Table of ContentsView AllTable of ContentsWhy It FailsHow Immunity HappensOther CausesWhat to Do
Table of ContentsView All
View All
Table of Contents
Why It Fails
How Immunity Happens
Other Causes
What to Do
Botox injectionsare 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 arenot without risk. Side effects range from bruising and redness at the injection site to headaches andallergic 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.
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What Happens When Botox Doesn’t Work
Botox doesn’tsmooth wrinklesimmediately. 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 resistance is most likely to occur in people who receive higher doses of Botox. Higher doses are often used to treat chronic medical conditions, likecervical dystonia.Some providers may also administer higher doses off-label when treating certain muscles, such as themassetermuscleof 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:
What to Do if Botox Doesn’t Work
If you try Botox and it doesn’t seem to work for you, you may:
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.
8 Botox Alternatives
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.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Satriyasa B.Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect.Clin Cosmet Investig Dermatol. 2019 Apr;12(1):223-228. doi:10.2147/CCID.S202919American Society of Plastic Surgeons.How long does botox last?.Ho W, Albrecht P, Calderon P, et al.Emerging trends in botulinum neurotoxin A resistance: An international multidisciplinary review and consensus.Plast Reconstr Surg Glob Open. 2022 Jun;10(6):e4407. doi:10.1097/GOX.0000000000004407Jinnah AH, Goodmann E, Rosen A, Evatt M, Freeman A, Factor S.Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes.J Neurol. 2016 Jun;263(6):1188-1194. doi:10.1007/s00415-016-8136-xFood and Drug Administration.BOTOX Cosmetic (onabotulinumtoxinA) for injection.Park K, Han H, Kim J, Kim H.Potency and quality of reconstituted botulinum neurotoxin type A according to storage temperatures.Dermatologic Surg.2020 Jul;12(1). doi:10.1097/DSS.0000000000002557Anido J, Arenas D, Arruabarrena C, et al.Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone.Clin Cosmet Investig Dermatol. 2017 Oct;10(1):413-421. doi:10.2147/CCID.S138274Alfonsi E, Restivo D, Cosentino G, et al.Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders.Front Pharmacol. 2017 Feb;8(1):1-10. doi:10.3389/fphar.2017.00080Additional ReadingAun MV, Chung, TM, Santos, KS, Battistella, LM, Rizzo, LV, Kalil J, Giavina-Bianchi P.Is age associated with the development of antibodies against botulinum toxin?Allergol Immunopathol (Madr). 2013 Jul-Aug;41(4):276-9. doi:10.1016/j.aller.2012.05.002Göschel H, Wohlfarth K, Frevert J, Dengler R, Bigalke H.Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies–therapeutic consequences. Exp Neurol. 1997 Sep;147(1):96-102. doi:10.1006/exnr.1997.6580Ojo OO,Fernandez, HH.Is it time for flexibility in botulinum inter-injection intervals?Toxicon. 2015 Dec 1;107(Pt A):72-6. doi:10.1016/j.toxicon.2015.09.037.Stephan F, Habre M, Tomb R.Clinical resistance to three types of botulinum toxin type A in aesthetic medicine.J Cosmet Dermatol. 2014 Dec;13(4):346-8. doi:10.1111/jocd.12108
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Satriyasa B.Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect.Clin Cosmet Investig Dermatol. 2019 Apr;12(1):223-228. doi:10.2147/CCID.S202919American Society of Plastic Surgeons.How long does botox last?.Ho W, Albrecht P, Calderon P, et al.Emerging trends in botulinum neurotoxin A resistance: An international multidisciplinary review and consensus.Plast Reconstr Surg Glob Open. 2022 Jun;10(6):e4407. doi:10.1097/GOX.0000000000004407Jinnah AH, Goodmann E, Rosen A, Evatt M, Freeman A, Factor S.Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes.J Neurol. 2016 Jun;263(6):1188-1194. doi:10.1007/s00415-016-8136-xFood and Drug Administration.BOTOX Cosmetic (onabotulinumtoxinA) for injection.Park K, Han H, Kim J, Kim H.Potency and quality of reconstituted botulinum neurotoxin type A according to storage temperatures.Dermatologic Surg.2020 Jul;12(1). doi:10.1097/DSS.0000000000002557Anido J, Arenas D, Arruabarrena C, et al.Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone.Clin Cosmet Investig Dermatol. 2017 Oct;10(1):413-421. doi:10.2147/CCID.S138274Alfonsi E, Restivo D, Cosentino G, et al.Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders.Front Pharmacol. 2017 Feb;8(1):1-10. doi:10.3389/fphar.2017.00080Additional ReadingAun MV, Chung, TM, Santos, KS, Battistella, LM, Rizzo, LV, Kalil J, Giavina-Bianchi P.Is age associated with the development of antibodies against botulinum toxin?Allergol Immunopathol (Madr). 2013 Jul-Aug;41(4):276-9. doi:10.1016/j.aller.2012.05.002Göschel H, Wohlfarth K, Frevert J, Dengler R, Bigalke H.Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies–therapeutic consequences. Exp Neurol. 1997 Sep;147(1):96-102. doi:10.1006/exnr.1997.6580Ojo OO,Fernandez, HH.Is it time for flexibility in botulinum inter-injection intervals?Toxicon. 2015 Dec 1;107(Pt A):72-6. doi:10.1016/j.toxicon.2015.09.037.Stephan F, Habre M, Tomb R.Clinical resistance to three types of botulinum toxin type A in aesthetic medicine.J Cosmet Dermatol. 2014 Dec;13(4):346-8. doi:10.1111/jocd.12108
