Botox and Dysport used to work on me. Now however I have become immune to both of them. Will this immunity be forever?

Hello, thank you for your question. Resistance to Botox is very rare and the cause is not completely known. What is known is that your body forms an antibody response to the Botox. If you do have resistance, there are other forms of Botulinum toxin that can be used. Other reasons for failure of treatment can be related to injection technique or inadequate number of units.

I have had patients develop a tolerance or "resistance" to Botox over years of treatment.  I've read the study referenced by your physician that states it may take 5 years for Botox to start working again.  One possibility, if you really want to try it, is to consider having someone inject Myobloc, which is botulinum toxin type B.  It may work, although I only have anecdotal evidence of this.  The downside is that most patients say Myobloc is painful to have injected.

It is difficult to say if your immunity to these products will fade over time.  You may want to try a different neurotoxin such as Juveau or Xeomin in the meantime.  You may also want to see if increasing the number of units of Dysport/Botox improves the result you are seeing.

Dear miamigrl1111,Rather than waiting you would be better served using a different neuromodulator, such as Xeomin or Juveau. There is no guarantee that waiting will reduce your immunity over time.Good luck,Nirmal R. Nathan, M.D.

·      Certified, American Board of Plastic Surgery

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I have been injecting Botox since 1991 and Dysport for over fifteen years. And while it is commonly maintained that the development of true immunity from their use is rare, in my long career and very extensive experience, I have encountered this on a number of occasions. Happily, in my cases, I have been able to override this relative resistance by increasing the concentration of the injection of the injected neuromodulators. Where this has not been successful, I have switched to injecting Xeomin, which is essentially Botox with many of the surrounding protein molecules (the ones most believed to actually be responsible for promoting resistance) stripped away. In most cases, this approach has proven successful. If not, an alternative non-neuromodulator approach, is to inject hyaluronic acid-based skin boosters, such as Restylane Silk (in the U.S.) or Viscoderm Hydroboosters, Restylane Skinboosters or Juvederm Volite (Israel, Canada, Europe) throughout the treatment area (such as the crow's feet, worry lines, bar code lines, etc.). Instead of working directly on the muscles themselves, like Botox, skin boosters, via increased hydration within the skin and stretching of the overlying skin, elevates and smooths the skin and to some extent resist wrinkling upon motion. Make sure to consult with a board certified aesthetic physician. Best of luck to you.

It is possible to develop resistance based on particular allergen present in Botox or/and Dysport. How long it may last it s not clear. You may try other forms of toxin like Xeomin and Juveau. Good luck.

Although not common, it does occur. Speak to your primary care physician about testing for antibodies if you are motivated. There is limited information about the prevalence of neutralizing antibodies to botulinum toxin. This is really no good evidence that waiting 6 months to retry these products will produce a different result. Similarly, it is unlikely that using Xeomin or Juveau will produce a different result. 

Thank you for sharing your question.  Although rare, tolerance to a product can occur and I would recommend taking 6-12 months off of treatment before then trying again.  You may also want to consider Xeomin or Juveau to see if they have some benefit to you.  

While it is rare, you can develop antibodies to the botulinum toxin that subsequently interfere with the desired results of the toxin.  If this is the case, the general recommendation is to wait 1 year and then try again.  I don't believe that one can test for these antibodies.  More commonly, you may need a higher dose, ie more units, to get the desired effect.  Dose and duration are intimately related; that is, for clients who only get a few weeks of results, they would benefit from a higher dose at their next treatment.  Also, it's important to adhere to the interval of at least 3 months between treatments.  
Best, Dr. Melissa

Hello there, 
     I have seen this in a handful of patients over the years. I typically recommend a "detox" of sorts for 6-12 months. This usually corrects the problem. I would also recommend making sure you are getting injected by an expert injector. Hope this helps. 
-Sarah RN BSN