Botox Resistant?

I've had botox injections for about 5 years now. Crow's feet, bunny wrinkle and upper lip lines. Lately, last 8 mos. or so, I haven't had good results in the upper lip area. Have gone for "touch ups" and still no real results. Have had Juvederm in lip area, but wrinkles return when I talk. What do you suggest?

Doctor Answers 5


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Hi -

Botox around the mouth is difficult - you don't want to over inject or you can end up with less ability to move your lips ie it can be hard to whistle or purse your lips in order to drink out of a straw. Juavderm or an HA filler can be used along the border of the lip to smooth fine lines but another modality you should try is a peel or laser. After treatment, the skin appears fresh and many of the fine lines that are difficult to treat with filler are much less visible! Peels and lasers are best to be done in the fall/winter so that you can easily avoid sun which can cause brown pigmentation over the treated areas if exposed to sun early on after treatment. Good Luck!!

Botox Resistant? Not really.

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Dear writer, Since you are not having the desired response after Botox on the upper lip area, but the frown, forehead and crows feet areas appear to be responding well, this is very unlikely to be a matter of resistance to Botox (for which we would have Xeomin, by the way). Most likely, your doctor was careful to not overdose the Botox injection in the upper lip, because doing so could also lead to difficulty pursing your lips and other similar functions. I recommend that you try the combination of Belotero filler (perfect for the lines around the lips!!) and Fraxel, to remodel and stimulate new collagen (thus fewer wrinkles) in that area. Please discuss these choices with your doctor. Best wishes from Miami, Dr. Bowes

Incidence of true immunoresistance to Botox rare

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A very, very small percentage of patients do develop neutralizing antibodies to Botox, but it is exceedingly rare.  The more likely scenario for your lack of adequate response has more to do with dosage, injection technique, and dilution.  I would suggest trying a treatment with another experienced surgeon to rule out these possibilities.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

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Upper lip wrinkles are the hardest to treat. I really try to tell patients that you need to sand them down with either laser, chemicals or dermabrasion if you want dramatic results. Botox cant really help this and filler only kind of work

Smoker's Lines Options

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Hi Sadee.  Botox around the mouth does not usually resolve the lines because you cannot use too much of it.  If too many units are used, the patient loses important muscle action that can change the smile or even make it difficult to drink.  

Rather, we use Botox (Dysport) in combination with Restylane or laser resurfacing.  In an ideal world we would resurface the patient 2-3 times to start and if that does not get the patient where they want to be, we would then combine Restylane and Dysport to finish the project.

The challenge with injections around the mouth is they don't last that long.  There is a lot of movement in this area and injection products as well as Botox are metabloized quickly by the body.  Injection durations can be half what they are in other areas of the face.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.