Botox immunity - can it go away with time?

Question

Hi, I developed immunity to Botox three and a half years ago. My Doctor at the time had never seen it before and tried another dose of Botox and when that didn't work she tried Azzalure, still nothing! I then tried Bocouture a year later and that didn't work either. That was two and a half years ago. I really miss it as I have strong "elevens" lines. Is it worth trying Botox again, will enough time have passed for the immunity to wear off or am I wasting my money? Is there any known case of immunity wearing off? Any feedback appreciated.

Ella Fedonenko, MD · Answer

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.

Caner Kacmaz, MD · Answer

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

Anna Petropoulos, MD, FRCS · Answer

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

Camille Cash, MD · Answer

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.

Kenneth D. Steinsapir, MD · Answer

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.

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Botox immunity - can it go away with time?

Answers (8)

Answer: Botox immunity

Answer: Botox immunity

Answer: Botulinum toxin resistance from cosmetic botulinum toxin services is relatively rare.

Answer: Botulinum toxin resistance from cosmetic botulinum toxin services is relatively rare.

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Everything you need to know about Botox

Our mission is to create a world where every investment in modern beauty is Worth It.