Botox Immunity and Why Botox May Not Work for You

Botox injections are a popular nonsurgical cosmetic procedure, but Botox doesn't work for everyone. Typically, Botox blocks chemical signals from nerves that cause muscles in the treated area to contract. This paralyzes the muscles, preventing movements that cause wrinkles to form.

Botox injections are not without risk. Side effects range from bruising and redness at the injection site to headaches and allergic reactions. Also, Botox may not be effective for everyone. After repeated use, some people may become immune to its wrinkle-reducing effects.

This article covers what happens when Botox doesn't work and why some people become immune to it. It also addresses reasons why botox injections fail, and what to do if yours don't work.

What Happens When Botox Doesn't Work

Botox doesn't smooth wrinkles immediately. Usually, the treated area starts to look smoother within four days after injection, while the full effect can be seen within one to four weeks.

If, after four weeks, you notice little to no change in your ability to move the treated muscles, there is a possibility you have developed Botox resistance. The first thing you should do in this instance is give your Botox provider a call and let them know what's going on.

When Botox is done correctly, the treated muscles should become completely paralyzed. For example, if your forehead was treated, you may be able to raise your eyebrows, but your forehead won't move at all.

If you are Botox-resistant, this won't be the case. When you move your eyebrows up and down, the muscles in your forehead will also flex, causing wrinkles to form just like they did prior to your Botox treatment(s).

Becoming Immune to Botox

Botox immunity occurs when the body responds to a Botox injection by producing antibodies. These antibodies fight off the proteins in Botox and counteract their effects. As a result, the Botox may partially or completely fail to paralyze the treated muscles.

Botox resistance is most likely to occur in people who receive higher doses of Botox. Higher doses are often used to treat chronic medical conditions, like cervical dystonia. Some providers may also administer higher doses off-label when treating certain muscles, such as the masseter muscle of the jaw.

According to a representative from Allergan, the company that makes Botox, "Occasionally some patients may develop an immune response to BOTOX/BOTOX Cosmetic that may reduce the effectiveness of treatment."

The packaging for Botox and Botox Cosmetic notes that the immune reaction which causes Botox resistance is a risk. The label therefore advises using the lowest effective dose and allowing gaps between Botox treatments to be as long as possible.

Other Reasons Botox May Fail

Aside from immune-related causes of Botox failure, other reasons Botox may fail include:

• Improper product handling: Botox providers should keep Botox products refrigerated at temperatures recommended by Allergan. Failure to store Botox properly can cause Botox to degrade and become less effective.
• Improper technique: Botox providers must tailor their injection technique from patient to patient, based on each person's unique muscle size, tone, and anatomy. Failure to assess a patient's features properly can result in less effective treatments.
• Under-dosing: Occasionally, a provider may underestimate the amount of Botox needed to paralyze the targeted muscles, resulting in incomplete paralysis.
• Disease progression: In people who are using Botox to treat a chronic disease, previously used doses may become less effective if the disease progresses. This can lead providers to administer higher doses of Botox, which can result in Botox resistance.

Most causes of treatment failure can be avoided by receiving Botox treatments from board-certified and experienced providers, such as a plastic surgeon or dermatologist.

What to Do if Botox Doesn't Work

If you try Botox and it doesn’t seem to work for you, you may:

• Talk to your provider. They may be willing to inject you again for free if you didn’t get results the first time.
• Get a second opinion. If you are not sure whether your treatment was effective, try contacting another board-certified dermatologist or plastic surgeon for an evaluation.
• Switch providers. If are still determined to have completed results, try seeing a different healthcare provider. Be sure to inform the new provider when you had your last Botox treatment, and, if possible, how many Botox units you received.
• Consider an alternative. Some treatment alternatives may even offer more long-lasting results. To learn more about them, consult with a qualified dermatologist or plastic surgeon.

If you still don’t get results, then you just may be one of those people who is “immune” to Botox. If that turns out to be the case, then you can thank your amazing immune system, or give one of the many alternatives to Botox a shot.

Summary

If Botox is not working for you, you may have developed Botox resistance. Immunity to Botox happens when the immune system develops antibodies that neutralize Botox proteins, rendering them ineffective. If you are immune to Botox, the drug will have partial to no paralyzing effect on your treated muscles.

Botox resistance is more likely to occur in people who receive higher doses of Botox, or more frequent treatments. Botox treatment may also fail if a provider uses improper technique. Receiving treatments from an experienced, board-certified provider increases your chances of successful Botox injections.