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Botox Resistance – When Botox Doesn’t Work

Immune to Botox?


Updated June 10, 2014

Immune to Botox?

It’s the most popular cosmetic procedure performed worldwide today, and with good reason. Botox injections are quick, low on the pain and suffering scale, relatively inexpensive (when compared to surgery), and require no downtime. All this, and results too. As with any cosmetic procedure, there is a downside. Botox injections are not without risk, and the effects last only a short time (3 to 4 months is the norm).

But what if Botox simply doesn’t work for you? I have heard from numerous readers who have had success with their first, second, and sometimes third treatments with Botox, only to reach a point where the effects are either greatly diminished or entirely absent. I have also heard from readers who appear to have been immune to the effects of Botox from the start. I have even been through it myself, seeing several doctors and being injected on numerous occasions (all in the name of research, of course), all to no avail.

Why It’s So Frustrating

One About.com user shares this story:

“I tried botox for those frown lines between my brows. The first time, I had a slight sensation for a few days, then a stronger dose the next time -- nothing -- one last dose -- still NOTHING. I was so disgusted and still hate the way it makes my otherwise young-for-my-age face look tired or mad. I've even had strangers walk up to me and tell me to stop frowning and smile!”

Actually, it is a little known fact that some people can become resistant to the effects of Botox. This only adds to the frustration of patients with this issue. The problem is that they may have a hard time finding someone who believes them. In fact, a couple of the doctors I interviewed for this article said that there was no such thing as “immunity” to Botox. These and other doctors claim that if Botox doesn’t work, it is because the product wasn’t stored properly to maintain its potency, or that the person injecting it was not using the correct technique or dosage. It seems that the typical protocol at that point is to simply offer more injections. The patient then ends up spending even more money on a treatment that just doesn’t work for her.

The Skinny From the Source

The answers I was given by the first few doctors I spoke to were similar to the response I received when I first contacted the people at Allergan, the company that makes Botox. However, after pressing further, one Allergan representative dug a little deeper and came back with this statement on behalf of the company:

“Occasionally some patients may develop an immune response to BOTOX/BOTOX Cosmetic that may reduce the effectiveness of treatment. This is because BOTOX/BOTOX Cosmetic is a protein complex, and in some patients the body’s immune system may respond by producing “blocking” (or neutralizing) antibodies capable of inactivating the protein’s biological activity. Antibody formation is more of a concern when patients must receive frequent injections or when it is used to treat medical conditions such as cervical dystonia that require higher doses. However, recent long-term studies have indicated immunogenicity to be a minor concern even with that treatment. Both the BOTOX/BOTOX Cosmetic labels (attached) advise that the potential for antibody formation may be minimized by injecting with the lowest effective dose given at the longest feasible internals between injections.”

To put it plainly, Botox resistance (immunity) is not common, but does occur in some patients. According to those who do recognize the phenomenon of Botox resistance, the numbers are low -– about 1% to 3% of patients who are injected will develop toxin-blocking antibodies. Still, with millions of Botox injections being given every year, this number is not insignificant. To minimize the risk of becoming resistant, patients should be given the lowest possible effective dose (which is a good idea for safety’s sake anyway).

Don’t Jump the Gun

Keep in mind that the success of Botox injections is in fact highly dependent on technique, and it is also entirely possible to get a “bad batch” that is less than fresh (and therefore, less effective). If you try Botox and it doesn’t seem to work for you, talk to your doctor. He may be willing to inject you again for free if you didn’t get results the first time. If it happens again and you are still determined to have a line-free forehead, try seeing a different doctor. If you still don’t get results, then you just may be one of those rare people who is “immune” to Botox. If that turns out to be the case, then you can thank your amazing immune system, and you could always try learning to accept and embrace those little expression lines…or you could consider trying one of the many alternatives to Botox.


Botulinum A Toxin Therapy: Neutralizing and Non-Neutralizing Antibodies--Therapeutic Consequences; Goschel H; Experimental Neurology, Volume 147, Issue 1, pp 96-102, September 1997.

Interview with Adam Tattelbaum, MD, Rockville, MD; conducted on December 7, 2007.

Interview with Eric Berger, MD, New York, NY; conducted on June 16, 2008.

Interview with Leslie Bryant, Corporate Communications Manager, Allergan; conducted on August 5, 2008.

Interview with Min S. Ahn, MD, Westborough, MA; conducted on September 11, 2008.

Interview with Timothy R. Jones, MD, St Louis, MO; conducted on September 11, 2008.

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