Why isn’t Botox or Dysport working for me? (Photo)

Question

Hi. I’m 50 and I’ve decided to try to do something with my 11’s. My Dermatologist suggested we start with 20 of Botox. I lost maybe 50% of movement after 2 weeks and wasn’t satisfied so he added 10 more. The 10 extra did nothing and he later explained that really it needs to be 30 together. So we waited 3 months and tried 30 but he suggested I try Dysport ... Again lost only ~50% of movement. It’s been 2 months since the 30 of Dysport and I’ve almost got all movement back already! Suggestions?

Caner Kacmaz, MD · Answer

Thank you for your question. Any line that is present at rest such as a frown line or a deep wrinkle will not disappear with Botox. When your face is at rest, if your deep lines are still visible Botox will fail to remove them. However, repeated treatment will certainly help soften your lines in time.

Brandon Richland, MD · Answer

Hi, and thank you for your question. Neurotoxin can be a great option to treat your frown lines, AKA 11’s. 20 units of Botox is standard dosing for that area, however, some people do require more units in general depending on the strength of the muscle. Dysport is dosed differently and the recommended starting dose is 50 units for the 11’s. The more frequently neurotoxin treatments are completed, the muscle will begin to atrophy (shrink) and not be as strong as before. Treatment is often recommended every 3-4 months for best results. I would potentially suggest consulting with another provider than may offer you various treatment modalities to address your concerns.

Anil R. Shah, MD · Answer

Hello JSoup! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. I am sorry to hear this! Based on the information, it seems that your muscles in the glabellar complex are very strong and may require more units to be injected. I recommend to try Botox injections again after 3 months and see if you notice any improvements. I hope this helps!

Jason Emer, MD · Answer

If Botox is not an option for you, Dysport or Xeomin are the next options. I suggest dermarolling at home to give the skin Botox-like effects with at-home treatment. See an expert. Best, Dr. Emer

Anna Chacon, MD, FAAD · Answer

Dysport, however, along with similar products Botox, require up to a week before they function at their best. This is because it takes time for the medication to take effect within the muscles and time for the skin to smooth out. Either it was not placed properly in the muscle, not enough was used, or you are immune. Some people require more than others, but actual immunity is extremely rare. In the vast majority of cases, the problem is failure to place the Dysport into the muscle properly. There are several reasons why someone might develop resistance to Botox. The most common reason is that the muscles in the treated area become accustomed to paralysis and learn to compensate for it. This can cause wrinkles and fine lines to reappear over time. You can expect to start seeing Dysport results in two to four days after your injections are administered. However, you shouldn't expect to see your final results within just a few days of your injection session. For that, you may need to wait 10 to 14 days.

Camille Cash, MD · Answer

There are a few reasons why your Botox and Dysport treatments aren't working.  One reason may that more product is needed to achieve the desired result.  Another has to do with the glabellar lines.  If they are present when not animating, meaning they are static, they may soften with the product but not fully resolve. In this case you may be seeing the maximum effect you can get from the product.  You may wish to add further treatments such as Morpheus8 to help improve overall skin tone and texture.

Viktoryia Kazlouskaya, MD · Answer

The amount of Botox needed to achieve the desired results varies from person to person. Some people may need more units than others. In some patients of mine I have used over 50U for glabella area only. Permanent wrinkles are not usually affected by Botox. In this case, you may only see some improvement, but not the desired result. It is recommended to start doing Botox earlier to prevent permanent wrinkles from forming. With regular Botox treatments, the wrinkles will improve over time. The activity of Botox is the strongest for the first 2 months. After that, it wears off, giving the impression that it is completely gone. However, it is usually still working, but to a lesser extent.

Bernard Tan, MBBS, MRCSB · Answer

One reason could be the frown lines (11s) have become static wrinkles due to long term frowning, leading to an impression that they are persisting after treatment with neurotoxin. Would be able to comment better with an in person or video consult to assess movement.
Rarely, you could have become resistant to the effects of neurotoxin, especially in cases of long term use. Try switching the brand of toxin, or using Xeomin (incobotuliniumtoxin A), which is less likely to develop neutralising antibodies

Douglas Taranow, DO, FACOS · Answer

Your physician is correct.  You either need more units, or you have become immune to the neuromodulating effects of Botox/Dysport.  
First, I'm sure your physician meant that they were using either 30 units of Botox or 90 units of Dysport (these are equal dosages as the Dysport bottle has 300 units while the Botox only 100, however, when reconstituted, each bottle treats the same amount).
Many patients who had Covid have become immune or less sensitive to Botox/Dysport in my practice.  Some patients develop an immunity to the product after several treatments.  I usually increase the dosage (from 20 to 30 units) and then switch the product from Botox to Dysport to Xeomin.  Each product has a little different molecular makeup (the protein binding to the A botulinum toxin).

Darice W. Fadeyi, MD · Answer

It’s really kind of difficult to figure out what’s going on here. 30 units of Dysport and 30 units of Botox are not equivalent dosages. 30 units of disport is really only 10 units of Botox, which is clearly an insufficient amount to treat established glabellar lines. It’s also possible that these lines are fully etched and will require a combination treatment using both neuromodulators and dermal fillers for improvement. I suggest you go back to your dermatologist and get a full explanation of the actual dosage used and how to proceed further.

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