I have developed a resistance to Botox, Dysport and Xeomin. Are there any other options or suggestions?

Question

I have been getting Botox for 10 years & have recently developed a resistance. I have used the same board certified plastic surgeon for over 5 years & always had great results. After a treatment last May, I noticed there was no result so I returned for a second treatment which did not work. Both Dysport & Xeomin have also been ineffective. Three doctors have confirmed that I am resistant. I am confident this is not due to improper technique or poor product. Are there any other options?

Ron Shelton, MD · Answer

ThermiRase uses injectable radiofrequency to direclty affect the nerves that allow the muscles of the mid lower forehead between the eyebrows to contract.  ThermiRase is not used for crows feet or other facial areas.There is significant swelling and possible bruising with ThermiRase so unlike Botox it is not a "no downtime" procedure. The swelling will last more than a week for most people. Local anesthetic has to be used during the procedure and I often provide other medication to make our patients comfortable so they arrange to have someone bring them home. A thorough consultation is needed to see if someone is a candidate during which I examine the anatomy and actually stimulate the nerves to see if we can use ThermiRase on them. Blood thinners are stopped before the procedure. The results can be more than two years.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

Jason Emer, MD · Answer

Alternatives to Botox/Xeomin/Dysport would be a combination approach with fillers, lasers and microneedling/prp. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Michael I. Echavez, MD · Answer

It is very rare to develop a resistance to Botox, but it is possible.  In my experience, if someone has truly developed a resistance, it is a resistance to all brands of neurotoxins. I have not found anyone who was resistant to one that was not resistant to all of them.  There may be some surgical or invasive procedure options for you, but no non-surgical ones of which I'm aware.

Michele S. Green, MD · Answer

If you have resistance to all of these neurotoxins then I would suggest you consider Thermage for radiofrequency skin tightening. There may be a new neurotoxin that is introduced this year so you can try that when it comes out.  In the meanwhile I I would try the new Thermage FLX for increased skin tightening.  Best, Dr. Green

Drew Varano, MD · Answer

There are a few options , myoblock is a product that was used years ago if patients were deemed Botox resistant , I’m not sure if it’s still available in the US . Also Thermiraise is a minimally invasive treatment that uses heated radio frequency to paralyze the nerve in the Glabellar region. It lasts much longer than Botox over 1 year

Timothy A. Janiga, MD, FACS · Answer

Unfortunately this is possible.  We have 4 patients in our practice that are resistant to all three also, confirmed and reconfirmed a year later.  These are the only 3 neurotoxins approved in the United States currently but there may be a new one coming in the next two years.  I would suggest trying that one when it comes out as there can be subtle enough variations that you may get a result from the new one.  If the area that you are interested in inhibiting is the glabella (the 11's between the eyes) try seeing your plastic surgeon to see if he thinks you are a candidate for a surgical procedure to help.  Good luck-Dr. Janiga

Leonard Grossman, MD · Answer

Although rare, there are some patients who are resistant to Botox during their first treatment and sometimes many years after having had been treated. The product that I have been using in such patients for the last 23 years is called Myoblock. It works great as it starts to work the day you receive the treatment, but unfortunately it also loses its effect sooner than does Botox. Myoblock is also considerably more expensive. Good luck from New York City

Nina G. Desai, DO · Answer

Thank you for your question. Unfortunately, Botox, Dysport and Xeomin are the only FDA approved Botulinum toxin in the United States as of now. You are correct, after 10 years of receiving the same treatment consistently you can develop resistance. Age is also a factor. Botulinum toxin is not indicated after a certain age. I hope this helps answer you question.

I have developed a resistance to Botox, Dysport and Xeomin. Are there any other options or suggestions?

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