If I Get Botox for Three Issues; ie Tmj, Is There a Proper Way to Space These Treatments to Avoid Developing a Resistance?

I receive botox for wrinkles, TMJ, and excessive underarm sweating every three months. However, due to the cost and the fact that these are all from 3 separate doctors( which all know I'm being treated for the other various issues) is there a chance that I will develop a resistance? I rotate to one each month, should I do all in one month or is it okay to space out, its 130 units total? I would like to avoid resistance and be able to continue to use botox. I have done this rotation for a year.

Doctor Answers 5

Space These Treatments to Avoid Developing a Resistance to Botox?

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 While it has been shown that some patients do develop antibodies to Botox, no real resistance to it's action has been shown in many millions of Botox treatments for over 25 years.  I would not worry and have the Botox as often as needed for symptomatic relief.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Staggering Botox

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Firstly, The amount of Botox that you use is not a huge amount. However, needing Botox under arms for sweating every three months does not sound like what we usually see. I would hope that the Botox in your axilla lasts at least six months. Do you start sweating in three months or just go back for more? Don't go back for more until you see how long yours lasts. Secondly, You probably should not stagger and have monthly. I think that some researchers have recommended decreasing frequency of injections as a way to try to prevent antibody formation. I would do the areas at the same time and maybe find one dermatologist that can do all of this together. 

Jo Herzog, MD
Birmingham Dermatologist
4.8 out of 5 stars 20 reviews

Why 3 doctors for botox instead of just 1?

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it's unusual to need botox at 3 month intervals in under the arms or in the axilla...botox in these areas should last much longer...6 months minimum or more likely 9-12 months...and the face is okay at 3 months...on average most people require about 100 units to the axilla and anywhere between 25-50 in the masseters...with a variable amount depending on the sites used for the face...resistance isn't a problem...and 130 units at one time is nothing to worry about...after all the dose for migraine is 155 units and even higher for muscular problems...

Ken Landow, MD
Las Vegas Dermatologist

The is really no definite information on this.

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130 units of Botox is a very large dose.  Staggering these treatments is probably a good idea.  Still you are at risk of having unpleasant side effects.

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

Avoiding resistance to Botox

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Although, as you have seen in your case, there has not been any resistance developed to Botox by having treatments every month for different purposes, I would think that you would lessen the chance of resistance by having the treatments at the same time.  In most cases, the effect from Botox for underarm sweating lasts longer than when used for TMJ or wrinkles, so it's possible that you wouldn't necessarily need to have that area treated every three months.  In fact, some people don't need to necessarily have treatments every three months for wrinkles or TMJ.  It's possible that a higher dosage could make the effects last longer for you.     

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

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