Botox® Didn't Work? What to Try Next
Author
Dr. Stephen Cosentino
PRESIDENT OF EMPIRE MEDICAL TRAININGhttps://depositphotos.com/photos/botox-treatment.html?qview=50696489
For the vast majority of patients, Botox® works time and again. Millions of Americans get this minimally invasive, nonsurgical treatment to address more than a dozen cosmetic and musculoskeletal complaints.
But Botox doesn’t work for everyone, every time. Botox treatments can fail or produce unsatisfactory results due to injector error, low dosing, or immune resistance. And patience is a virtue — Botox results can take weeks to fully blossom.
Not satisfied with your most recent Botox treatment? Want to understand your options if your next Botox injection doesn’t go as planned? Here’s what you need to know.
Botox Didn’t Work? Here’s Why (Probably)
Botox injections usually fail for one of four reasons.
The Results Need More Time to Appear
Botox results don’t appear overnight. If it has only been a few days since your treatment, be patient and wait a little longer. It takes time for the active ingredient in Botox to work on your facial muscles, and post-injection swelling and bruising can obscure the early results.
The Dose Was Too Small
Experienced injectors know to follow Botox dosing guidelines and adjust dosing as necessary for each patient. For example, men generally need more units of Botox because they have more muscle mass.
Less experienced and “budget” injectors often underestimate the dose, leaving patients dissatisfied. Less commonly, unethical injectors may intentionally dilute the solution to stretch their Botox supply further.
The Injections Weren’t Done Properly
Less experienced injectors are also more likely to make Botox injections in the wrong locations. Often, they skip the critical pre-treatment Botox mapping process, or they don’t know how to do it.
This outcome is much more likely when you work with an experienced injector who has completed advanced Botox training — ideally, a plastic surgeon or other board-certified medical provider.
You’ve Developed Botox Resistance
Botox resistance is more common in patients receiving Botox treatments for chronic clinical conditions, such as migraine and strabismus.
It’s less common in patients receiving Botox Cosmetic, the formulation for cosmetic procedures, mostly because cosmetic patients tend not to get Botox as often.
However, Botox Cosmetic patients do develop Botox resistance. Over time, the immune system’s response to Botox improves as it learns to attack and neutralize botulinum toxin, the active ingredient in Botox. More units are needed to achieve the same results, and treatment may eventually stop working altogether.
What to Do When Botox Doesn’t Work
Here’s what to do in response to a failed or unsatisfactory Botox treatment.
Wait Longer
Remember, Botox effects take time to appear. Give it two weeks, then assess your results.
Schedule a Follow-Up Treatment
If you suspect your Botox dose was too low, schedule a follow-up appointment to receive additional Botox units. Ask the provider for free or discounted Botox; if it’s truly their mistake and they want to keep your business, they should oblige.
Use a Different Botox Injector
If you’re concerned that your Botox injector missed the muscles you wanted to treat, get a second opinion from another provider. If your suspicions pan out, don’t return to the original injector; they could make the same mistake again.
Consider Alternative Treatments
If you suspect that you’re becoming immune to Botox, consult a trained injector to discuss your options. Minimally invasive Botox alternatives include hyaluronic acid filler injections and thread lifts. Plastic surgery is also an option, but it’s riskier than injectable treatments and threads.
Preventative Measures for Botox Resistance
If you've experienced Botox resistance or are concerned about developing it, there are some proactive steps you can take to help prevent or delay this issue:
Space Out Treatments
One of the key factors that can contribute to Botox resistance is the frequency of treatments. The more often you receive Botox injections, the higher the chance your body will develop antibodies against the botulinum toxin.
Try to space out your Botox treatments as much as possible, aiming for the longest interval between injections that still maintains your desired results. Many providers recommend waiting at least 3-4 months between treatments.
Try Alternative Neuromodulators
While Botox is the most well-known neuromodulator, it's not the only option. Medications like Dysport, Xeomin, and Jeuveau use slightly different formulations of the botulinum toxin.
Switching to one of these alternatives, either temporarily or long-term, may help prevent your body from building up resistance to Botox specifically. Your provider can help determine if an alternative neuromodulator could be a good fit.
Consider Combination Treatments
For some patients, using Botox in combination with other treatments may help delay or prevent resistance. This could include pairing Botox with dermal fillers, laser treatments, or other minimally invasive procedures.
The idea is to reduce your overall reliance on Botox alone, giving your body a break from the repeated exposure to the botulinum toxin. Your provider can advise on the best combination approach for your individual needs and goals.
By being proactive and working closely with your injector, you can take steps to try to avoid or manage Botox resistance, ensuring you continue to get the results you desire from your treatments.
Don’t Give Up
When Botox treatments fail to deliver the desired results, it can be frustrating. However, there are several steps patients can take to address the issue and find a solution that works for them.
First and foremost, it's important to be patient and allow the full effects of Botox to develop over the recommended two-week timeframe. If the results are still unsatisfactory after this period, consulting with the original injector or seeking a second opinion from another experienced provider can help identify the root cause, whether it be an improper injection technique, an insufficient dosage, or the development of Botox resistance.
For those experiencing Botox resistance, exploring alternative neuromodulator options or combining Botox with other treatments may help delay or prevent further resistance. Additionally, spacing out treatments and allowing more time between injections can also be an effective strategy.
By working closely with a skilled and experienced injector, patients can navigate the challenges of Botox treatment and find the best path forward to achieve their aesthetic goals. With a proactive and collaborative approach, the vast majority of patients can continue to enjoy the benefits of this popular and effective cosmetic treatment.
