I Feel Like My Botox Stopped Working. Is This a Real Thing?

Photo-Illustration: by The Cut; Photo: Getty Images

This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.

Q: How can you reduce wrinkles if you’ve grown “Botox resistant”? I recently asked a dermatologist, who said this is incredibly rare and not really a thing (at least not for many). But I’ve been getting Botox for seven or eight years, and I’ve noticed it barely works for me anymore — if at all. I recently tried a different brand of neurotoxin, and it still didn’t work. I think I’ve become immune; is that possible?

A: “It isn’t common, but there are cases of resistance to toxin — meaning there’s absolutely no response,” said HNTFUYF derm diva, Heidi Waldorf. It was more often seen in patients treated with very large amounts of the original Botox for neurological disorders, said Waldorf. So long before Botox Cosmetic became a household name, Allergan, the company that manufactures it, reduced the amount of protein in the toxin and the resistance decreased.

If you happen to be one of the few people (fewer than 1.5 percent of patients, according to one study) who develop antibodies to any of the toxin brands, you’ll be resistant to all of them because they’re all produced from botulinum toxin type A, said Waldorf. Why might you develop antibodies? If you’ve been getting large doses or many over a long period of time or frequent “booster” shots, your risk is higher.

Theoretically, there may be a reduced risk of resistance if you switch to the brand Xeomin because it’s formulated with fewer proteins, said Waldorf. There are case reports of patients who are resistant to Botox having a successful response to Xeomin months to years later, but that’s unusual.

True neurotoxin resistance — having no response — should be distinguished from having a lesser response and/or shorter duration of effect, said Waldorf. The latter can generally be treated by increasing the number of units of neurotoxin used, the former by injecting a slightly different area or by forgoing injections completely till the antibodies disappear from your bloodstream, which can take as long as five years.

But maybe you’ll want to consider that your body is trying to tell you something?