Botox not effective - I am told I "metabolize" this too quickly

Hi Katherine,  Research studies have shown that even patients who have antibodies to Botox associated complexes circulating in their bloodstream can still respond to its effects. I'd actually try going to a different provider and trying Botox again. There are many factors that can affect the efficacy of Botox's effects and your provider may have diluted it too much, had it sitting on the shelf for too long, bought it from a source not directly from Allergan, or not used enough units on you.   Dysport and Xeomin are also options, but, I'd actually try switching providers at this point.  Hope this helps!Dr. Kiripolsky 

My only suggestion would be to try another doctor. Your issue is not unheard of, but bottom line, Myobloc isn't going to make a difference. However, a higher dosage of Botox may help. Consult with a different board certified plastic surgeon in your area to discuss. Good luck --

Hi Katherine.  In the last 10-15 years we have only seen 2 or 3 patients with your set of circumstances.  These patients were not getting short duration or an allergic type reaction, they were just not getting the same results as everyone else.  So, what you are describing is possible.The only way to know for sure is to go to a new provider and try a higher dose.  It should not matter if it is Botox, Dysport or Xeomin as long as the does is high enough.  We would not recommend Myobloc as we have used this on those patients as well and it did not make a difference.  Los Angeles Dysport before and after photos at the link below.

My recommendation will be to use BOTOX only and be sure,  you let pass at least 3-4 months in between dosis.Your body may create antibodies and never see results of any type of Botulinum Toxin (Botox, Xiomeen, Dysport etc) ever again.Be encouraged.Dr. Cardenas

I would considering using dysport or xeomin or using much higher levels of botox if you do not see the best results.  Best, Dr. Emer.

Thank you for your question.  This is a rare case where Botox is no longer working, and Dysport and Xeomin are not either.  I suggest you try much higher doses of Xeomin or Botox.  Myobloc is unlikely to do anything and if it does it will be very short-lived.  Another option you may consider to look into is ThermiRase which is a micro invasive technique to disabel the nerves that control the muscles responsible for frown lines.  It has been shown effective up to a year.  Regards, Dr. Matthew J. Elias

Was this all done with the same provider? It may just be that the dose you responded to initially is not longer effective. As we age higher doses are often required for the same effect. It's also possible that your provider may have diluted it too much. I would suggest going to another, very experienced, injector and try either botox or xeomin again at a higher dose. Hope this helps.

There are a few factors that can lead to less effective results with Botox.  Foremost is the responsibility of the provider to properly assess and re-evaluate the precise dose and localization of Botox.  As we age, higher doses can be required for longevity of effect.  Depending on the areas treated, addition of a hyaluronic dermal filler such as Restylane or Juvederm may be an option and these fillers can extend duration of effect and may themselves improve the result.  The other factor that can be helpful is to exercise the muscles treated immediately after for one hour.  All of of these factors are directed by your treatment provider and if not, then seek a treatment provider who is a qualified dermatologist and true expert in this field.

I would consider having a higher concentration of Botox injected and possibly even changing providers and product; however, you are not describing a shorter duration of activity with injections but lack of any activity, so it would not be a matter of being metabolized quickly as you would have activity for shorter duration. You may have developed antibodies Botulinum Toxin A preparation, in which case, Myobloc, a Toxin B preparation, may be helpful.

Hi, this can happen, though rarely does in patients.  I have used Botox for 30 years and have seen this in only a couple of patients.  I'd try a larger does of Botox and see what happens.  Hope this helps.