I have developed antibodies to Botox after using it for about 6 years. Will Frotox be an alternative for me?

Doctor Answers 6

Other Neurotoxins Since Botox Isnt Working

Xeomin and Dysport are both available if you feel Botox isn't as substantial anymore.  All work very well and can be used for various different instances. I suggest speaking to your dermatologist or plastic surgeon.  I wish you the best of luck, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Frotox instead of Botox

Frotox is not FDA approved or available in the US.  There is no indication yet that it is effective.  If you have developed antibodies to Botox I would try Xeomin or Dysport to see if you have better results.  Please let me know if the other neuromodulators work better for you.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Hold The Frotox; Xeomin Can Be Effective When Botox and Dysport No Longer Work As Well

I have been using Botox for cosmetic reasons since 1991. Since that time, I occasionally encounter a patient who at first responded well to Botox, but after several treatment sessions, no longer responded as well or has not maintained his/her improvement for as long as previously. Some, for example, who in the past may have enjoyed six months of correction were seeing no more than four to eight weeks of results. I have been using Dysport for over ten years already and have seen a similar phenomenon with this neuromodulator, as well.

One possible explanation that has been proposed for this problem is the development of antibodies to the injectables, although this is considered to be quite rare. Nevertheless, in such cases, I have been switching these patients to Xeomin, a neuromodulator very much like Botox, but whose manufacturer has taken pains to strip all unnecessary excess proteins from the active molecule in order to reduce its potential to provoke antibody formation. So far, I have generally had success with Xeomin in cases where patients have been suspected of antibody formation to the other two approved agents. I definitely believe it is worth a try in these instances.

Frotox, or Coldtox, as it is also known, is enticing, in so far as it seems to be a non-neuromodulator method for temporarily freezing the nerves. It is not available in the U.S., and it has neither yet stood the test of time nor undergone extensive use, and for this reason I would be cautious in embracing or recommending this technology before it has done so. 

Consultation with a board certified aesthetic core physician with expertise and extensive experience with all neuromodulators would be strongly advised before embarking on any "next new thing."

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Antibodies to Botox, what can I try instead

Frotox is not available for use in the United States at this time and I don't see it becoming available for some time. You could try Dysport or Xeomin instead of Botox as alternatives.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Botox antibodies

Consider Xeomin and, depending upon your appearance, fillers might also be beneficial. There are many ways to address the aging face and Botox is only one of our tools.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 39 reviews


An alternative to consider is Xeomin made by Merz Aesthetics. The manufacturing process is different then the other neuromodulators.

Jeffrey Fromowitz, MD, FAAD
Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 4 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.