What is the best Botox alternative?

Question

Hi! I been getting Botox for over 10 years and my body seems to be resistant…I’ve tried Jeuveau, Daxxify, Dysport, etc. Can someone please provide insight on the best Botox alternative? Which alternative is the “best” and most effective? So sick of wasting my $$$. Please help! Thank you!

Kally Papantoniou, MD, FAAD · Answer

If you’ve noticed your usual Botox results fading faster or not taking effect, you may be developing a mild resistance—especially after many years of treatment. While this is uncommon, it can happen when the body forms antibodies against the proteins used in certain neurotoxins.

If you haven't already tried Xeomin, it's often the next best option. It’s a “naked” neurotoxin—meaning it contains no accessory proteins—so it’s less likely to trigger antibody resistance and may work well when others stop being effective.

If Xeomin doesn’t restore your results, it’s worth exploring treatments that don’t rely on muscle relaxation, such as:

Microneedling RF or fractional CO2 laser to rebuild collagen and smooth etched lines.

Targeted fillers when volume loss, rather than muscle movement, is the main cause.

The best alternative depends on what’s causing the wrinkles, loss of elasticity, volume loss, or repeated movement. A dermatologist can help design a plan that strengthens the skin and restores natural smoothness without relying solely on neurotoxins.

Caner Kacmaz, MD · Answer

When you develop a resistance to Botox, there are other options  you can choose. My suggestion is to try a higher dose with less frequent treatments. This is important to prevent resistance. Another simple thing to do is to try a different neuromodulator product.

Ella Fedonenko, MD · Answer

If you have not tried Xeomin yet it’s worth trying it in your situation. Xeomin is the least likely to cause resistance out of all the Botulinum toxin formulations.

Nelson Lee Novick, MD · Answer

Resistance to Botox does happen, despite claims to the contrary. People who have received treatment with Botox, as well as others, such as Jeuveau and Dysport, in higher dose ranges, or too frequently or have had touch up treatments too soon after the primary treatment (such as one to two weeks after the initial treatment), are more likely to develop resistance.  In such cases, the resistance stems from essentially being vaccinated to the neuromodulator by the too frequent or too soon touch up treatments. It can also come as a result of antibodies to the complexing proteins that are attached to the active molecule. 
In the latter case, Xeomin can be tried, as the manufacturer has eliminated the complexing proteins that may be responsible for initiating the immune reaction responsible for the loss of product effectiveness. I have had success with Xeomin in patients who have come to me after having been too frequently treated with the other neuromodulators on the market. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Kenneth D. Steinsapir, MD · Answer

It is more likely that the crummy treatment pattern you have been getting is no longer getting the job done. Generally we do not test for botulinum toxin antibodies. That is really only done for research studies. What you should know is that if you actually do have neutralizing antibodies to one botulinum toxin A, likely it will effect all of the botulinum toxin A products including Daxxify Jeuveau, etc, Study my patented Microdroplet Lift® . Stay away from bad fillers like Radiesse, Sculptra, and grafted fat. At your age, it is improbable that you need surgery but there is no substitute for an actual in person consultation.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It sounds like you're really familiar with Botox and have tried various alternatives over the years, which can be frustrating when your body seems to build a resistance. Botox resistance, while relatively rare, can happen due to the development of antibodies that block the neurotoxin from working effectively. When it comes to alternatives, Daxxify might be your best bet—it's a newer neurotoxin that’s formulated with a peptide stabilizer to help it last longer and possibly reduce the risk of antibody development. Clinical trials have shown that Daxxify can last up to six months or more, which is longer than typical Botox. Alternatively, you might also want to consider Radiesse or Sculptra, which are dermal fillers that stimulate collagen production and can give some lift or softening in areas that Botox would typically treat, though they work through a different mechanism. Ultimately, the best alternative depends on your facial anatomy, the areas you're treating, and how your body responds to these different formulations. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

If you’ve been using Botox and similar neuromodulators like Jeuveau, Daxxify, and Dysport with diminishing results, it might be time to explore alternative treatments that can address your concerns effectively. Here are a few options to consider:

Dermal Fillers: Unlike neuromodulators that relax muscles to reduce wrinkles, dermal fillers add volume to the skin and can help smooth out lines and wrinkles. They are particularly effective for deeper wrinkles and areas where volume loss is a concern.

Laser Resurfacing: Treatments such as fractional laser therapy or intense pulsed light (IPL) can improve skin texture, tone, and appearance by stimulating collagen production.

Microneedling with PRP: Microneedling combined with platelet-rich plasma (PRP) can enhance skin rejuvenation by promoting collagen production and improving skin texture and elasticity.

Chemical Peels: Depending on the depth of the peel, this treatment can improve skin texture, reduce fine lines, and enhance overall skin appearance.

Ultrasound or Radiofrequency Treatments: Procedures like Ultherapy or Thermage use ultrasound or radiofrequency energy to stimulate collagen production and tighten the skin.

Topical Retinoids: While not as immediately effective as injectables, retinoids can improve skin texture and reduce fine lines over time by promoting cell turnover and collagen production.

Each of these alternatives has its own set of benefits and considerations, so it’s important to discuss your specific goals and skin type with a dermatologist or cosmetic professional. They can help tailor a treatment plan that best suits your needs and offers the most effective results.

Camille Cash, MD · Answer

If you're finding the neuromodulators are no longer working and you've tried the variations you can try taking a "holiday" from them and concentrating on other methods to help the skin.  There is no substitute for neuromodulators but you can keep skin looking healthy by incorporating treatments such as Morpheus8, lasers, and peels.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Leonard Grossman, MD · Answer

When an individual develops resistance to Botox and similar products, they have to seek out practitioner who has a lot of experience with using Myobloc. This is the only product that works in people who have developed immunity to Botox and similar products. I have been using Myobloc for over 20 years with a great deal of success,  I hope this helps and good luck from Leonard Grossman MDorganic plastic surgery.

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