Nonresponder? Am I immune to Botox?

Question

I got 40 units of Botox in my forehead, two weeks later I have movement. So, I went back to the med spa and they said I may be a "Non-responder" and so they tried dysport. I feel okay after 5 weeks of that, but I think i am seeing some movement. At this point I don't really know if that is normal, is that such a thing to be immune to Botox?

Kenneth D. Steinsapir, MD · Answer

Unforuntaly cheating people on how much botox is in their botox solution is an easy way of increase profits.  This seems to happen a lot.  I recommend finding a new botox injector,  Try an ethical physician or surgeon with an excellent reputation.  Try a Microdroplet Lift® injector.  You can find one on the site using the physician directory.

Samir Undavia, MD · Answer

Its possible that you are just one of those patients that require a higher dose of either product.  Its worthwhile to try that, or switching to a different product like Xeomin.  I have a few patients that require much higher doses for the desired effect compared to the average patient.   Its definitely more expensive with the higher number of units you'll require but if it works, you'll be happy.  It can also be more expensive to see a board certified facial plastic surgeon, plastic surgeon or dermatologist, but also worthwhile to get their expertise.  And make sure you sign up for the rewards program of what ever product you eventually use regularly so that you can take advantage of their discounts.  Good luck!

Jason Emer, MD · Answer

It may be that additional Dysport is needed to get the results you want. Xeomin is another alternative. Deeper wrinkles need a combination of Botox/Dysport/Xeomin with fillers, lasers and microneedling/prp to get improvement. See an expert. Best, Dr. Emer

Vilma Di Maria, MBBS · Answer

thankyou for your question,
If you were truly a non responder then this means no form of Botulinum will work. It is most likely the dose that was injected . You may just need more . Some patients just do.
I would try again but elsewhere . Swapping doesn't make any sense.

Laura Phan, MD · Answer

There is a phenomenon wherein patients develop antibodies against the neuromodulator and become "resistant" to the neuromodulator. When this happens, I do switch to a different brand, Botox to Dysport or Dysport to Botox, to see if a different protein carrier on the neurmodulator might make a difference. However, such antibodies are usually due to some years of treatments. After switching, I would increase the dosage if there is still suboptimal effect before determining "resistance."

Beata Danek, MD · Answer

There is a possibility to become nonresponder after prolonged use, but it is very rare. But if you responded to Dysport, it sounds suspicious. Also to give 40units of Botox into Forehead is kind of unusual, usually it is less. 
I would suggest to try it with a different provider next time.

Adrienne E. Stewart, MD · Answer

It is rare that anyone is a "non-responder" to Botox. What is common in the Medspa industry is that they use diluted Botox which they advertise at low prices. There  have also been  instances of  "bootleg" Botox being used. Allergan, the maker of this product tries to oversee these practices and shut them down. Even with this oversight  these practices still exist.  I would recommend getting an opinion from a board certified dermatologist or plastic surgeon that have a good reputation and have a practice that includes cosmetic Botox. Adrienne Stewart MD FAA D

Melvin Elson, MD · Answer

You are not immune to Botox and it makes no sense to switch from Botox to Dysport as that is like switching from Bayer aspirin to St Josepj. Get away from the medspa and see a board certified dermatologist

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your
photographs Kvad. I understand your concern. Botox is a purified protein
used to address wrinkles associated with facial expression. When injected into
the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The
most common areas of treatment are in the upper face. These include the
horizontal lines seen on the upper forehead when one raises the brows, the
vertical lines seen between the brows when one frowns (frown lines), and the
crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without before and after photographs or a
formal exam in the office where I can view the skin in multiple angles and observe
wrinkles formed with facial expression. However, I hope the information
provided here is useful.The appearance of frown lines is variable from
person to person. Usually they are in a vertical orientation but sometimes they
can be oblique and sometimes a horizontal line is seen across the upper portion
of the nasal bridge. The most common variation is to have two parallel lines,
hence the common term "11's" to describe them. But some people have
one, three, or more lines. Some people also will see a bulge in the area when
contracting the muscle. This bulge is smoothened out after a Botox treatment.The pivotal studies used 20 units of Botox in
the glabella area between the brow to address the frown lines. These studies
demonstrated that the peak results are seen 14 days after the treatment and
most people enjoy their results for 3-4 months. At that point, a maintenance
treatment is recommended. While some people start to see results as early as
the next day, it can take two weeks for full results so patience is
important. We have our patients return two weeks after their treatment to
assess their results via photographs. At that time additional units may be
added if necessary. The pivotal studies used 20 units of Botox in
the forehead area above the brows to address the horizontal lines seen when one
raises the brows. These studies demonstrated that the peak results are seen 14
days after the treatment and most people enjoy their results for 3-4 months. At
that point, a maintenance treatment is recommended. While some people start to
see results as early as the next day, it can take two weeks for full
results so patience is important. We have our patients return two weeks after
their treatment to assess their results via photographs. At that time
additional units may be added if necessary. Although 20 units is a good standard dose to
start with, some people require a higher dose because of higher muscle volume. This
is common in mature patients, in those with large bulges from expressive faces,
and in men. I find that Botox still works in these cases, just a higher dose is
required. I have used up to 40 units in the glabella.In rare cases, some people are resistant to a
certain neuromodulator such as Botox. In this case the treatment can be
repeated using a different neuromodulator such as Dysport or Xeomin. This usually occurs after years of treatment with a neuromodulator and not at the first session.Please consult with a doctor for specific
recommendations. Good luck!

Leonard Grossman, MD · Answer

If you saw a response to dysport for even a few days, that means you do respond to dysport as well as Botox. Chances may be that the botox that was used on you was either too old or too diluted. I would go to a reputable plastic surgeon like myself or a dermatologist rather than a spa. Good luck from New York City

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