Botox not working. Should I try a Botox alternative? (Photo)

Question

Should I try alternatives to Botox? I just did 40 units of Botox in forehead 5 weeks ago. I did not work. Seven weeks prior to that appointment I did 55 units of Botox. I’m not sure why it’s not working anymore. It was done at a plastic surgeons office who I’ve been going to for a few years. Should I try a Botox alternative? Lines are starting to form low below my brows. I want to completely freeze the lines.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. This is a great question. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

Lack of appropriately long response to Botox (usually lasts 3-6months) or complete lack of response, as appears to be the case here, can sometimes mean that too low a dose and/or too high a dilution was used. If this is not what occurred then switching to an alternative neurotoxin, such as Dysport or Xeomin, may be helpful. When there is concern for resistance to Botox, I have found that the use of Xeomin, which is stripped of the usual proteins that may engender resistance can be helpful. You would be wise to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Camille Cash, MD · Answer

An alternative to Botox such as Dysport or Daxxify may give you the correction you are wanting.  Each neuromodulator is formulated a little differently and may give you improvement.  I've included a video I hope you find helpful.

Robinson Facial Plastic Surgery - Alpharetta · Answer

Hello, and thank you for your question. Trying a new product would not be a bad idea. I have seen patients get better results when switching to a different product (typically Dysport), and also alternating products from one treatment to the next. While I have seen patients develop resistance to all toxins, it is very, very rare. 
That said, your actual forehead looks nice and smooth. You just seem to have a good bit of movement in the glabella (the area between your brows). Another option would be to increase your dose of Botox, as this too can effect longevity. It is not unheard of to have to increase your dose after doing the same thing for some time. That being said, I would only change one variable at a time, so that you can pinpoint what works and what does not. It is great that you have a provider that you have seen for a while and trust. I would stick with that person as you know whatever they were doing before was working, and that is one less variable you have to worry about. Good luck!

Sharon D. Lawson, MD · Answer

Short answer - yes! There are some people who just stop responding to Botox. Most commonly it's because of antibodies that stick to the Botox molecule and prevent it from acting on the treated muscle. In order to reduce the chance of these antibodies forming, we usually recommend using the smallest (effective) dose, avoiding "booster" injections and making sure that you wait the full 3 months prior to getting Botox again. Thankfully, there are multiple alternatives to Botox you can use if aren't responding. Dysport, Xeomin, Jeuveau are the more common ones. Daxxify is a newer neuromodulator that is supposed to last a bit longer but not widely available at this point.

Darryl J. Blinski, MD · Answer

Based on your post of photos and doing two sessions of Botox, I might try one more session seeing a fresh, frozen vile of Botox, mixed in front of you to make sure it is done with unused Botox. Or try a Botox alternative like Daxiy, Xeomin, Dysport or other options. Best to see true expert injecting MD, try Plump cosmetic injectables.

Leonard Grossman, MD · Answer

You should not rush to a conclusion and try using a different product. It’s very possible that the Botox  you recently received was just plain too old or was not stored properly. To see if you are resistant to Botox, I would inject a small amount of Botox around crows feet on one side of the face only. You would be followed one week later to see how much of an effect you have. If the results are acceptable, I would continue with the use of Botox. On the other hand, if you are resistant to Botox, you may have to switch to Myobloc which would be the last option available. I hope this helps. Good luck from New York City Plastic Surgery .

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