Botox Does Not Work on Third Time?

I am 52. I had my first Botox injection at June 2011 most for Furrow 13 units and 15 to forehead. I liked the result (eye lift) but I could Furrow my Brow. My second injection was at December 2011. The same result. My third injection I had at end of the August and no result at all. Even I had 32 units. My doctor repeated the procedure in 4 weeks and gave me 28 units to my Brow only and some to forehead.No results.

Doctor Answers 8

It is rare to find a non-responder to botox

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It is rare to find a non-responder to botox, but this has been reported.  I would obtain a consultation with a Board Certified Facial Plastic Surgeon to discuu the treatment options.

Portland Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Botox not working

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There are various reasons why the Botox may not have worked this last time. It is possible in a very small percentage of people for Botox to stop working with repeated injections. There may also be other issues, such as depth of injection, amount injected, technique, etc. Speak with an expert injector to see about your options. You could certainly try one of the newer botulinum toxins such as Dysport or Xeomin which would like work for you.

Benjamin Barankin, MD, FRCPC
Toronto Dermatologic Surgeon

Botox injections for furrows

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Before and after photos would be helpful in determining what effects you have had with Botox.  You should consider being assessed by an experienced dermatologist or plastic surgeon.  If Botox really does not work for you, you could try Dysport.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

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Dysport and Xeomin Can Work Well For Botox Resistant Individuals

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I have considerable experience using Botox for aesthetic purposes, having started doing so in 1991, eleven years prior to its official FDA-approval for this purpose. Throughout that time, from time to time, I have encountered individuals who had at first responded well to treatment, but who, after two or more prior treatments, demonstrated either no response, weaker response or shorter duration of response.

The medical literature estimates the development of antibodies in the range of 3%-13%. However, it seems that  even among those with proven antibody formation few actually demonstrate any significant loss of responsivity to further treatments. This of course does not rule out that some may indeed do so and this fits my own experience in twenty-one years of injecting Botox for dynamic wrinkles.

An increased chance for promoting antibody formation may also be related to the routine practice of bringing patients back after just two weeks to touch up any areas that may not have completely responded to treatment. For this reason, it is currently deemed wiser to bring patients back no sooner than a month following treatment for touch ups.

When there exists no other obvious explanation for loss of response or shortening of duration of response (such as changes in dosing or concentration, etc.), and antibody formation is suspected, a trial of Xeomin, another bolulinum neuromodulator would be reasonable.

Xeomin is essentially a naked  Botox, stripped of the proteins that come attached to Botox that are believed responsible for triggering the development of antibodies. I have found Xeomin to helpful among the few patients I have had recently  in whom I have suspected antibody-related resistance, In such instances I have seen full responsivity restored.

Although Dysport, the third approved botulinum neuromodulator available in the U.S. market, does contain additional proteins, I have nonetheless also found this product to be useful as an alternative in patients who appear to have grown resistant after several successful prior treatments.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Botox not responding

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I do have patients that become resistant to Botox. Dysport has been a very good option when the Botox is not responding.

Botox not working

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Without seeing you in person to assess your specific needs, it's difficult to answer your questions. However, for you not to respond to treatment is highly unlikely and it also is unclear why you waited so long inbetween treatments. If you're visiting a reputable office that is well-known for their injection practice and employs well-trained and experienced injectors, you should be more educated about the longevity of Botox and have a consult that discusses all of your needs.

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Some people develop resistance to Botox. Try Dysport.

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When I have patients who become resistant to Botox, they will almost always respond to Dysport.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews


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Did you go to the same physician for these treatments? Or did you go to 3 different doctors? There is no reason for it not to have helped or worked for you, unless they are diluting it differently.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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.