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