Is it possible for Botox to be effective in one area, but not another? Follow up and clarification to my previous question.

First time w/Botox/Dysport, etc. Have UTMOST faith in my injector. First treat: 12u - glabella, 4u - brow lift, 10u - forehead. 2 wk post: forehead - perfect, brows - slight lift, glabella - significant movement (but def felt effect from initial 12u). Retreat: 20u - glabella (total of 32u), & 8u - brow lift. 12 days post, both areas unresponsive (based on b&a pics). Just curious why areas responded to lower dose, but no change when dose nearly doubled. Could my body build up immunity in 2 weeks?

Doctor Answers 9

Is it possible for Botox to be effective in one area, but not another?

Thank you for your question stellar0326. Some areas require higher dosing than others. If the same dose was used previously and you got your desired result, the same dose usually gives the same response. There may be minute differences from lot to lot, but this should not make a significant difference.
I recommend waiting two full weeks after a treatment to assess results. I have had patients not have full results 10-12 days after a treatment, but at 14 days they had full results. Sometimes it just takes a little longer for the results.
This does not sound like immunity. But I recommend you speak with your doctor about it. Good luck!

Encino Physician
5.0 out of 5 stars 3 reviews

Botox injection and dosage

I would not consider resistance to Botox 2 weeks after one injection. Resistance is rare and when it does occur it is usually after years of Botox injection. The initial Botox dose to the glabella was a little low but with the additional 20 units it is an adequate dose. Some patients do require pretty high doses for the glabella. As for the brow lift, you may have received all the brow lift you were going to get with the initial 4 units. I would wait another week or so to see if the glabella improves. If not, I would discuss your results with your injector. In some cases, it is etching (lines at rest) and not dynamic lines that patients are noticing and this can be treated with filler.

Shaun Patel, MD
Miami Physician
5.0 out of 5 stars 55 reviews

Botox and Effects

Some areas on the face, particularly the glabella area, can take increased amounts of Botox, whereas other areas need "baby" Botox.  It doesn't sound like a problem with resistance. Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

Botox effect

Hi there,

I would not worry about building antibiodies or immunity to botox this early after an aesthetic injection.
Wait a little longer to see if the effect takes place (particularly in the glabella).

Antibiodies can be formed against botox, but it is usually after years and years of injections of very high doses of botox for muscle spasms (not for wrinkles). The incidence of antibiodies is less than 0.3%when used for spasm.

For now, I would recommend waiting a full 3 weeks before deciding what to do. You could consider trying a different preparation (like Xeomin) and increasing the dose for the glabella. I think sometimes you need a little extra dosing in the glabella particuarly the first time. In case this problems persists, you can get tested for antibodies to botox.

Hope this helps!

Myriam Loyo, MD
Portland Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Yes, it is possible!

Often times, with such deep wrinkles Botox needs to be given frequently . With time, the 11s should lighten up. From time to time, subcision (needling) can be done to weaken the muscle and cause new collagen formation.

Michael A. Burnstine, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Is it possible for Botox to be effective in one area, but not another? Follow up and clarification to my previous question.

Hello Stellar0326,

There are a range of doses that can be used in the various areas of the head when using Botox.  The fact that you responded in any area indicates that with the right dose, you will respond everywhere.  Resistance only develops after an extended period of time with high doses and frequent injections.  In your case, you just need a higher dose in the areas that have not responded like you would like.  For the glabella you may need as much as 50 units, even though it is your first time (my wife took 40 units to that area to see any result on her first treatment).  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Unresponsive to Botox

It is difficult to say but immunity usually results over a period of time and is quite rare. I am not certain what occurred here, but go back and try getting treated in the glabellar complex with 20 units and evaluate

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 4 reviews

Botox effect

Thanks for your question.  It is difficult to completely answer your question without seeing your before and after pictures and seeing exactly where the botox was injected.  I have some patients who definitely require more units in one part of their face compared to what I would consider to be the "normal" treatment.  Sometimes they have particularly strong muscles in one part of their face that requires additional treatment.  I have not heard of anyone building up an immunity to botox treatments.  Best of luck!

Josh Waltzman, MD, MBA
Long Beach Plastic Surgeon
5.0 out of 5 stars 15 reviews

Botox not effective

Was your "injector" a board certified dermatologist, facial plastic or general plastic surgeon? this was your first treatment, how did you develop the "UTMOST" faith in your "injector". Not knowing anything about you (don't even know age) or how you were treated, it would be difficult to comment but given the information you have provided, it would be most likely "injector"-dependent.
Botox and fillers are medical procedures with potential medical risks and complications and should only be administered by qualified physician, otherwise, the "injector" will need to address the concerns and complications that arise.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 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.