Neuromodulators – Should Resistance be a Concern?
As a physician assistant at Advanced Dermatology, I frequently encounter questions from new patients about neuromodulators such as BOTOX®, Dysport®, Xeomin®, and Daxxify®. One of the most common concerns is whether long-term use of these treatments could lead to resistance, making the results less effective over time. Let me reassure you: resistance to neuromodulators is extremely rare and typically not a concern for most patients; and is overhyped on social media.
Neuromodulators work by temporarily relaxing the targeted muscles that cause dynamic wrinkles, such as frown lines, crow’s feet, and forehead lines. These treatments have been used for decades with an excellent safety profile, and the vast majority of patients continue to experience consistent results over the years. Resistance, when it does occur, is usually
linked to the development of antibodies against the active ingredient, which can occasionally happen with frequent, high-dose treatments.
To minimize this risk, our approach is to “treat to complete.” This means administering the correct dosage to achieve full correction during each session, allowing the results to last as intended—typically three to four months, depending on the neuromodulator used and individual factors. When patients receive proper dosing, they need fewer touch-ups, reducing the likelihood of over-treatment and ensuring the best long-term results.
It’s important to note that resistance if it does happen, is extremely rare. In those situations, I work closely with that patient to determine if there might be another explanation, such as natural variations in anatomy, metabolism, or the type of product used.
One of the advantages of having multiple neuromodulators available—such as BOTOX®, Dysport®, Xeomin®, and Daxxify®—is that we can tailor the treatment to each patient. For example, Xeomin® is a “naked” version of botulinum toxin that lacks the accessory proteins found in other brands, making it a good option for patients who may be concerned about antibody formation. Dysport®, on the other hand, is known for its quicker onset, while Daxxify® offers the potential for longer-lasting results. This variety allows us to switch to a different product if needed, ensuring patients continue to achieve their aesthetic goals.
Ultimately, neuromodulator treatments are incredibly effective and reliable for the vast majority of patients. The key is working with an experienced provider who understands the nuances of each product and tailors the approach to your individual needs.