Understanding Why Your Tox Might Not Be Working Like It Used To

By Get Tox’d

At Get Tox’d, we’re all about results—long-lasting, natural, and consistent. But occasionally, a client comes in and says:

“I used to see amazing results from Botox, but now… not so much. What’s happening?”

If that sounds familiar, you might be experiencing something called Botox resistance or Botox immunity. Although rare, it’s a real medical phenomenon—and knowing the difference between the two can help you make informed decisions about your treatment plan.

Let’s break it down.

What Is Botox, Exactly?

Botox (onabotulinumtoxinA) is a purified neurotoxin derived from Clostridium botulinum. It works by blocking the communication between nerves and muscles, which temporarily softens lines and wrinkles.

When Botox Stops Working: Resistance vs. Immunity

Botox Resistance

Resistance means that the Botox injections aren’t as effective as they used to be, but it’s not due to your immune system. This is usually related to technique, dosage, or timing.

Causes of Resistance:

• Under-dosing (not enough units)

• Incorrect injection placement

• Too much time between treatments

• Muscle adaptation (stronger muscles over time)

Study (Journal of Cosmetic Dermatology, 2022):
Found that 10–15% of patients who reported “Botox not working” were actually under-dosed or had suboptimal injection technique—not true immunity.

Botox Immunity

Immunity, on the other hand, involves your immune system producing antibodies that block the effects of Botox. This means the product literally stops working, even with proper dosing and technique.

Causes of Immunity:

• Overuse or frequent high-dose treatments

• Switching brands repeatedly (e.g., Botox → Dysport → Xeomin)

• Genetic predisposition to forming neutralizing antibodies

Study (Aesthetic Surgery Journal, 2023):
Roughly 1.5–3% of patients develop resistance due to antibody formation. This is more common in those receiving large doses for medical conditions (e.g., spasticity) than in cosmetic patients.

How Do You Know Which One It Is?

Ask yourself (or your provider) these questions:

• Are your results diminishing slowly over time? → Likely resistance.

• Did results suddenly stop, even after increasing dose or switching areas? → Possible immunity.

• Have you been getting high-dose Botox every 8–10 weeks for years? → You may be at higher risk for antibody formation.

Antibodies: The Science Behind Botox Immunity

Your body may develop neutralizing antibodies that block the botulinum toxin from binding to its target. These antibodies essentially “turn off” the effects of the treatment.

Study (Toxins, 2021):
Patients receiving over 600 units per year (mostly for therapeutic use) had a higher incidence of antibody-related treatment failure.

For cosmetic patients, standard doses (20–50 units per treatment) are well below this threshold and rarely lead to immunity—especially when spaced out appropriately.

What About Xeomin and Dysport?

Different brands, different formulations:

• Botox contains accessory proteins, which may increase the risk of antibody formation in rare cases.

• Xeomin is “naked” botulinum toxin—free of accessory proteins—and is sometimes recommended for those with suspected immunity.

• Dysport has different diffusion characteristics, and some people respond better to it even if Botox begins to lose effectiveness.

Study (Clinical, Cosmetic and Investigational Dermatology, 2023):
Patients who developed partial resistance to Botox saw improved results when switching to Xeomin due to its purified formulation.

What Can You Do If Botox Stops Working?

1. Consult Your Injector: Let our team at Get Tox’d evaluate your muscle response and treatment history.

2. Try a Different Brand: Xeomin or Dysport may bypass partial immunity.

3. Take a Tox Break: A 6–12 month pause can allow antibodies to decline.

4. Get Tested: Blood tests are available to check for neutralizing antibodies (though not commonly used for cosmetic cases).

Prevention Tips from Get Tox’d

• Stick with one brand if it’s working well

• Don’t over-treat or come in too frequently (wait at least 3 months)

• Choose trained providers who use the right technique and correct dosage

• Space treatments strategically to avoid overexposure

Final Word from Get Tox’d

Botox resistance and immunity are rare—but they’re real. If your results aren't what they used to be, don’t panic. Our expert injectors will help assess whether it’s a case of resistance, technique, or the rare possibility of antibody-related immunity.

Your face isn’t the same as everyone else’s, and your treatment plan shouldn’t be either. At Get Tox’d, we tailor every appointment based on science, anatomy, and your personal aesthetic goals.

Still noticing a drop in results?

Book a free consult with one of our providers. We’ll walk through your full Tox history and find the most effective next step—whether that’s adjusting your dose, switching products, or giving your system a reset.