially cause a decrease in effectiveness.- Changes in facial structure: As we age, our facial structure changes, which could impact the way Botox works.
If you are experiencing a decrease in the effectiveness of Botox, it's important to speak with your healthcare provider. They can evaluate your situation and recommend any necessary changes to your treatment plan.
I hope this information is helpful to you.
Best regards,Dr Telich

Nima Shemirani, MD · Answer

Hi @youbeauty. The most common reason that Botox does not work is that not enough was administered. Another reason can be that winkles are too deep for Botox to work on its own. If you have deep lines that are present at rest when you are not using the muscles, then you may not be able to get rid of those wrinkles with Botox alone. In that case, injection of a dermal filler may be needed to provide further improvement. True Botox resistance is rare. A more common occurrence is that some people build tolerance to Botox after repeated use and tend to need increased doses over time.

I would recommend increasing the dosage if you don’t see results from your Botox treatment. If this doesn’t work, there are other products on the market like Dysport, Xeomin, or Jeuveau. They are similar to Botox except for minor differences in their formulation.

I would recommend increasing the dosage if you don’t see results from your Botox treatment. If this doesn’t work, there are other products on the market like Dysport, Xeomin, or Jeuveau. They are similar to Botox except for minor differences in their formulation.

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

Nelson Castillo, MD · Answer

Thank you for sharing your question. Unfortunately without photographs it is difficult to offer advice.  If. you have creases that are present when you are not animating then it may be that you need filler to improve the skin in that area.  Botox should still be working to prevent these creases from getting worse, but an in-person examination would offer better advice. If unclear about your treatment from your provider, seek out a second opinion.

Oakville Plastic Surgery &amp; Medspa · Answer

Sometimes as we age, we need to change our treatment plan and this may mean increasing your dose in certain areas. A little filler around the eyes can definitely help with deeper crows so it may be worth trying! And sometimes a different brand can work better for some people. Lastly, there is a recent study published that concluded that some people who received the covid vaccine may have issues with their response to Botox.

Rene Garcia, MD · Answer

Botox is a muscle relaxer. It works well only in dynamic wrinkles. In static wrinkles can improve the appearance. You mention that you have been getting botox for the last 18 years. Botox works wonderful when we are younger, as we get old we need additional treatments to stimulate collagen and elastin. As we age we loose bone structure, we have loose of elasticity of the ligaments we loose muscle mass and fat. In addition we suffer a re-distribution of the face fat. I know is not nice, but the goal is to try to delay this process. You may need something else beside botox.

Camille Cash, MD · Answer

There could be several potential reasons for the decreased results from Botox.  It could be that the product is still correcting the muscle action, but skin laxity may be masking the results.  It could be that you now require higher doses of the product to achieve the same results.  Or it could be that you are developing a resistance.  You may want to try a different modulator such as Dysport, or the longer lasting product Daxxify.

Douglas Taranow, DO, FACOS · Answer

It is common to require more units of neuromodulators (Botox, Dysport, Xeomin...) as you age.  We develop more and deeper wrinkles with age whish may be a factor, or you may have developed a tolerance to a particular type of neuromodulator.  First, try Dysport the next time to evaluate your response.  If similar, increase the number of units with your standardized treatments.
Best wishes.
Dr. Taranow

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. A face to face consult and examination is always best however in this scenario it is possible that the botox has become less effective. This is due to overlying skin tissue laxity and volume loss around the area. Please always seek treatment from a trained medical professional for any cosmetic treatment. Best wishes

I've been getting Botox for 15 years. Why is it less effective now?

Answers (9)

More Botox Questions

Should I be concerned about this vertical groove in my forehead? How to get rid of it? (Photo)

Uneven chin when smiling - is there anything I can do about this? (Photo)

Botox is not helping to minimize the appearance of crows feet - is this common with aging?

What happens to the acetylcholine when Botox is injected?

Botox for men: how many units would I need?

WE SEND PRETTY
EMAILS