Neurotoxin resistance? Did waiting only 2 months that one time make me immune?

Question

I had been getting Botox in forehead, crows feet, gummy smile, & masseters since May 2021 every three months. I was treated with botox & dysport october 2022 & December 2022 (only 2 months bc movement returned & injector said it was ok). March 2023 treatment unsuccessful. Switched back to all botox in July no reaction. Followed up with xeomin 2 weeks later no reaction.

Anil R. Shah, MD · Answer

Hello lins012193! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. I am sorry to hear this! Neurotoxin resistance may occur when a patient has been using the same neuromodulator for a over a certain period of time. Based on your history, this may be likely. I highly recommend scheduling an in-person consultation in order to better assess your face and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

J. Renee Booth, MD · Answer

The rate of developing an immune reaction to botulinum type A is low, around 1-3%. The risk factors for developing antibodies include genetic factors, high doses (usually to treat cervical dystonia), total cumulative dose, and frequent exposure. To minimize the risk of developing antibodies, it is helpful to keep the dose per treatment session below 100 units of Botox. For most patients, a one-time session at 2 months instead of 3 months is fine. In general, waiting 3 months between treatments is best to reduce the risk of antibody development, especially for patients that notice reduced effect from botulinum type A. There is no cross-reactivity between botulinum type B (Myobloc) and botulinum type A, so that is an option. Unfortunately, this product often is not used or offered by cosmetic practices. It can also cause some stinging upon injection and typically lasts 2 months. The other method to manage the situation of poor response to botulinum type A is to take a 3-year break from use.

Camille Cash, MD · Answer

Resistance to Botox and other neuromodulators is uncommon, but it can happen.  There is typically no issue with having additional treatment two months after a previous treatment if the product effects are wearing off.  Since you have tried several neuromodulator products you may wish to wait a few months and try again.

Neurotoxin resistance? Did waiting only 2 months that one time make me immune?

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