Botox Resistance - Why Doesn't Botox Work for Me?

Question

I had Botox injections between the brow.  The frown line was still present a few weeks later so I returned for another injection. I am starting to think that I am crazy. I can feel the other muscles in my forehead "fighting" the paralysis. The line is still there and it seems that from the point of the arch of the brow the muscles are furrowing inward.  If I lift my brows the line goes away but when I relax the forehead the furrow is back. The MD who did my injections said he gave me a lot of Botox.  I went to him because he is a friend of one of my friends so I don't think he is using inferior product.  But I am so disappointed.  Is it possible that Botox just doesn't work for me?

Brett S. Kotlus, MD, MS, FACS · Answer

It is possible to develop a resistance to Botox, but this is extremely uncommon. Other reasons for failure of treatment can be related to injection technique or inadequate number of units. The dilution technique is not relevant, but the total number of units injected is the key.
Another reason for "failure" may be when the corrugator/procerus muscles are immobilized there is recruitment of orbicularis oculi muscles. What this means is that the eyelid squeezing muscles can create some movement between the eyebrows, but any resultant lines should be significantly less severe than those present before Botox treatment.
If it is determined that there is patient resistance, one option is to try a different variety of botulinum toxin such as type B (Myoblock). This is off-label for cosmetic use. Another alternative is radiofrequency ablation of the corrugator nerves. This is a procedure marketed by Bioform (Relaxed Expressions) that is FDA approved for peripheral motor nerve ablation and can produce a Botox-like effect for a longer period of time than Botox.

Harold J. Kaplan, MD · Answer

We're wondering whether you are resistant to Botox or if Botox is not the right tool for the problem. Every once in a while, we see a patient with ONE vertical line in the area between the eyes that is so deep that Botox will not fix the problem. In these cases, it is possible to use Botox and/or a dermal filler such as Restylane to solve the problem. While this injection technique is not that common, it can be very effective when used by an experienced injector.

David Shafer, MD, FACS · Answer

Julianna,

	Resistance to Botox is very rare (1:10,000) and the cause is not completely known. What is known is that your body forms an antibody response to the Botox. If you do have resistance, there are other forms of Botulinum toxin that can be used. That said, it is unlikely that you are resistant. From your description, it seems more likely that you need a dermal filler in addition to the Botox. Botox works on dynamic wrinkles - that is, wrinkles that appear when the muscle contracts. Wrinkles that are there at rest are called static wrinkles. These wrinkles are not completely treatable by Botox. The wrinkles are due to years of trauma to the dermis (skin) from continual movement. (These could have been prevented had you started Botox before they appeared) Now that the wrinkles are there and not treatable by Botox, you need a filling agent such as collagen, fat or any of the off the shelf fillers to push the wrinkle out from below.

	I hope this is helpful.

Peter A. Aldea, MD · Answer

"Why doesn't Botox work FOR ME?" and "What is wrong WITH ME?" are the most commonly heard self-directed complaints we hear from patients coming to us from other offices or spas thinking that somehow they are to blame for inferior or non-existent Botox results.
Let's cover the causes of "Botox work for me"RAREST cause - your body has formed a resistance to Botox by forming antibodies to it. It is known as TACHYPHYLAXIS (take notes - this would sound great at a cocktail party...). I have done thousands of Botox treatments and have never seen it. Can it happen? theoretically, yes with large doses of Botox given frequently.
Common cause - you have a wrinkle which is present at rest. If the wrinkle deepens when you smile or frown BUT is present when you do not. Botox, despite of how potent of expertly it is given you, will not smooth the wrinkle by itself. A filler needs to be put it.
COMMONEST CAUSE - you were given an insufficient amount of active Botox. The Botox in your syringe was either too old and inactive, overly diluted and watered down (too few active units), fake Botox or all of the above. A touch up with more (active) Botox is in order.
REMEMBER - Unless you are Superman, properly administered Botox WILL work on you.

Steven Wallach, MD · Answer

It is unusual for a patient to be immune to Botox. However, there are some patients that develop resisitance and newer products not yet available may be helpful( Reloxin). Reloxin is derived from a different strian of botulinum toxin than Botox.

	If the muscle are paralyzed and theline is still there, then it is most likely a dermal deficiency crease which may benefit from undermining surgically or a filler or the combination of the two to soften its appearance.

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Answers (10)

Answer: Why Botox doesn't work for some

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