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.

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.

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.

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

Answers (9)

Answer: Botox Resistance-- Dysport, Xeomin, Microneedling

Answer: Botox Resistance-- Dysport, Xeomin, Microneedling

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

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

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.

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

Answers (9)

Answer: Botox Resistance-- Dysport, Xeomin, Microneedling

Answer: Botox Resistance-- Dysport, Xeomin, Microneedling

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

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

Browse related questions

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.