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Resistance to Botox


Did you know that you may be resistant to Botox? Keep reading to learn more.

What is Botox?

Botox is a purified protein that’s been used for decades to treat wrinkles caused by facial expressions. These include the vertical frown lines between your eyebrows you see when you frown, the horizontal wrinkles on your upper forehead you see when you raise your eyebrows, and the crow’s feet you see around your eyes when you smile. Botox relaxes muscles and smooths out your wrinkles.

How does Botox work?

Botox specifically works by blocking the signal from your nerves to your muscles. Your nerves release substances onto the muscles that makes them contract. Botox prevents this substance from being released. In this way, your muscle doesn’t contract and becomes relaxed. Since muscle contraction is a major cause of many wrinkles in the face, Botox is used to fight these wrinkles.

What is resistance to Botox?

It’s important to understand what resistance to Botox is and what it isn’t. There are many times when Botox doesn’t work as intended. But resistance is something specific. Sometimes you won’t see results simply because it hasn’t been long enough. Although most people see the results of their Botox in the first few days after their Botox treatment, sometimes it takes two weeks to see your full results. So patience is important. Sometimes you won’t see optimal results from your Botox treatment because the dose used was too low. When this happens, you may see partial to no improvement in your wrinkles. The simple fix is to use a higher dose. Sometimes the Botox may be placed incorrectly so that you don’t get the results you expect. Some people require a higher dose than others because they have larger or stronger muscles; this is common in men as compared with women since in general men have larger muscles than women both on the body and on the face. People that are active, thin, and/or exercise a lot tend to have a fast metabolism and will go through their Botox more quickly. There are a number of reasons (other than resistance) why it might now work at all. For example, it may be a bad batch of Botox, the temperature may have changed during transport, the saline used to reconstitute the Botox was bad, the amount of saline used to reconstitute the Botox was incorrect, the Botox touched alcohol to denature it, the Botox was expired, the refrigerator storing the Botox broke down, etc.

Unlike any of these causes, resistance to Botox is something different. Resistance to Botox is when you have been getting Botox for years using the same dose, and slowly over time you don’t see the same results any more. This can happen in up to two percent of people. This is how resistance to Botox works: every time you get a Botox treatment your body detects the Botox as a foreign substance and creates neutralizing antibodies against the Botox. This is usually very minimal given how much Botox is used for cosmetic purposes. Resistance is much more common for people who get Botox for pain because the amount of Botox used in larger muscles is much higher. Also, there is more blood flow to larger muscles so the Botox is more easily exposed to the immune cells in your blood, allowing for this kind of reaction. In this way, neutralizing antibodies that cause resistance to Botox are formed more easily.

This type of true resistance to Botox is thought to occur more frequently if you get treatments less than every three months. This happens in people who receive low doses every six to eight weeks. When you do this, your body gets exposed to Botox more frequently and can make the antibodies more quickly. Another thing that is thought but not completely understood is that some people may have a genetic predisposition to forming neutralizing antibodies to Botox. This is more common in people with autoimmune disorders such as lupus and rheumatoid arthritis, among others.

The way to know if your body is becoming resistant to Botox is mostly your results. The most common thing you’ll notice is that you don’t see the same response to the dose you previously receive with good results. You may try again with a higher dose, which may or may not work. Or you won’t enjoy your results as long as you had in the past. There is also a blood test you can do, but it is not routinely available. So you really need to see your body’s response to your Botox treatments.

What can I do if I’m resistant to Botox?

 If you develop a true resistance to Botox, there are other things you can do. If you get a low dose, try a higher dose with less frequent treatments. This is important to prevent resistance. Another simple thing to do is to try a different neuromodulator product. Fortunately, we now have multiple alternatives including Dysport, Xeomin, and Jeuveau. And another product without a brand name of yet called daxibotulinum toxin will be available soon. A lot of the times if your body becomes resistant to one neuromodulator (Botox), your body may still respond to another one. Theoretically, Xeomin is thought to have the least possibility for resistance so it may be a good one to try. A much less desirable method of dealing with resistance to Botox is to take a break from getting Botox treatments. This break usually makes your body stop making the neutralizing antibodies that makes you resistant to Botox. Unfortunately, however, the break required could be up to five years. You can also try other treatments that will improve your skin. For example, the wrinkles treated by Botox are usually deeper when you lose collagen. That’s because collagen keeps your skin firm and tight. So as you slowly lose collagen over time your skin becomes looser, thinner, and more wrinkled. Using topical products such as retinoids will help stimulate collagen formation in your skin. Treatments to further stimulate collagen include chemical peels, skin tightening treatments, Ultra Microneedling, and fractional laser treatments.

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Dr. Alex has performed over 10,000 cosmetic treatments with many satisfied patients. Contact us to schedule an appointment for a free consultation with Dr. Alex in our Encino, CA office.

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