Is it possible that Botox simply does not work on some people?

Several years ago I had Botox and it never worked. Three weeks ago I had Botox again in three areas - forehead, eyes and Glabella by a leading plastic surgeon but, again, it has not worked. Even the very fine lines around my eyes are exactly the same.

Doctor Answers 9

If Botox Does Not Work, Dysport May Be Considered

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Some people may not see the results they want with Botox. This maybe an issue with dosage. Some people have stronger muscles and require higher dosages.

In some cases, individuals may experience the changes they want with Dysport. Dysport has fewer proteins around the main molecule. Therefore it is not as likely to be rejected by the immune system.

The molecules of Botox and Dysport work to block the release of acetylcholine. Without this input, the muscles will stay relaxed. Both injections are intended to reduce dynamic wrinkles which appear when your face moves. Static fine lines may have developed over the years due to repeated muscle contractions. These can be addressed with a very precise filler called Belotero. Botox and Dysport cannot eliminate tiny surface creases.

Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 33 reviews

Botox works in almost all cases

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There are a small number of patients in whom Botox does not work due to immunoresistance. This is exceedingly rare. I would recommend following up with your surgeon to review the results.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Immunoresistance to Botox

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When Botox was first purified, there were a larger number of patients on which it did not work (immunoresistance). With the current batch, it is exceedingly rare to have true immunoresistance to it. Far more likely are inadequate dosing, or improper storage/handling.

As a patient from a troubleshooting perspective, follow up with the leading plastic surgeon and let him/her know the results. He/she may then add more units. If this still fails to show any response, then you may want to try Dysport or Xeomin. Dysport and Xeomin have different accessory proteins (Xeomin does not have any) and so even if you are immunoresistant to Botox, you should show a response.

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

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Botox Doesn't work

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In some patients, Botox doesn't seem to work though these patients are very rare. Generally, a larger bulk of muscle requiring more Botox, inappropriate injection, or inadequate dilution (cheap botox) can lead to decrease effectiveness. Some individuals develop an antibody to botox after their first treatment so each successive treatment doesn't work. Best option is to talk to your plastic surgeon and discuss other options such as Xeomin, Dysport, or a browlift to interrupt muscle movement.

Does Botox not work on some people?

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There are some people who get no response from Botox treatments. These are people that somehow have developed a natural resistance to the toxin in Botox. It is very rare to have this issue occur, but I have seen it a few times. It is possible that if you have never had Botox work on you that you could be one of these people, unfortunately.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Is it possible that Botox simply does not work on some people?

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I would recommend following up with your physician, as a higher dose may be necessary for you to achieve the best result. Location of the injections, technique, and dosage are all factors that will influence the outcome of your treatment. I hope this information helps, and I wish you the best of luck.

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

How Botox Works

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There are two basic types of wrinkles. Some wrinkles appear with expression. These are called dynamic wrinkles. Some wrinkles are present even when your face is relaxed. These are called static wrinkles. Botox works by relaxing muscles and helping the wrinkles that occur with facial expression (dynamic wrinkles).

There are several reasons why your Botox may not be effective. One is that your wrinkles are the static type. If that is the case, Botox will not help. Another possibility is that the Botox dose is not high enough or the Botox was not injected in the ideal location.

If you have the right type of wrinkles, and the dose and injection location is correct, Botox virtually always works. I would suggest returning to your doctor to discuss your treatment and seeing if a touch up might help.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Is it possible that Botox simply does not work on some people?

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Follow up with your physician to evaluate the area, he/she would know how many units were applied, you may need a stronger dose if you have strong muscle movement

How many units?

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Botox always works. The effect can take up to 2 weeks for a full effect.

You must need a higher dose. How many units were you given in each area? Return to the doctor for re-evaluation.

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.