Is Myobloc a Good Alternative to Dysport or Botox if Your Immune?

I have had 3 botox and 4 dysport treatments over the years with different reputable doctors and neither have any effect anymore. Only the very first one lasted, with them progressively taking longer to kick in and lasting only a few weeks till now even rather large dose has no effect at all. I have seen the doubting Dr's posts about being immune, but that was the conclusion of my own Dr's. They don't stock myobloc and i can't find anyone in MA with it, so before i travel... does it work?

Doctor Answers 6

Xeomin Can Work Well For Botox Resistent or Dysport Resistent Persons

Many of us with a long experience in injecting Botox and Dysport (I have been injecting Botox for aesthetic purposes since 1991) have encountered patients who at first responded well, but after one or more additional treatments seemed to react less favorably. While only special laboratory tests (mostly used for research purposes) can document the development of immunity (antibody production) against these neuromodulators, the presumption has been that this may play a role in the observed loss of response to treatment. 

Myobloc, a different category of botulinum neuromodulator, has been around for quite a few years. However, it has not enjoyed much popularity in large measure due to the fact that its effects are quite short-lived. Hence, it makes a poor alternative in cases of presumed Botox or Dysport resistence. 

Xeomin, a neuromodulator that can best be described as Botox without attached proteins (the proteins believed to stimulate an immune reaction), is the newest kid on the neuromodulator block. For most people who respond well to either Botox or Dysport, my response is essentially that of the old commonsense adage,  "If it ain't broke, don't fix it." 

However, in cases where it is clear that the degree of response to Botox or Dysport has waned with time, I usually recommend a treatment with Xeomin. In most cases, I have had success with this approach. 

New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Myobloc vs Botox or Dysport

I have not personally used Myobloc. I was excited when it was first discussed, and then along with most others, very saddened by its actual clinical trials and uses. I don't know anyone who uses it, especially cosmetically. Xeomin could be a choice for you, but it tends to last a shorter amount than Botox or Dysport too. Only having had 7 treatments it's unlikely you are "immune" to either Botox or Dysport. I have seen some people with a bit of immunity, but that's been after 10 or 12 YEARS of treatments. Plus, others actually get a longer benefit after more and more treatments. It depends entirely on each person. But personally I wouldn't recommend you "travel' to get Myobloc treatments. I think you will be saddened by the cosmetic results because they aren't great at all.

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

If I am Immune to Dysport, Will I Be Immune To Myobloc?

It is not accurate to state that if you have neutralizing antibodies to botulinum toxin A that you will also have neutralizing antibodies to botulinum toxin B (myobloc).  I would also be the doubting doctor camp that you are in fact immune to Dysport or BOTOX.  The antigen exposure from cosmetic treatment is so low, that it is overwhelming more likely that you are not being treatment with enough agent rather than you are immune to its activities.  Myobloc was a big disappointment which is why no one uses it cosmetically any more.  It doe not last very long and it seems to be associated with more systemic side effects.  So I think you would be better off see a more experienced injector for BOTOX or Dysport rather than searching out Myobloc treatment.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews


If you really have developed immunity for Botox and Dysport, you developed immunity to the protein attached to the molecule. Myoblock may have the same.

May be you want to consider other alternative methods.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Myobloc Is One Alternative.

We did some of the early published research on Myobloc. It definitely is an alternative to Dysport and Botox, but, as a general rule  Myobloc does not last as long. Perhaps as a better alternative, you may wish to consider Xeomin.

David Goldberg, MD
New York Dermatologic Surgeon
3.3 out of 5 stars 4 reviews

Lack of responsiveness to dysport and botox

You have not had very many treatments to imagine being immune to botulinum toxin. Possibly there is a medication or herb that you take that affects the result (not that we have good information about such an interaction) and certainly you may just need many more units than someone else. There are some women who need 25 to 35 units of botox in the glabellar region between the eyebrows but their former doctors wouldn't inject more than 12.

I don't know if Myobloc is currently available. I don't know any colleagues who use it. The theory with Myobloc was that it was of a different serotype than Botox and Dysport so that if there were an immune situation with one serotype, there might be less of a problem with the other. If your doctors are convinced you have had a maximum number of safe units of Botox and Dysport, and although Xeomin is of the same serotype as these products, your doctors might wish to consider a treatment with Xeomin.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.