Resistant to all neurotoxins - can Xeomin eventually become more effective?

Question

I am, unfortunately, resistant to all neurotoxins. My 1st Botox treatment only lasted 3 weeks. Dysport worked wonderfully for about 2 years and then I became resistant. I have tried Daxxify as well with no luck. I did try Xeomin once but it also had no effect. I just read an article that said Xeomin is meant to be used for 1-2 years as a "washout period". That the toxin will eventually become more and more effective. Is this true? That is quite an expensive investment to try and hope that it will "eventually" work. My Doctor also told me my face is too thin for fillers so I am unsure where to turn now for minor help.

David Yew, MD · Answer

Thank you for your question, and I’m truly sorry to hear that you may be developing resistance to Botox. You're not alone—this issue is becoming increasingly recognized, though the reasons behind it remain unclear. In my 18+ years as an injector, having treated thousands of patients, I've personally seen about a dozen who appear to have developed some degree of resistance.

Unfortunately, there doesn’t seem to be a common thread—resistance can occur in both men and women, across all age groups, and regardless of whether someone has had only a few treatments or many. There are countless theories circulating online, but as of now, there’s no definitive, evidence-based explanation.

We've tried all FDA-approved neurotoxins—Botox, Dysport, Xeomin, Jeuveau, and Daxxify—on some of these patients without significant improvement in efficacy or duration. This makes sense from a scientific perspective since all these products share the same active molecule. If someone develops neutralizing antibodies to that molecule, switching brands typically won't help. It’s similar to comparing different brands of bottled water: the packaging and process may vary, but the core ingredient remains the same.

I also urge caution when reading marketing claims or anecdotal stories online. It’s important to verify information with experienced, evidence-based providers before making decisions.

In terms of what to do next: some patients choose to take a break from neurotoxins for a year and try again—but often, results are still limited or short-lived. From a financial and satisfaction standpoint, it’s important to weigh whether it’s worth continuing.

Instead, many of our patients who’ve encountered resistance have found success and satisfaction through alternative treatments—like microneedling, laser therapy, RF microneedling (e.g., Morpheus8), and investing in high-quality medical-grade skincare. These modalities can improve skin tone, texture, and fine lines—without relying on neurotoxins.

I hope this helps you navigate your next steps. You’re welcome to reach out if you'd like to explore alternative treatments that might work better for you.

— Dr. David Yew, Aesthetics Hawaii

Dana Goldberg, MD · Answer

I have never heard this about Xeomin, and it doesn’t make much sense to me scientifically. For the money invested over 1-2 years, you could explore other options like laser resurfacing, microneedling, or ultherapy. They don’t do the exact same thing but are other modalities that could reduce fine lines and wrinkles.

Leonard Grossman, MD · Answer

It sounds like you have become resistant to neuromodulators of botulinum type A. You still have a wonderful option of using Myobloc, which is a botulinum toxin type B and which works on almost everyone who is resistant to the traditional Botox like products. I have been using Myobloc longer than 25 years with amazing success. I hope this helps and good luck from Leonard Grossman, MD, organic Plastic Surgery NYC.

Resistant to all neurotoxins - can Xeomin eventually become more effective?

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Resistant to all neurotoxins - can Xeomin eventually become more effective?

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