Can You Build a Resistance to Botox?

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. 

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.

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.

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.

While there is no scientific evidence that a person can develop antibodies to Botox, I clearly see situations of resistance in my practice.  It is not uncommon for people to begin to notice that Botox does not work as well (or as long) as it did in the past. This may be a resistance, or it may be that there are now so many "bargain" injectors of Botox that the matieral is overly diluted, poorly stored, or even purchased from non-legitimate sources  such as overseas pharmacies.  In these situations, switching to Dysport (same neurotoxin but with slightly different proteins around it) seems to work.