Q: Dr. Eppley, I have been using Botox for 10 years now and I have found that this last year it is lasting half the time it used to. I do my entire forehead and around the eyes. My esthetician suggested using a different product but same limited result occurred. Is there anything permanant that can paralyze the muscles in those areas? I forgot to mention I have used the same nurse in a board certified plastic surgeons office the entire 10 years so I know she knows what she is doing.
A: While uncommon, there is definite resistance to the effects of Botox over time that has been described by numerous anectodal experiences. It does not seem to occur in the vast majority of patients but I suspect we will see more of it in the next ten years as the number of people who have received it over a long time is increasing. The mechanism of resistance is not yet known. Once it occurs, there is no known reversal or alternative treatment other than trying the other approved botulinum toxins that are available which have slightly different molecular structures. (Dysport, Xeomin) There is no method of permanently paralyzing facial muscles, injectable or otherwise.
Dr. Barry Eppley