Botox immunity - can it go away with time?

There is a good chance that you have overcome Botox resistance after two and a half years. I think it’s worth trying Botox injections again.

In rare cases, some patients may develop an immune response to Botox that may reduce the effectiveness of treatment.

My advice is to use the lowest effective dose and allow gaps between Botox treatments to last as long as possible. Best of luck to you

Hello and thank you for your question! Yes, there have been rare cases where Botox immunity has lessened or worn off over time, though this is not guaranteed. In your case, it’s likely that you developed neutralizing antibodies to botulinum toxin type A, which can block the effects of treatments like Botox, Azzalure, and Bocouture. This usually happens after repeated exposure, particularly with higher or frequent dosing. However, some individuals have reported a return of responsiveness after several years—typically three to five—without any further toxin treatments, as the immune system may gradually stop producing the antibodies once the trigger is removed.

Since it's been over three years, it may be worth cautiously testing a small dose again in one area (such as the glabella) to see if any effect returns. However, if that still proves ineffective, there are non-toxin alternatives that may help soften strong “elevens” lines. These include energy-based treatments like radiofrequency microneedling or ultrasound-based skin tightening, which can stimulate collagen and improve skin texture over time. Another option is dermal filler placed strategically to soften static lines, particularly if the lines have become etched in due to years of muscle movement. While fillers won’t address the muscle activity itself, they can reduce the appearance of deep furrows.

Although there's no guarantee your immunity has worn off, you’re not necessarily wasting your money by trying again. Just make sure to proceed conservatively and work with a provider experienced in managing resistance to neurotoxins, who can guide you through both injectable and non-injectable alternatives.
Best of luck!
Genie Alexander, RN BSN
for Anna Petropoulos, MD FRCS
Center for Classic Beauty
Boston & Danvers, MA

Generally it is a casual conclusion by a doctor and not bases on antibody testing, which honestly is seldom done. It is possible to develop antibody based resistance. When that occurs, the resistance could diminish with time but is will soon be back. If you actually have it, then please understand that no botulinum toxin A product will be effective. The commercially available botulinum toxin B is not a practical treatment option. It simply is not as effective or long lasting as botulinum toxin A, and generally not worth your money and effort. You did not post photographs. You might consider trying a different injector, sometimes "resistance" is not resistance but reflects an ineffective treatment pattern. Please consider sharing what you learn about your situation because it can help others with similar experiences.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. I recommend trying a different product such as Dysport, especially since you've had no success with Botox, Azzalure, or Bocouture in the past. While it's rare, some individuals do develop resistance to botulinum toxin type A, often due to the formation of neutralizing antibodies. Since it's been a few years, it's possible—but not guaranteed—that your immune response may have decreased. However, Dysport is a slightly different formulation, with a different protein structure and diffusion pattern, and some people who don't respond to one brand may respond to another. I hope this helps and best of luck!

Developing resistance or "immunity" to Botox (botulinum toxin type A) is relatively rare, but it can occur. This resistance is often due to the body developing antibodies against the botulinum toxin. Here are some considerations and potential options for your situation:

Understanding Botox Resistance:

Some individuals develop neutralizing antibodies that can render Botox and similar products less effective or ineffective. This is more likely with frequent, high-dose treatments.
There are different formulations of botulinum toxin, such as Azzalure and Bocouture, which you have tried. These products contain similar active ingredients but may have different protein complexes.
Possibility of Immunity Wearing Off:

There is limited evidence on whether immunity to Botox can diminish over time. Some anecdotal reports suggest that a long enough break from treatment might reduce antibody levels, potentially restoring sensitivity.
However, this is not guaranteed, and scientific data on this aspect is sparse.
Alternative Options:

Switching Products: While you've already tried Azzalure and Bocouture, some patients have success with other formulations or brands. Discuss with your dermatologist the possibility of trying a different type of botulinum toxin, such as Xeomin, which lacks accessory proteins that might trigger antibody production.
Non-Toxin Alternatives: Consider other cosmetic treatments for reducing "elevens" lines, such as dermal fillers, microneedling, or laser therapy, which do not involve botulinum toxin.
Consultation with a Specialist: Seek advice from a dermatologist or a specialist in cosmetic procedures who can provide personalized recommendations based on your history and current condition.
Cost-Benefit Consideration:

Before deciding to try Botox again, weigh the potential benefits against the cost, especially given your previous experiences. Discuss with your healthcare provider whether a trial might be worthwhile.
Ultimately, the decision to try Botox again should be made in consultation with a trusted healthcare professional who can assess your individual case and explore viable alternatives if necessary.

If you have true resistance to Botox, then all botulinum neurotoxin type-A products shall not meaningfully work - although, perhaps Daxxify (by Revance) might be worth considering (simply because it is notably different). I do not believe that the immune response shall disappear, although it may transiently decrease if there's no exposure to the toxin for a few years. You could try Myobloc, which is botulinum neurotoxin type-B, but its duration of activity v. cost is, in my opinion, not worth it for patients seeking year-round softening (which is the majority).

It's not common to develop immunity but it can happen. We often recommend trying different neuromodulators in a situation such as yours since each are formulated a little differently. Dysport, Juveau, and Daxxify are others you can try. You may find improvement after taking a break from it, but there is no way to predict if it will work without trying again.

Botox immunity is caused by the antibodies formed by your body against the botulinum toxin type A.
This implies that basically every type of neuromodulator in the same category will no longer work on you. You can however, try Myobloc, which is a botulinum toxin type B and it works in the majority if not all of the patients who no longer respond to Botox and similar products. I have been using this product for over 25 years with a great deal of success. I wish you good luck from Leonard Grossman, MD, organic Plastic Surgery NYC