The Surprising Reason You Could Become ‘Immune’ to Certain Injectables

A couple of times a year, I’ll see a reader email us this question, or a friend will shoot me a text: “I feel like my Botox isn’t working anymore. Am I becoming immune to it?” If this has ever happened to you, you’re not crazy—it is possible. For some people, their line-smoothing neurotoxins (they work to temporarily paralyze the muscles that contract and cause wrinkles) “stop working” over time. We’ve got the inside scoop from the experts on the reasons why, and what to do if it happens to you.

You’re Getting Injected Too Often

According to New York dermatologist Doris Day, MD, because of the way the neurotoxins are processed, the more you are exposed to it, the more likely you are to build up a resistance. “If you get a treatment and then wait three months, the drug is completely out of your system and has completely worn off, so the next time you get it, it’s like getting it for the first time,” she explains. “People who get ‘Baby Botox’ more often—fewer units every four to six weeks—are increasing their risk of building their immunity to the neurotoxin. And it’s not that they want to look frozen, but some people may benefit from treatments more often to get the look they want. However, if you keep getting it over and over in less than two-month intervals, you’re more likely to build up a resistance. The way to minimize the issue is to make sure you space your treatments out every three to four months.”

The only product on the market that the resistance wouldn’t occur with is Xeomin, Dr. Day says. “All the other neurotoxins available in the U.S. are formulated with binding proteins, but Xeomin is the only pure form of the drug without any other elements that might create an antibody response. I think Xeomin works great, and in my hands, I use it very precisely and get fantastic results. I can also modify the treatment based on the patient’s goals.”

New York dermatologist Julie Russak, MD, agrees, saying the body can develop antibodies to a specific product and your immune system will resist it. “In most cases, people build up antibodies to the accessory protein in Botox Cosmetic and Dysport, rather than the active molecule. If this happens, we can switch to Xeomin, which doesn’t contain this specific type of protein.”

What most patients don’t realize, says Los Angeles facial plastic surgeon Kimberly J. Lee, MD, is that there are different strains of Botulinum toxin, with Botulinum toxin A being the most common type for cosmetic use. “It’s become significantly harder to get the other strains of botulinum toxin, so if one type of neurotoxin doesn’t work, many times a competing brand’s neurotoxin will,” she explains. “Even if it’s the same strain of botulinum toxin, there are some nuances that work better with some patients more than others. There are also some other reasons why an injector would choose one type of botulinum toxin over another so it’s best to consult with an expert who can guide you to achieving the results you seek.”

With all this being said, however, Dr. Day says she doesn’t see this “immunity” happen very often. “In the 20-something years I’ve been using Botox and other products, it’s not often that I see this problem. But, we are now starting to use these products a lot more often in the form of ‘Baby Botox,’ so I do think we’ll start to see more of this problem.”

You’re Part of the 4 Percent

Dr. Lee says patients can be resistant to neurotoxins entirely. “Approximately 4 percent of the population is resistant to neurotoxins, meaning they have no effect from the injection.”

It May Be the Result of Natural Aging

According to Purchase, NY plastic surgeon Michael Suzman, MD, there’s a possibility that the neurotoxin is still working, but you’re perceiving it differently after many years of getting injected. “If a patient sees a lessened effect after receiving their regular injections, it may be because they are so used to the smooth look they have achieved, but still continue to age normally over time, and therefore see less of a ‘youthful’ result,” he explains. 

You Didn’t Go to an Expert Injector

Neurotoxins have been around for decades and are super quick to administer—my forehead and glabella take less than five minutes total—but that doesn’t mean they shouldn’t be considered a serious procedure. Injecting anything in the face should be left to a board-certified dermatologist or plastic surgeon, or a qualified injector. “Another reason someone might think their neurotoxins aren’t working is if the injection missed the strongest part of the muscle and concentrated between areas of muscle where it is less effective,” says Dr. Suzman. “A touch-up with product from a fresh vial should correct the issue.”

