Botox Resistance: True/False?

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Botox doesn’t last forever. But can repeated treatments make your muscles unresponsive and cause them to lose their elasticity?

READER QUESTION:

Will getting Botox over time weaken the muscle, making it sag and atrophy, and as such droop? Shouldn’t we be stimulating the muscle so it stays tight?

Dr. John Martin, MD is a cosmetic plastic surgeon practicing in Coral Gables, Florida. He specializes in eye, facial, and neck rejuvenation. Dr. Debra Jaliman, MD is a Charlotte’s Book Premier Provider and a dermatologist practicing on the Upper East Side of Manhattan. Dr. Jaliman is recognized as a leader in the field of Botox treatments. Here’s what they had to say about our reader’s questions:

MD ANSWER:

“The doses used for cosmetic Botox are very small,” says Dr. Jaliman. “I’ve been using Botox in my practice for 25 years and have never seen anybody become resistant to Botox. The only people who may become resistant to Botox are those who use much higher doses for severe medical conditions. They may develop antibodies to Botox.”

On Muscle Response

Dr. John Martin gives some context: “When Botox or other neurotoxins are injected into the forehead, it will relax the horizontal creases. The forehead muscles, called the frontalis, are responsible for lifting the brows. If a patient has a low brow, forehead injections may make the brow appear even lower since they won’t be able to lift the brow with the frontalis muscle. Most patients are very aware of the low brow position when this occurs, and injections into the forehead are avoided in the future. For someone with a high or normal brow height, Botox into the forehead will not usually cause this problem. Long term injections into an area can cause some weakening and atrophy of the muscles, but once the injections are discontinued, the muscle should come back to its normal strength. Aging can cause a lowering of the brow on its own, and this is not due to the Botox injections.”

Dr. Jaliman says, “Getting Botox over time will not make your muscles sag. Since I’ve watched thousands of patients get Botox over the course of 25 years, I can say this with certainty. Some people have muscles that are very relaxed and they don’t frown very much or wrinkle their forehead. When you get Botox you relax the facial muscles, so you have less facial expression—like someone with a naturally un-wrinkling forehead. You don’t need to supplement Botox with micro-current or acupuncture. Sometimes people have deep lines and we need to supplement Botox with facial filler, since the lines are etched into the face. In these cases, Botox alone is not enough to totally get rid of the lines.”

What About The Dreaded Droopy Eyelid?

“A droopy eyelid can occur any time that Botox is injected,” says Dr. Martin. “It occurs less frequently with skilled injectors, but it can happen. It does not occur from hitting a nerve, but from the diffusion of the neuromodulator into the upper eyelid muscle which lifts up the eyelid.  We think that this occurs when Botox is injected into the forehead, close to the brow. It can then track down into the upper lid.  Prolonged use of the Botox is not going to cause this. And while you may get some atrophy, once you stop using the Botox the muscles come back.”

READ MORE

Our Founder Robin Shobin on why Botox shaming needs to stop.
Plus, the many risks of cheap Botox (you definitely get what you pay for).

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