I've built up a resistance to Botox over the last 10 yrs, will Botox ever work for me again?

I started having botox about 10-12 yrs ago, the last year has been terrible, I keept going to different places to have botox because it wasnt working, I thought it was the injectors that were diluting too much or giving me a "unbranded" product, needless to say I have figured out that I have built up a resistance. I dont want to go the filler route because I dont like the "puffer fish" look. Will botox ever work for me again & uf so, how long must I wait?

Doctor Answers 11

Botox resistance

Botox resistance occurs with number of patients but there are alternatives to Botox that can be used. As expected, those alternatives are not as popular because they cost more and there is greater discomfort after injection. I would suggest you to talk to your provider about Dysport and Myobloc. Moreover, depending where you wee getting botox injections, there are other treatments that can help you attain more permanent results and less “puffer fish” look such as limp implants or Restylane for fine lines and wrinkles. Good luck!

Summit Emergency Medicine Physician
5.0 out of 5 stars 45 reviews

Botox resistance

Hi there.  We have actually seen Botox resistance in practice.  Although Xeomin is commonly offered as an alternative, they are both Botulinum type-A toxins, which often means clients also see the same result after Xeomin injection.

The best alternative would be Myobloc which is botulinum type-B.  However, there is substantial extra cost, as well as much more discomfort with injection.  The product requires some experience to use and is offered much less often.  Make sure that your results are genuinely due to Botox resistance first and try the Dysport and Xeomin before moving up to Myobloc.  Good luck!

Reza Tirgari, MD
San Diego Physician
5.0 out of 5 stars 4 reviews

More Options

You can try to switch to another product like Dysport. It does the same thing that Botox does. Many patients can switch back and forth between the two if they are noticing a resistance. It's best to consult with a local physician. You may also need to have more units injected.Good luck!

Janet Allenby, DO
Delray Beach Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Botox Alternative--Try Xeomin or Dysport

I would considering using dysport or xeomin as an alternative to Botox. I recommend getting a formal consultation with a cosmetic dermatologist. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

To "B" or Not to "B" - that is the question.

There is a theory that one can develop antibodies with consistent Botox use.  The theory describes this phenomenon as occurring with too small a dose, and too frequent an interval, of treatment. I have not seen this clinically in my practice; but have seen the "Wow" effect diminish in certain individuals that use Botox as the only modality to address an issue.  Without knowing much about your lifestyle habits, I cannot speak specifically to you.  Perhaps something of what I say will resonate.  The rate at which an individual ages is genetically determined and influenced by environment and lifestyle choices.  For instance: appropriate "sun savvy" regimens; a valuation of loss of volume in the area; UV damage to the skin itself; and how the entire face appears and interacts as an expressive unit should all be considered.

Lastly, even if none of the aforementioned plays a role, the placement of the Botox needs to be altered by a few millimeters from time to time.  This can be challenging in that you do not want to stray too far from the placement to achieve your optimal effect - experienced hands come into play here.

David Owers, MD
Vancouver Physician
5.0 out of 5 stars 1 review

?Resistance to Botox over Time

Thanks so much for your question.

If you have any reason that you aren't fully confident that the offices you are going to are using less, overdiluting or using an unlicensed product, then you are going to the wrong offices. This is your face and incredibly important. You should be going to an office with an experienced physician supervising every element of treatment and a great reputation for experience and results in using any medication in the Botox class.

I personally (as well as many of my patients) prefer Xeomin to Botox. Dysport is used in many offices, but spreads more and if used around the eyes may have a higher risk of dropped eyebrows and complications. Xeomin has the same core active molecule as Botox, but a less immunogenic 'jacket' which is less likely to provoke an antibody response and a shortened or incomplete response as you are experiencing to Botox.

Rebecca Gelber, MD
Incline Village Physician
5.0 out of 5 stars 2 reviews

Botox resistance

I am sorry to hear about your resistance to Botox, rest assured this occurs in a percentage of the patients. If the Botox brand doesn't work try Dysport or Xeomin or even Myobloc which is another type of Botox. You may also try energy-based devices such as fraxel or Ulthera to tighten the area and rejuvenate your face without the need to do serial injections. 

Neil Sadick, MD
New York Dermatologic Surgeon
4.0 out of 5 stars 4 reviews

Resistant to Botox, try Xeomin or Dysport

If you  have a resistance to Botox (with antibodies), you should try one of the other 2 neuromodulators on the market. If your problem is wrinkles which are caused by volume loss, no amount of neurotoxin will improve the problem. All filler results aren't "puffer fish". Filling is an art and you need to go to a specialist for great results from filler.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.7 out of 5 stars 41 reviews

Botox resistance

Thank you for your question jobaby. I am sorry to hear about your situation. Botox is a purified protein used to address wrinkles associated with facial expression. In rare cases, some people develop a resistance to Botox. In these cases other neuromodulators may work. In the United States we have Dysport or Xeomin. Overseas other neuromodulators are available. 

Please consult with a doctor for specific recommendations. Good luck!

Alex Eshaghian, MD, PhD
Encino Physician
5.0 out of 5 stars 4 reviews

Botox not lasting.

Hello jobaby!. Good question. Botox has an inactive protein. Why is that important to you? We develop antibodies to proteins. This attacks the drug and it might not last as long. Although this happens with very high doses of Botox, I have seen it even with low doses over long period of time. So.... you might have developed antibodies to the Botox proten. Solution? Try swritching to Xeomin. It has no inactive protein. Ask your expert injector. Im sure you will see great results! Good luck!


Shoib Myint, DO, FAACS, FAOCO
Henderson Oculoplastic Surgeon

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.