Can You Build a Resistance to Botox?

I have had botox for several years and love it but I am debating on having dysport as I think botox doesnt work as well now - can you build up a resistance to Botox?

Doctor Answers 24

You can build a resistance to BOTOX,

You can build a resistance to BOTOX, but it’s rare. With the newer BOTOX formulations, very few people (less than 1%) really develop a true resistance to BOTOX. Some people who have had a resistance to BOTOX have had good results when they switch to a different neuromodulator like Dysprot or Xeomin.

New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

Botox Resistance

It is possible to develop a resistance to Botox,usually through your body making antibodies to the Botox. Also be aware that the expertise of the injector and the number of units injected are also variables that may account for decreased response. However, if you have developed a resistance, then Dysport or Xeomin are an alternative that may still work. 

Dysport, Xeomin and Botox are all preparations of botulinum toxin A which is a derived protein. It works at the nerve-muscle interface to relax targeted muscles. 

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

Resistance to Botox

Yes, you can develop antibodies to Botox that will render it ineffective.  Try Dysport.  It has a different molecular composition and is more likely to work well.  I've had two patients with this problem and Dysport worked great. 

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

Botox resistance

is unlikely. If it used in higher doses a resistance can develop. There is no difference between the manufacturers.

Robert Kasten, MD
Mainz Dermatologic Surgeon

Botox Resistance

It is very possible to develop resistance to onabotulinum toxin A (Botox Cosmetic), although rare. It would be a great idea to try Dysport with an injector who is experienced in using both of these drugs to see if you can get the same results with Dysport as you used to with Botox.

Sumit Bapna, MD
Columbus Facial Plastic Surgeon
5.0 out of 5 stars 47 reviews

Does Resistance to Botox REALLY Exist?

Theoretically, our bodies can form a tolerance to many drugs if they are given to us for prolonged periods of time. The medical term is TACHYPHYLAXIS. However, in practice, this rarely happens. It is FAR more common for Botox not to work properly because :
- it was injected by an unskilled injector
- it was expired Botox
- it was old or overly diluted (less active units)
- it was a cheaper fake or overseas Botox (poorly shipped - not properly refrigerated)

I have a large Botox practice and have heard many new patients coming in telling me that "somehow Botox does not work on me". In every single such case, Botox DID work making the earlier Botox failures due to one of the above or a combination of the above factors.

Dr. Peter Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Resistance to Botox is rare; Dysport may be a solution

Although rare, it is thought that antibodies can develop to the Botox molecule, resulting in shorter durations of effect.  For my patients where this has been a concern, usually switching to Dysport will provide the expected results.  

Timothy G. Rodgers, MD, FAAD
Frisco Dermatologist
4.8 out of 5 stars 4 reviews

If Botox doesn't work for you, try Dysort!

I have patients who have reported a change in the effectiveness they perceive from Botox injections in my practice - as you have related in your inquiry. While the cause of this occurrence is not known for certain, it certainly would be a great option to try Dysport or in cases of significant lack of effect, Myobloc. Good Luck.

Benjamin Bassichis, MD, FACS
Dallas Facial Plastic Surgeon
4.7 out of 5 stars 40 reviews

Botox and tolerance

Most physicians who inject much Botox for cosmetic use are not convinced of the development a resistance to Botox as a real effect but there may be a couple of my patients who don't maintain benefit longer than two months despite considerable units being injected.  Switching to Dysport might be worthwhile despite both Dysport and Botox being composed of serotype A of Botunlinum toxin and therefore a difference in resistance shouldn't be an issue. It might be worthwhile to try Dysport as there is at least one report in the medical literature that Dysport may last a few weeks longer.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Botox resistance is uncommon but possible

The usual explanation for lessening effect with Botox after repeat injections is the formation of antibodies, but this is actually rare. More likely, what happens is that when muscles are repeatedly targeted with Botox, adjacent muscles can be "recruited" to take over, and so an adjustment in technique to include these muscles may be the solution. Dysport also works well and I have had at least one patient who had resistance to Botox but had a good response with Dysport. The answer may be that Dysport spreads a little bit more after injection so it may have affected nearby muscles more.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 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.