Botox, Dysport & Xeomin not working. What is wrong?

Question

I have had botox injected for 5 years then my dr. switched to dysport. All was good for another 4 more years then all of the sudden nothing. Botox failed along with dysport at working to get rid of my wrinkles as before. Waited 4 months tried xeomin, still nothing. Now I have waited a whole year, just got xeomin by a fabulous well know dr. its been 7 days and I still see no change. What is wrong?

Kenneth D. Steinsapir, MD · Answer

Cosmetic botulinum toxin resistance due to neutralizing antibodies is very rare for people getting cosmetic botulinum toxin.  Not impossible but rare.  So rare that it is more likely that you are just disappointed with your botulinum toxin results.  Do your doctors take photographs of you before and 2-3 weeks after treatment to assess the effect of service?  I find that many individuals think that botulinum does not work on them but actually have wonderful modest results.  Generally what they really need is a surgical procedure to accomplish what they are looking for.

Anna Avaliani, MD · Answer

Hello and thank you for your question. It is rather rare but not impossible to develop immunity to the medication it may also be that the dose needs to be much higher. Do you not respond completely or just partially? Botox Disport, Xeomin and all type A toxins and the only way to see if you develop an immunity is to do a blood test to check for specific antibodies.  The only option left to relax muscles is MyoBloc, which is a type B toxin.  Talk about it with your provider.  Hope this helps. Best, Dr,Avaliani

Martin Jugenburg, MD · Answer

Any neuromodulator takes a full 14 days to take effect.  It is best to wait for two weeks than re evaluate.  It is uncommon to have an immunity to it but not entirely unheard of.

Jason Emer, MD · Answer

It can take 1-2 weeks for final results with Xeomin. You may need 2-3 times the normal dose if these are not working or consider Thermirase.  It may be that a combination approach is needed with lasers, microneedling/prp and/or fillers. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Michael I. Echavez, MD · Answer

The results from Botox, Dysport and Xeomin are dependent on the dose used and the placement of the injections.  Without knowing the details of each of your treatments, it is difficult to know if you see no results because of an issue with injection location or dosing.  It is rare, but it is also possible to develop an immunity to Botox, Dysport and Xeomin, where there is no longer any effect from the treatment.  This would be another possible explanation for your problem.

Botox, Dysport & Xeomin not working. What is wrong?

Answers (5)