Botox No Longer Working! :( Used to Last 5 Mo's, Now Only 2! Tried Zeomin & Need More in Just 6 Wks? (photo)

When I started Botox it lasted 5.5 mo's & my forehead was frozen! :D Then I tried Dysport. It didn't take as well, so I went back to Botox; however, Botox then lost it's efficacy! only lasting 2.5 mo's & my forehead is never frozen as in the past :( I tried Zeomin (35 units) 6 wks ago & guess what! My forehead is moving! :( I'm not any more active, I may be taking more vitamins, I'm healthy. Ugh!! Why is nothing working??? Anything I can do or try? -Just grow old I guess ;) NO! Lol!!

Doctor Answers 11

Botox No Longer Working! :( Used to Last 5 Mo's, Now Only 2! Tried Zeomin & Need More in Just 6 Wks?

  Botox and other neurotoxins (Dysport, Xeomin) results are based on dose (how much are they diluted) and injection techniques.  When Neurotoxins are used in regular intervals, I believe this results in continued weakness of the muscles and more effective wrinkle reduction.  However, once you let the muscles return completely...this benefit is lost.  Neurotoxins typically give around 90 day reduction of lines and wrinkles.  

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Botox and efficacy

Botox is intended to last around 3 months, and having treatments too close together can sometimes cause you to build up somewhat of a resistance to it. Not always, but it is in the literature. Staggering between differing neurotoxins is a good idea, always mindful of timing!

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

May Need More Units

This greatly depends on the mixture of the toxins and also the amount of units placed in each area.  It is recommend that you follow up with the treating provider, as you may need additional units.

Kimberly Butterwick, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 19 reviews

Botox no longer working?

Xeomin, Botox, and Dysport are not interchangable in terms of dosing. They are not 1:1:1. 35 units of Xeomin is very low, so it makes me wonder two things: 1. what was the dosage of Dysport and Botox, and 2. did you have the same injector every time? I'm reluctant to switch people from Botox to Dysport to Xeomin or vice versa unless there's a reason to. If a person likes Botox and has good results, there isn't a reason to switch to other neuromodulators. While you may need more Botox as you get older, because simply, you may need to treat more areas over time as different wrinkles and lines form, you shouldn't be having drastic changes with injections and lasting unless you've been switching injectors, as well as products.

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

Botox no longer working?

There is more than one possible answer to your problem. One is that you are needing more as you get older. I think that this is the least likely of the explanations. I think that you might not be getting the exact equivalent and placement that you were getting in the past. Is the same person doing your injections? Also, Xeomin has been marketed as being 1:1 dosing with Botox but I do not believe that this is the case. I think that we need more to get an equal result. I would go back to the person that did your injections when you were most satisfied and discuss this problem

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 19 reviews

Effects of Neuromodulators like Xeomin and Botox

I am sorry your experience hasn't been great.  My experience has been that Botox, Dysport, and Xeomin work about the same in 98% of the population.  Certain individuals have a preference for, or actually get a better result with one or other of the brands.  It is very hard to compare your result with Xeomin at 35 units (a rather low dose in order to achieve a motionless forehead) without knowing how much Botox you received.  Some patients develop a relative resistance to Botox via antibody formation, but it remains a relatively rare occurrence.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

Botox efficacy

it may be that you require more botox now than you used to require. This includes Dysport or Xeomin. I would discuss this with your provider and see if he/she would be willing to inject you with more units. Good luck.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Some things to think about if Botox "doesn't work"

There are several different factors at play, so it is hard to compare.  Botox, Dysport & Xeomin are dosed differently and so it is not a straight forward comparison, especially if you are changing injectors (you didn't mention if these products were all performed by the same physician).  If you find a product and reputable injector who gets you good results, stick with him/her.

For your comparison, I usually use 25 units of Botox in the glabella (the vertical frown lines between the eyes).  I have found a dose of 75 units of Dysport is required to get consistent results there.  Finally, I have noticed some inconsistent results w/ Xeomin for now at a dose of 25-30.  That is, some patients get good initial results but it wears off earlier than I would like. 

Rarely, patients can develop antibodies to the botulinum toxin, which inactivates the medicine before it can work.  As I said, this is rare, and you would probably find that you got 0% response to the injection rather than a weak injection if you had high titers of antibodies.

One other possibility is that you are receiving diluted or "counterfeit" Botox from a less than reputable location.  You can't readily check to see if the product has been overly diluted, but if you have any concerns about counterfeit product, you can check out the Botox bottle, which has an Allergan hologram on it to assure you it is the real deal.

In summary, I would check back with the injector who gave you the good results with the Botox, and try that formula again (same injector, same product).

Michael Bowman, MD
Roanoke Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Botox Not Lasting as Long

There are different reasons for why Botox/Xeomin/Dysport may not be lasting as long. It is very unlikely that it is from lifestyle changes. It could be due to placement or dosing. The neuromodulators are not at a one:one dosing ratio, and exact placement matters.                                               It could be placement and/or dosing.It could be placement and/or dosing.ItItUnfortunately, it is also possible to develop antibodies to the Botox protein. If this is the case, then the treatments might not last as long. Xeomin has no complexing proteins, and has been shown to have less antibody development. However, this might not affect the length of time it works.           In the experience of our clinic, it does seem that Dysport may cause a more solid "freeze" of the muscles. So maybe try that again. A good dose would be 65 units (about 25 U of botox) for the lines between your eyebrows, and an additional 40-45 units for the horizontal lines across the upper forehead. If you are recruiting muscles to make yourself frown, have an experienced physician ask you to frown and raise your brows to see exactly where to place the injections.  

Jennifer Reichel, MD
Seattle Dermatologist
4.5 out of 5 stars 42 reviews

Botox No Longer Working

The issue is likely the amount and the placement.  35 units of Xeomin is a relatively small amount for both the frown lines and horizontal forehead lines, if you are trying to "freeze" the forehead.  You may have had good results when you were younger with 25 units of Botox, but I often find that as we grow older and wiser, we need a bit more than in the past.  You may also be recruiting muscles alongside the frown lines and these recruited muscles, if not injected will take over and create the frown lines.  I suggest you consider having more units injected either now or your next session, and consider more units total.  You should let your injector see how much movement you have at 6 weeks with the 35 units.

(This answer is not intended nor implied to be a substitute for medical advice.  It is posted for patients’ general education only.  Always seek the advice of your physician or other qualified healthcare provider for further evaluation of your individual case.)

Mireille Chae, MD
Seattle Dermatologist
5.0 out of 5 stars 1 review

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.