Botox not working anymore? (Photo)

Question

Gotten Botox for 4 yrs. Started w/ 25units each side & as time went on the units have increased & the duration of it working has shortened. Recently, Botox stopped working so I tried 65units on each side & it felt like it was working but then it completely stopped and the muscles bulked up rapidly within a month. It's been like this the past year & now Botox isn't working. I've been going to the same injector too. Any thoughts?

Harold J. Kaplan, MD · Answer

Hello,As the panel members suggested, it's possible, although not common, for patients to develop a resistance to the product.  Our nurse manager has had this condition for the last several years despite being a good responder for 3-4 years before the resistance developed.  The resistance transitioned into an actual allergic response to all neuromodulators including Myobloc.  The theory is that the protein "wrapper" of the products (regardless of Type A or B) triggers this response.  It definitely would be recommended to try the other products after waiting a  minimum of 3-4 months between injections.  Having frequent injections on higher units is not recommended if you are suspecting impending resistance.  In addition, trying a new injector is also worthwhile to determine if the issue may be with the product/dilution even though you have been using the same practitioner over the years.

Jason Emer, MD · Answer

It may be that additional Botox is needed. Xeomin/Dysport are Botox alternatives. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Peterson Pierre, MD · Answer

Your situation is very frustrating! Though rare, it is possible to develop Botox antibodies over time which would decrease the product's effectiveness. Xeomin and Dysport are alternatives. The other possibility is that your Botox is being watered down which is a common practice depending on where you go and how much you're paying. If the deal sounds too good to be true, it probably is.As with all cosmetic treatments, the skill of the doctor is of utmost importance. Don't trust your face to just anyone! Consult with an expert in facial aesthetics to maximize your results while minimizing side effects. You'll be happier and save money in the long run.

Melvin Elson, MD · Answer

Every time Botox is injected patients make blocking antibodies and in some patients the blocking antibodies get to the point that they do keep the Botox from working as well and rarely some patients become botox failures--i have only seen one.  Switching to Xeomin or Dysport will not help

Leonard Grossman, MD · Answer

First of all, it is possible to develop Botox resistance even though it's quite rare. You may want to try using other products such as dysport or xeomin and lastly but not least is the product called myobloc. It can be used in patients who are resistant to all others. Good luck from New York City

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Botox not working anymore? (Photo)

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