Botox Resistance – When Botox Doesn’t Work

What you need to know about this Botox phenomenon

woman getting botox
Thomas Barwick/DigitalVision/Getty Images

Botox injections are the most popular cosmetic procedure performed today worldwide. Yet it doesn't work for everybody. 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? Some 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. Others appear to be immune to the effects of Botox from the start. 

Why It’s So Frustrating

It is a little known fact that some people can become resistant to the effects of Botox. It was once thought that the product wasn't working because of improper storage, or injector error involving not using the correct technique or dosage. The patient's own antibodies were never questioned, and so the typical protocol at that point is to simply offer more injections. As a result, the immune patient then ends up spending even more money on a treatment that just doesn’t work for her.

The Skinny From the Source

Since the explosion of Botox use, researchers and doctors are realizing that a resistance to Botox can develop and, even that there may be some who are completely immune to its effects.

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. 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 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). There are also studies that are looking at how age and frequency of treatment may affect a person's ability to develop Botox resistance.

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.


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.

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.

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. Epub 2015 Oct 9.

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.

Continue Reading