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Satriyasa B.Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect.Clin Cosmet Investig Dermatol. 2019 Apr;12(1):223-228. doi:10.2147/CCID.S202919American Society of Plastic Surgeons.How long does botox last?.Ho W, Albrecht P, Calderon P, et al.Emerging trends in botulinum neurotoxin A resistance: An international multidisciplinary review and consensus.Plast Reconstr Surg Glob Open. 2022 Jun;10(6):e4407. doi:10.1097/GOX.0000000000004407Jinnah AH, Goodmann E, Rosen A, Evatt M, Freeman A, Factor S.Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes.J Neurol. 2016 Jun;263(6):1188-1194. doi:10.1007/s00415-016-8136-xFood and Drug Administration.BOTOX Cosmetic (onabotulinumtoxinA) for injection.Park K, Han H, Kim J, Kim H.Potency and quality of reconstituted botulinum neurotoxin type A according to storage temperatures.Dermatologic Surg.2020 Jul;12(1). doi:10.1097/DSS.0000000000002557Anido J, Arenas D, Arruabarrena C, et al.Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone.Clin Cosmet Investig Dermatol. 2017 Oct;10(1):413-421. doi:10.2147/CCID.S138274Alfonsi E, Restivo D, Cosentino G, et al.Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders.Front Pharmacol. 2017 Feb;8(1):1-10. doi:10.3389/fphar.2017.00080
Satriyasa B.Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: A literature review of clinical use and pharmacological aspect.Clin Cosmet Investig Dermatol. 2019 Apr;12(1):223-228. doi:10.2147/CCID.S202919
American Society of Plastic Surgeons.How long does botox last?.
Ho W, Albrecht P, Calderon P, et al.Emerging trends in botulinum neurotoxin A resistance: An international multidisciplinary review and consensus.Plast Reconstr Surg Glob Open. 2022 Jun;10(6):e4407. doi:10.1097/GOX.0000000000004407
Jinnah AH, Goodmann E, Rosen A, Evatt M, Freeman A, Factor S.Botulinum toxin treatment failures in cervical dystonia: causes, management, and outcomes.J Neurol. 2016 Jun;263(6):1188-1194. doi:10.1007/s00415-016-8136-x
Food and Drug Administration.BOTOX Cosmetic (onabotulinumtoxinA) for injection.
Park K, Han H, Kim J, Kim H.Potency and quality of reconstituted botulinum neurotoxin type A according to storage temperatures.Dermatologic Surg.2020 Jul;12(1). doi:10.1097/DSS.0000000000002557
Anido J, Arenas D, Arruabarrena C, et al.Tailored botulinum toxin type A injections in aesthetic medicine: consensus panel recommendations for treating the forehead based on individual facial anatomy and muscle tone.Clin Cosmet Investig Dermatol. 2017 Oct;10(1):413-421. doi:10.2147/CCID.S138274
Alfonsi E, Restivo D, Cosentino G, et al.Botulinum toxin is effective in the management of neurogenic dysphagia. Clinical-electrophysiological findings and tips on safety in different neurological disorders.Front Pharmacol. 2017 Feb;8(1):1-10. doi:10.3389/fphar.2017.00080
Aun MV, Chung, TM, Santos, KS, Battistella, LM, Rizzo, LV, Kalil J, Giavina-Bianchi P.Is age associated with the development of antibodies against botulinum toxin?Allergol Immunopathol (Madr). 2013 Jul-Aug;41(4):276-9. doi:10.1016/j.aller.2012.05.002Göschel H, Wohlfarth K, Frevert J, Dengler R, Bigalke H.Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies–therapeutic consequences. Exp Neurol. 1997 Sep;147(1):96-102. doi:10.1006/exnr.1997.6580Ojo OO,Fernandez, HH.Is it time for flexibility in botulinum inter-injection intervals?Toxicon. 2015 Dec 1;107(Pt A):72-6. doi:10.1016/j.toxicon.2015.09.037.Stephan F, Habre M, Tomb R.Clinical resistance to three types of botulinum toxin type A in aesthetic medicine.J Cosmet Dermatol. 2014 Dec;13(4):346-8. doi:10.1111/jocd.12108
Aun MV, Chung, TM, Santos, KS, Battistella, LM, Rizzo, LV, Kalil J, Giavina-Bianchi P.Is age associated with the development of antibodies against botulinum toxin?Allergol Immunopathol (Madr). 2013 Jul-Aug;41(4):276-9. doi:10.1016/j.aller.2012.05.002
Göschel H, Wohlfarth K, Frevert J, Dengler R, Bigalke H.Botulinum A toxin therapy: neutralizing and nonneutralizing antibodies–therapeutic consequences. Exp Neurol. 1997 Sep;147(1):96-102. doi:10.1006/exnr.1997.6580
Ojo OO,Fernandez, HH.Is it time for flexibility in botulinum inter-injection intervals?Toxicon. 2015 Dec 1;107(Pt A):72-6. doi:10.1016/j.toxicon.2015.09.037.
Stephan F, Habre M, Tomb R.Clinical resistance to three types of botulinum toxin type A in aesthetic medicine.J Cosmet Dermatol. 2014 Dec;13(4):346-8. doi:10.1111/jocd.12108
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