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

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.

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.

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.