Thank you for your question.
You state in your question that you've been getting Botox for 11 years and recently you
were used to or accustomed to seeing lines going flat.
And recently you went to get Botox and you feel like you had no effect, you got additional
five units you still have no effect.
So you're asking are you are in some way immune to the effects of Botox.
Well I can certainly help you with this question.
I'm a board-certified cosmetic surgeon and a fellowship-trained oculoplastic/oculofacial
plastic reconstructive surgeon practicing Manhattan Long Island for over 20 years.
As an aside it's important to note that oculoplastic surgeons were amongst the first doctors to
use Botox along with neurologists because before there was the cosmetic indication there
was the original medical indication, and we were treating patients with various spasms
like benign essential blepharospasm.
So it's certainly a reasonable question you're asking.
What I try to do to help patients understand whether or not the Botox is working is first
to distinguish the presence or absence of the line is one indicator, but the more important
indicator is the activity of the muscle that is intended to be treated.
And that the only way to test that is by activating that muscle.
So if you injected the crow’s feet lines without scrunching your face or without pushing
the cheeks upward just squint your eyes and if the muscles continued to contract, well
then it's it's either the injection was not effective, dosage may not have been high enough,
or you have some type of resistance.
And the same thing can be applied for any where else - first see if the muscle - if
you can frown like if you can move that muscle and then in that case, the same applies.
Now what happens of course with time is the collagen and soft tissue in the areas of concern
can also diminish.
which means that lines that formerly were flattened as you described may need additional
modalities to help improve the depth of those lines.
It's not uncommon to need a combination of Botox and a filler, or Botox and filler and
platelet rich plasma.
The idea is that when we are losing volume - if you think of facial aging of loss of
bone, muscle, fat, soft tissue, it's important to understand that.
But to make that distinction make sure that you can differentiate between muscle activity
in the absence of muscle activity.
Now that being said, it is it is possible to have antibodies to botulinum toxin.
In my own practice and personal experience, when I found that patients would demonstrate
something like this, it is it is relatively rare even with a large volume of patients
who we treat, it is possible to try other drugs such as Dysport and Xeomin and see how
they respond to that.
So you're not completely lost or left without some kind of treatment, but you
can certainly try these other these other drugs which structurally differ from botulinum
toxin that's found in Botox.
So I think we need to discuss the details with your doctor and understand and different
and figure out differentiate lack of the causes of your own lack of satisfaction from the
results of the most recent Botox treatment.
So I hope that is helpful, I wish you the best of luck and thank you for your question.