Botox doesn't work anymore! Is there a way to make it work again?

Question

I have been getting botox, Dysport an Xeomin injections for years and now none of them work! I get a small effect but it does not last long. The procedure has been done by several different clinicians so I don't think it is the way it is done. I think I have built up a resistance. I love the effect when it works. Is there any new formulas or way to make it work again?

Manish H. Shah, MD, FACS · Answer

Hello hvar,Thanks for your question.With years of use of various neurotoxins, you have most likely developed significant antibodies.  In this situation, one thing that you can do is just use a larger does to try and offset the effect of the antibodies on removing the neurotoxin before it can even work to weaken the muscle.  Of note, it may be time for other treatments such as laser and surgery to manage some of the areas of wrinkles.See a specialist in facial rejuvenation, both Surgical and Nonsurgical, to be evaluated for the best option.Good luck,Dr. Shah

Jerome Edelstein, MD · Answer

You may want to consider having a more aggressive treatment, or explore other options if your body has built up a resistance to Botox. Fillers may help depending on the area you'd like to have treated.

Asif Pirani, MD, FRCS(C) · Answer

I have never seen this.  You may want to consider seeing a reputable physician with a lot of experience and stop shopping around.  You may find better results.

Bryson G. Richards, MD · Answer

Thank you for your question. Please have your injector take good picture with you performing scowling or full smile motions. Take these pictures before and after. I am sure you will notice a difference. After time, the muscles can be so atrophied that the amount of improvement may seem less because the muscle isn't as strong to begin with before the treatment.I hope this helps.- Dr. Bryson Richards

Raffy Karamanoukian, MD, FACS · Answer

Its quite possible that you are resistant to the Botox injections. You may try to increase the dosage with a trained physician. Best, Dr. Karamanoukian Los Angeles Botox

Hratch Karamanoukian, MD, FACS · Answer

I have yet to see a patient who is resistant to Botox or Dysport or Xeomin and my experience is that of others. I recently participated in a seminar and lecture by a world expert on this subject who stated the same. Unfortunately, there are no cost effective tests to determine whether you are resistant with antibodies to these neurotoxins.

Dean P. Kane, MD, FACS · Answer

Dear hvar:I hear this about once a day. While it is possible that Antibodies to the molecule reduce its effectiveness, I have yet to see this following 1000's of patient injections.With careful observation, a well experienced, Board Certified  Plastic Surgeon, Facial ENT, or Dermatologist will find that:1. The muscles previously injected have atrophied to a point of not working. You will find that injections to other muscles will relax them. You will need a more skilled injector.2. With aging, the laxity of the tissues and the attachments of the frontalis (and other) muscles to the skin, release and slide. Greater pull or relaxation using these muscle balancers will not produce the same effects. You will need to consider a surgical option.Consider a 2nd opinion in-person consultation.I hope this has helped. All the best.

Botox doesn't work anymore! Is there a way to make it work again?

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