For anyone devoted to wrinkle-relaxing injections, few things feel more frustrating than looking in the mirror and thinking: Wait, did this not work? The idea that your beloved neurotoxin has suddenly stopped doing its thing can cause instant panic (and maybe even more frown lines), but expert injectors say the truth is usually less dramatic than it feels.
Featured Experts
- Jennifer Segal, MD is a board-certified dermatologist in Houston
- Dr. Deborah Longwill is a board-certified dermatologist in Miami
- Janine Hopkins, MD is a board-certified dermatologist in Southlake, TX
The Common Culprits
Sometimes the issue comes down to technique. Houston dermatologist Jennifer Segal, MD, points out that not every injector is meticulous. “Non-reputable providers may dilute toxin inappropriately, decreasing efficacy and longevity,” she says. That doesn’t mean you’ve built up resistance. It may just mean the product wasn’t used optimally.”
Dr. Segal also notes that “rarely does one need to change toxin due to a ‘tolerance.’ Toxins are fairly comparable in terms of longevity at this point.”
For others, it’s about timing and muscle strength. “Judging results too early, like at day three or five, can feel like nothing happened,” says Miami dermatologist Dr. Deborah Longwill. Certain muscle groups, like the forehead or jaw, may simply require more units or a different distribution. “High expressers or athletes can see shorter duration,” she adds. And when it comes to static etched lines, “they won’t disappear with neurotoxin alone.”
Mismatched Expectations
When patients feel like their neurotoxin has “stopped working,” it is often not the product failing, it is perception, notes Southlake, TX dermatologist Janine Hopkins, MD. “Patients often come in saying they’re still seeing lines and wrinkles after treatment, which makes them feel like their tox has stopped working,” she says.
The truth is more complex. “In some cases, patients can actually develop resistance to certain brands of neurotoxin due to neutralizing antibodies, though this is not very common,” Dr. Hopkins explains. “More often, the issue is that neurotoxins only work on dynamic wrinkles, the ones caused by muscle movement. They do not address collagen loss, skin laxity or volume loss, which also contribute to visible lines as we age.”
Helping Results Last
If you are still not satisfied after two weeks, that is the time to circle back with your injector. “Revisit your injector to adjust units or refine placement,” says Dr. Longwill. “Sometimes adjacent muscles need treatment for balance. If optimized technique still fades early, switch within botulinum toxin A options and space visits to 12 weeks to minimize antibody risk.”
Dr. Hopkins stresses that often the solution lies in combining treatments. “Neurotoxins are great for relaxing muscles, but they are not a complete solution for facial aging,” she says. “If a patient isn’t satisfied with their results, we might switch to a different neurotoxin brand if resistance is suspected. More commonly, though, we need to layer treatments. This may include dermal fillers to restore lost volume, biostimulants to encourage collagen production or energy-based treatments such as lasers, ultrasound or radio frequency to smooth and tighten the skin.”
