Botox not working anymore?

Question

Hello, I'm a 49 yo female and I've been getting botox in my frown lines for 15 years, some in my crows feet, and marionette lines for about 5. I'm finding the marionette lines and crows feet botox is wearing off in about 2 weeks, and the frown lines are wearing off in about a month. II realize I'm getting older, but my skin is still in excellent condition. Why is it not working anymore? sed to last Botox used to last about 4 months depending on the placement.

Eric M. Joseph, MD · Answer

Sometimes with continued usage, people can become tolerant to the effects of Botox. When this happens, we typically recommend a different brand. You may wish to consider either Dysport or Xemin moving forward. Hope this helps! Sincerely, Dr Joseph

Jason Emer, MD · Answer

​For glabellar lines (or frown lines / "11" lines), we inject Botox, Xeomin, or Dysport into the muscle, causing the muscle to weaken and improving the appearance of the lines. These work by binding to receptors that send nerve signals for muscles to contract. Since your body makes new receptors and neurotransmitters all the time, it needs to be maintained otherwise the wrinkles will slowly return as the muscle regains function over time. Neurotoxins take 2 to 4 weeks to start working and lasts for up to 6 months.

For deeper glabella lines or strong 11s, I use a combination of Botox with fillers, lasers and microneedling with PRP. I suggest getting a formal evaluation with an experienced cosmetic dermatologist and expert in lasers and fillers. Best, Dr. Emer

Jon E. Mendelsohn, MD, FACS · Answer

Hi. This is a very common occurrence over the years of getting Botox and it happens for a few different reasons. The main reason is our skin thins and loses the elasticity as we age, making it easier for any slight muscle movement to create a wrinkle within the skin. So make sure to do at home medical grade vit c and retinols, also laser treatments along with micro needling to increase the tone in your skin. Another issue that makes it seem like the Botox isn’t working as well is that we lose volume in our fat muscle and bone, and with less volume … skin can crease easier as well. Such as in the brow area, these muscles, thin and separate as we age, and the slightest muscle movement, will allow for a creasing. if you place filler into this separation and create a little volume, the Botox would seem to work better and give a smoother effect over the brow.

Nelson Lee Novick, MD · Answer

I have been injecting Botox for aesthetic reasons since 1991. Occasionally, after repeated treatments over several years, I have encountered individuals who have become resistant to Botox's effects in the way you describe--either or both shorter durations of effect or less than adequate response. In such cases, I have found switching to alternative neuromodulator, such as Xeomin, to be effective. In the manufacture of Xeomin, it has been stripped of some proteins that are believed to be responsible for leading to resistance to its use, and this is conjectured to be the reason for working when Botox no longer does. You would be wise to consult with an experienced, board certified dermatologist injector to explore this option. Hope this helps and best of luck.

Jeffrey H. Spiegel, MD · Answer

You may be asking too much of the botox now. An injection is all you need for a perfectly smooth result when you are younger. When you are 49 it will help but may not be enough to keep you where you want to be.  You can try a different brand, but, most likely the answer is considering a different intervention. Send a picture so we can see.

Joseph Kurt Bivens, MD · Answer

The body's immune response works to develop antibodies against harmful pathogens that have been introduced to the body. Because you have been consistently getting Botox treatments for many years, this has increased your exposure to the toxin and thus, the antibodies that work against it. This hinders the effectiveness of the toxin as your body has developed a resistance to Botox. There are other brands of neuromodulators that have the same effect as Botox, but are comprised of different proteins. It is suggested to get treated with a different brand of neuromodulator to accommodate this issue.

Niraj Mehta, DO · Answer

Assuming proper placement, technique, dilution, etc of Botox, you may be a high metabolizer of the toxin. It is less common for you to BECOME a high metabolizer if you weren't always one but it's always possible.
It may be best for you to try another place and/or another product (like Daxxify) to see if there's any change. If Daxxify also doesn't last long, then you are definitely a high metabolizer and there's no way for it to last longer.

Camille Cash, MD · Answer

Are you visiting the same injector that you have always used?  Are the same number of units being injected?  If so you may want to try an alternate neurotoxin such as Dypsort or Daxxify.  Note that the number of units needed for correction varies by product.

Raman Mehrzad, MD, MHL, MBA · Answer

Hi!
I've gotten this question from multiple patients after they have been treated with neurotoxins elsewhere and there could be multiple reasons for this. First, ensure that you practice proper post-neurotoxins care:
-Exercise Your Face - About an hour after you receive neurotoxins injections, exercise your facial muscles by frowning, squinting, smiling, and raising your eyebrows for 30 seconds. Repeat these exercises several times throughout the day to help the neurotoxins solution infiltrate targeted muscle-Wait a Couple of Days Before Heading Back to the Gym. -Avoid Putting on makeup for the rest of the day.-Do not lie down or leaning forward significantly for 4-6 hours - so dont get neurotoxins at nighttime. -Try to sleep on your Back. -Don't drink alcohol before or after for 1-2 days-Avoid the sun
Now, If you do all of those things, then it might not be you that is the answer but in fact the injector. -Ensure that you get proper units to each of the treated areas. Less units will have less affect and many dont know how much the injector is actually injecting-Ensure that the injector knows the anatomy and inject in the right areas. Anatomy is key for injection and that's why plastic surgeons are trained to understand both facial anatomy and changes in facial anatomy that happens with age. You see, as you grow old, some of the facial muscles tissues might move around, so one has to be aware to inject in the right spot-Perhaps the neurotoxin you get is not the right for you. Currently there are different brands on the market and each one has a bit different effects, so it might be wise to try a different one. 
 
Raman Mehrzad

Anna Avaliani, MD · Answer

Do you go to the same provider or keep changing places or toxins?The real primary resistance is super rear. Secondary resistance is rare also but can be from medications, injection technique, inadequate storage or preparation techniques, genetic predisposition, etc. You need to discuss with your injector.

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