Why is my Botox not working anymore?

We have 5 unlucky women in our office right now that are completely resistant to not only Botox but all available (neurotoxins) approved for the aesthetic consumer market. The exhaustive list includes Botox, Dysport, Xeomin, Jeaveua and now Daxxify. Can you imagine? How horrible? How did this happen? Is it going to happen to you? We have also had more complaints that regular dosing that has been enjoyed by patients for years is no longer working. We know in our office alone, it is requiring 10-12 more units than it used to, for our patients to get their once enjoyed aesthetic result.

If your injector hasn’t shared this, you develop antibodies to absolutely every single neurotoxin we put in. Stop freaking out sis, it’s normal and you should not be overly concerned with that seemingly scary information. However, studies also show that when we use unnecessarily large doses and do not wait at least 12 weeks in between your appointments we ARE putting you at risk for immunity issues in the future with your neurotoxins.

There are two types of resistance to neurotoxin: primary and secondary. 

Primary is when we inject the patient, and they NEVER respond. Studies are showing that it’s either a cross-reaction of other antibodies from vaccines (people who have served in the military who have had numerous vaccinations are usually the victims), pre-existing antibodies to botulinum toxin, chronic exposure to botulinum in childhood, and abnormalities of BoNT-A acceptors. Ya’ll this is so rare, it hardly ever happens. I have been injecting for 15 years and I have NEVER had a primary non-responder.

Secondary resistance is described as an initial result/benefit from the treatment followed by a decrease in effect or no effectiveness at later treatment dates. This is what our 5 female patients are going through, and I know several injectors in my industry who are now completely immune to all neurotoxins. After interviewing all 5 women, they all had the same common denominator which was not using enough units to last 3 months and instead coming in every 6 weeks to get touched up if anything moved.

This is why here at the L.A.B. med spa, we use the lowest most effective dose to treat to aesthetic end points and we will also make you wait at least 3 months in between your appointments. I promise we aren’t just being mean, all the studies are showing that the worst thing you can do is come in every 6 weeks to get a touch up so nothing moves EVER. Now, that doesn’t mean we won’t ever touch you up, as you all know sometimes an eyebrow goes rouge, your 50th birthday party is coming up,  your treatment isn’t quite as tight as it usually is, your daughter/son is getting married, you are going to your High School Reunion, you are going to see your ex with his new girlfriend…………..these are all good reasons for a touch up, but you only get one a year, so use it wisely.

We have recommended that all of these women go 6 months without any injections, we will try to inject them again, if they still have immunity, the new wait period will be 2 years, we will try to inject them again and if they are still resistant, we will extend the waiting period to 5 years. If they are still resistant at year five, the chances of them decreasing their titers enough to be successful with any neurotoxin again is unlikely and we will have to deliver the news as best we can, so everyone please keep these women in your thoughts and your prayers.

Obviously, we are using other aesthetic treatments such as medical grade skincare, collagen induction therapy and laser/energy-based devices to help prevent their wrinkles and keep their skin as tight as possible. However, we all know this is not best-case scenario as neurotoxins still deliver the best results from the eyes up. Even though there is very little evidence at present for us to understand why some patients get resistance and some don’t, from what we can tell it is usually from large doses, not waiting 12 weeks between treatment periods, and decreased purity of botulinum toxin preparation.

Our final word on this subject will be, Dosing and Duration and Drug matter. Please make sure these things are being discussed at your injectors office, so you are able to enjoy these fabulous. anti-aging tools as long as possible. 

Share this Article