It's Personal

At NewBeauty, we get the most trusted information from the beauty authority delivered right to your inbox

hbspt.forms.create({ portalId: "8806970", formId: "a8aef9b2-6178-4dad-9e2a-98b7661febc2" }); Find a Doctor

Find a NewBeauty "Top Beauty Doctor" Near you

Select a state State AL AR AZ CA CO CT DC FL GA HI IA IL IN KY LA MA MD MI MN MO NC NE NJ NV NY OH OR PA SC TN TX UT VA WA WI Select a state Specialty Cosmetic Dentist Dermatologist Facial Plastic Surgeon Hair Restoration Specialist Oculoplastic Surgeon Periodontist Plastic Surgeon Prosthodontist Vein Specialist Select a state Treatment Abdominal thread lifts Accent your Body Acne Treatments Alexandrite Laser Arm Lift Asclera Bellafill Belotero Blue Light Body Body Lift Botox Botox Browlift Brachioplasty Brazilian Butt Lift Breast Augmentation Breast Augmentation with Fat Grafting Breast Implants Breast Implants with Saline Breast Implants with Silicone Breast Lift Breast Lift with Implants Breast Reconstruction Breast Reduction Browlift Butt Enhancement Carboxytherapy Cellulite Treatment Cheek Augmentation Cheek Augmentation with Fat Grafting Cheek Implants Cheek Lift Chemical Peels Chin Augmentation CO2 lasers Cool Lipo CoolSculpting CoolTone Crowns Dental Bonding Dental Implants Dimpleplasty Diode Laser Dysport embrace Active Scar Defense Emsculpt Endermologie Endoscopic Browlift Endoscopic Facelift Endoscopic Tummy Tuck Erbium Lasers Exilis Ultra 360 Eyelift Eyelift with Fat Grafting Face Facelift Facelift with Fat Grafting FaceTite Fat Melters and Fat Reducers Fat Transfer Forma Fractional CO2 lasers Fractional Resurfacing Lasers Fractora Glycolic Peels Glytone Enhanced Brightening Cream Gum Dermabrasion Gum Lift Hair Hair Removal Hair Transplant Hair-Loss Treatment Injectables & Fillers for Cheek Augmentation Injectables & Fillers for Eyelift Injectables & Fillers for Lip Enhancement Injectables And Fillers Injectables and Fillers with Fat Grafting Intense Pulsed Light (IPL) Invisalign Isolaz Juvéderm Juvéderm Volbella Juvéderm Voluma Kybella Lactic Acid Peels Laser Liposuction Lasers Lateral Tension Tummy Tuck Limited Incision Facelift Lip Enhancement Lip Enhancement with Fat Grafting Lip Implant Lip Lift Liposculpture Liposuction Liquid Facelift Long Pulsed N: Yag laser Lower Blepharoplasty Lower Body Lift Lower eyelid surgery Lower Facelift MACS Lift Mandelic Peels Microdermabrasion Microinjection Microneedling Microwave Laser Treatment Mini Tummy Tuck Mini-Facelift Mommy Makeover Nd: Yag Neck Liposuction Necklift Nonsurgical Facelift Nonsurgical Rhinoplasty Obagi Blue Peel Otoplasty Perlane Phenol Peels Photobiomodulation Photodynamic Therapy (PDT) Photofacial PiQo4 Plasma Resurfacing Lasers Power Assisted Liposuction Prevelle Pulsed Dye Radiesse Radio Frequency with Microneedling Radio Frequency-Assisted Lipolysis Red Light Restylane Restylane Defyne Restylane Lyft Restylane Refyne Restylane Silk Revision Rhinoplasty Rhinoplasty Salicylic Peels SculpSure Sculptra Aesthetic Selphyl Silhouette Instalift Skin Skin Tighteners Skin Treatments Slim Lipo Smart Lipo SMAS facelift Smile Smile Makeover Smoothshapes Straightening Stretch Mark Treatments TCA Chemical Peels Teeth Whitening Thermage ThermiTight Thigh Lift Titan Tooth Contouring Traditional Facelift Tumescent Liposuction Tummy Tuck Ulthera Ultherapy Ultrasound Assisted Liposuction Umbilicoplasty Upper Blepharoplasty Upper eyelid surgery Vanquish ME VASER Lipo Vein Treatments Velashape Velasmooth Veneers Xeomin Search