Sometimes things are too good to be true. Case in point: the day our tried-and-true neuromodulators, namely Botox Cosmetic, Dysport, Xeomin and Jeuveau, stop working for us. It might sound like nothing short of a nightmare, but it’s not totally out of the question.
“It’s rare for a neuromodulator not to work, but it can happen,” says Chicago dermatologist Lauren Fine, MD. “Your skin can get used to the products, so you may not see the same results over time,” adds Kailua-Kona, HI dermatologist Monica Scheel, MD. “This typically occurs when your body produces antibodies to a protein component of the product,” says Dr. Fine.
Chicago plastic surgeon Niki A. Christopoulos, MD explains: “Some patients develop neutralizing antibodies to Botulinum toxin and this is often, but not always, related to frequency of exposure (i.e. repeat injections) and dose per treatment (or higher doses lead to increased risk for antibody formation). The development of these antibodies can lead to treatment failure or ‘becoming immune’ to neuromodulators.”
However, Dr. Christopoulos notes that this immunity is rare, contending that in her 10 years of injecting various neuromodulators into countless patients, she’s only seen it happen once. Dr. Fine also notes that after regular injections, she find that the effects of neuromodulator actually start to kick in quicker—”almost like the muscles remember what to do!”
Another reason injections may not be working for you: Scottsdale, AZ, facial plastic surgeon Kelly Bomer, MD, adds that older patients with major skin laxity may not get much improvement because excess skin and volume loss do not improve with Botox Cosmetic. There is a small amount of people who see results, yet have a reaction—mostly headache-like symptoms due to rare allergies associated with the product.
If you feel like your regular wrinkle reducer isn’t doing much of anything for you anymore, Melbourne, FL dermatologist Anita Saluja, MD says to talk to your doctor about changing the course of treatment. “You may need to treat the surrounding muscles, increase the dose or switch to Dysport or Xeomin.” Another option that may help, according to Dr. Christopoulos: ensuring your doctor is using small doses of your selected toxin and not overtreating.
If you still experience the same effects, neuromodulators may not be your answer. “You can fill in wrinkles with filler, use a high-grade medical skin-care program and engage in monthly skin treatments like microneedling with platelet-rich plasma (PRP), IPL, light chemical peels and dermaplaning to rejuvenate your face,” says Dr. Bomer. You can also opt for a treatment like ThermiRase, which uses a probe inserted under the skin (local anesthesia is used) to disable the muscles that cause lines to form (it lasts about two years and can cost up to $2,500 per treatment).
There are also over-the-counter skin-care products available, too, like Simply Venom Day and Night Cream ($59-$69), Perricone MD Re: Firm ($155) and Silk Therapeutics Silk + C30 Film ($330) that help improve the look of skin. While they don’t work exactly like a neuromodulator, nor do they provide the same effect, they can help to lessen the look of some lines and wrinkles with time.