The Surprising Reason You Could Become 'Immune' to Certain Injectables—and the One to Switch to If It Happens

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Some people say their wrinkle-fighting neuromodulators (specifically Botox Cosmetic and Dysport) “stop working” over time, but is this really the case? Or are other factors to blame? We’ve got the inside scoop from the experts.

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Yes, it can happen...
According to New York dermatologist Julie Russak, MD, some patients have said their neuromodulators, which work to temporarily paralyze the muscles that contract and cause wrinkles, have “stopped working” over time. “Your body can develop antibodies to a specific product, so your immune system resists it,” she says. “Luckily, there are a few brands—Botox Cosmetic, Dysport and Xeomin—that we can use interchangeably to combat this. 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, to alleviate the problem.” Also, if you’re an avid exerciser, your body may metabolize injectables faster, which can cause the effect not to last as long.

It's not likely...
Purchase, NY, plastic surgeon Michael Suzman, MD, says it is exceedingly rare for someone to become “immune” to neuromodulators, and that most patients find them to be very effective at the same dose, even over many years. “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. 

Another reason for this “reduced effect,” according to Dr. Suzman: “The injection could have missed the strongest part of the muscle and concentrated between areas of muscle where it is less effective. A touch-up with product from a fresh vial should correct the issue.”

The bottom line: You can develop antibodies to certain brands of injectables, and can switch to another product to fix it, but you can’t become immune to them entirely.

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  • nina D
    Posted on

    Hi I have not had a lot of botox, I'm 47 and skipped all treatments for 3 years after a severe allergic reaction. I'm seeing a Doctor who researches and is board certified to find out what is going on. The regular botox didn't work, we tried xeomin next and it looks like it isn't working either (it's been 8 days) then I think he will try Dysport. I think I'm that rarity! Unfortunately... Any suggestions on what to do next to help the lines and aging that botox used to help so nicely with???

  • Ruby
    Posted on

    I believe it. This happened after 10 years of Botox it no longer works on me I switched to dysport it worked great for awhile but now it’s starting to do the same :(

  • Tess Martin
    Posted on

    I am one of those rare people that have a resistance to both botox * dysport. Unfortunately there is no remedy for me!

  • Chellie
    Posted on

    This is article is incorrect. Developing antibodies to the accessory proteins does not affect efficacy, only neutralising antibodies to the active neurotoxin block the treatment working. The immune irritating effect of the accessory proteins in botox and Dysport may mean it is more likely patients develop neutralising antibodies to the active neurotoxin which blocks the effect. When this happens the effect of treatment will lessen with each treatment over time until the antibody level is so high that the treatment will not work at all. Switching between products will not help, and xeomin is not the answer. You may be less likely to develop antibodies with xeomin however once neutralising antibodies develop, none of the botulinum toxin type A brands will work. So evidence shows you do become completely immune however it is rare, but true rates are not tested nor reported

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