Neither Botox nor Dysport are working for me. Could I be resistant? Or could it be technique? How can I tell?

I began getting Botox at age 26 in intervals of one treatment per every 2 years until I turned 30. I will be 33 in August and I have had Botox and Dysport several times over the last 3 years. I began seeing a new Dr. last fall. At first i was completely frozen but my last 3 treatments have had zero effect. What else can I do? Could it be poor technique? Or have I devolved a resistance?

Doctor Answers 12

Kybella Cost

Kybella is a very expensive procedure but works extremely well.  Allergan bought the company that developed Kybella and now increased the price to market it.  Since there is no direct competition they can set the price.  It may take quite a while before the price comes down.  The price may drop in the future if there is a similar product. For now, Kybella is for people who do not want to have any surgery and will pay the price, while others may very well go with liposuction, downtime, scars. I often combine Kybella with Ultherapy to treat the neck area and tighten the skin laxity at the same time an dit yields amazing results.  Best, Dr.Avaliani

New York Physician
5.0 out of 5 stars 7 reviews

Botox resistance?

Thank you for your question megand8301. Resistance to Botox is rare. In many of these cases treatment with another neuromodulator such as Dysport or Xeomin will work. It is also important to know the dose used and make sure the dose that previously worked is used. I recommend speaking with your doctor for specific advice and checking with your previous doctor for the dosing previously used. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 4 reviews

Botox and Dysport

First, I would like to know- did you have any movement whatsoever after your treatment(s)? Second, I would like to know, do you know how many units were used in each area. If you did not have any results whatsoever with both products (assuming they were re-constituted correctly and in appropriate doses) then you may not react to the active ingredient in both of these products, botulinum toxin A. Another option for you may be to try Xeomin, which has a different active ingredient called incobotulinumtoxinA. Xeomin works in the same way that Botox/Dysport do, by blocking nerve stimulation. 

Justin Harper, MD
Columbus Physician
5.0 out of 5 stars 19 reviews

Botox resistance

It is very rare to develop a botox resistance.  Discuss this with your provider as sometimes a larger dose is needed.  Also ensure you are going to a reputable board certified plastic surgeon/dermatologist.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

Dosage, doctor are both important

It is rare for Botox, Dysport, or Xeomin "not to work". I have had patients report one works better/faster/longer than the others. Assuming you have a reputable, board certified dermatologist or plastic surgeon, the next step for you is to try Xeomin, or discuss a dosage change with your doctor.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Neither Botox nor Dysport working

Most cases of Botox "resistance" that I see in my clinic are usually due to underdosing. If, in fact, you have true Botox resistance, which is extremely rare, I would try Xeomin.

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 58 reviews


It would be helpful to know the units of Botox that was injected into the forehead.  It may be that you need more units of Botox in that area. If it still doesn't work then you should try Xeomin.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Poor Results with Botox and Dysport -- Try Xeomin

For patients that do not have optimal results with Botox or Dysport, I suggest trying Xeomin. It is also possible this is due to skill of injector. Please seek a board certified dermatologist. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

Neither Botox nor Dysport are working for me. Could I be resistant? Or could it be technique? How can I tell?

Thank you for your question.  The first step would be to identify the number of units you have recently received to see if your new doctor has given you the same dosing as you received previously to good effect.  If this has remained constant and your new doctor gives injections in the same locations as your previous injectors you may have developed some tolerance to Botox and Dysport and you can try Xeomin as a possibility.  If you have questions as to your surgeon's ability you can also seek a second opinion to see if they are able to have better results.  Hope this helps. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 68 reviews

Confused as to what you mean by zero effect

Botox - on label lasts for 3 months.  When you state that you had one treatment every two years - that interval is extremely long.  You state that at first you were completely frozen - how long were you completely frozen?  If it was longer than 3 months, the botox worked as it should have.  Rare to develop resistance, however I have had several patients where I changed from Botox -> Dysport -> Xiomen with great results.  One way to know if it is technique, or perhaps old botox is to go to another practitioner where he./she can assure you the botox/disport is fresh and try it that way.  Good luck. 

Elliot Duboys, MD, FACS
Long Island Plastic Surgeon

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.