Can it be possible for someone to be completely resistant to Botox? (Photo)

In 2014 I tried Botox for the first time for deep forehead lines. I had 26 units and literally none of it took. I decided to try again a 6 weeks ago with 30 units this round. I had it injected by a board certified plastic surgeon who is highly regarded where I live and whom family and friends have gone to for their Botox and all have had great results. After two weeks this round, it took perfectly. However now 6 weeks later it's gone. How can this be?

Doctor Answers 12

Resistant to Botox

Hello, 

Thank you fro your question. Its is very rare; however, it is possible. You may require a larger dose. I'd recommend booking a consultation with a skilled and qualified injector to discuss your options.

Take care.

Botox Resistance

There are a few reasons why botox works better for some people than others. It is possible to be resistant to botox, but it is uncommon. The way the botox was diluted can have an affect on the duration as well as a patient's metabolism. It's been know that botox doesn't last as long on patient's with higher metabolisms. I would recommend going back to your practitioner to discuss your concerns.
 

Can it be possible for someone to be completely resistant to Botox

Although theoretically possible for someone to be completely resistant to Botox, it is extremely rare. I have never noticed it in treating thousands of patients over 20 years. There are probably more likely scenarios. Possibly, Botox was reconstituted with water incorrectly diluting it to a very low dose. Do remember that Botox dosing is correlated with muscle mass. If you have significant ability to wriggle your for it with a larger than normal frontalis muscle, you may require more Botox than average. Discuss your concerns with your plastic surgeon.

Can it be possible for someone to be completely resistant to Botox?

Thank you for your question. It is possible for to be resistant, but it is also rare. I would recommend visiting your surgeon for an examination. 

Regards, 

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Botox not working and not lasting very long

Acquired resistance to botulinum toxin is possible, but uncommon, and it occurs to the binding proteins accompanying the toxin. Resistance is more commonly seen in patients receiving high doses frequently, i.e. for medical reasons. If you tried Botox Cosmetic the first few times, try another formulation like Xeomin or Dysport. Xeomin has no binding proteins with it so resistance is uncommon. Also remember that people metabolize medications differently, so some never get results for four months. Initial results from botulinum toxin have a lot to do with concentration of the product and placement. This requires an experienced injector. Occasionally, a batch of botulinum toxin can be weaker or inactive. This could explain your initial poor response to treatment. Good luck!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

Resistance to Botox

It is certainly a possibility though not very common. all patients make some degree of antibodies against Botox when injected but the effects remain subclinical. Rarely, are there patients who do not get a response of any significance or none at all. it would do no good to switch to another form of the toxin

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 6 reviews

Botox and Metabolism and rates of effect NYC

I have definitely seen over the years that patients metabolize the product differently.  It could be that less product was used or the batch wasn't as strong as another.  I would return to your treating physician for examination.  Possibly Dysport would be a better alternative if this happens again.  Best, Dr. Green

Botox lack of effect

I agree with the other Dr.s. I would certainly try dysport or Xeomin. However,'I have found that my patients typically need 30% more Xeomin units compared to Botox. Dysport has also worked well in my patients with reduced or no response from Botox. 

T.G. Khan, DO, FACS
Fort Lee Oculoplastic Surgeon
4.5 out of 5 stars 24 reviews

Botox

I have found that patients that are very active ( marathon runners, triatheletes, personal trainers) tend to metabolize it quicker. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Resistant to Botox

Complete resistance to Botox is highly unlikely. And it does not appear to be the case here, since you said you initially had a good, if somewhat slow, response to your most recent injection. Response is related to muscle bulk and strength, which is why some people need more Botox in an area than others. Different people do recover at different rates, as well, so some people find the effect wears off faster. Finally, Botox and Dysport have proteins combined with the toxin. People can have an immune response to those which makes the product less effective. You might try Xeomin, which is pure toxin, without protein, and see if it works better.

Nicole Kafka, MD
New York General Surgeon
1.0 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.