Recently, actress Jennifer Garner was quoted in an interview published in the fashion magazine Harper's Bazaar, saying that Botox "doesn't work well on her." Garner later revealed that this is actually the reason she tends to wear bangs, which conceal the fine lines on her forehead. She added that her doctors even advised her to avoid Botox injections, contrary to the clear trend among women around the world and in Israel. But is Botox really not suitable for everyone?
Let’s first explain what Botox is and how it works. Botox, or by its scientific name Botulinum Toxin Type A, is a toxin used to relax muscles and is derived from a bacterium called Clostridium botulinum. Although it is quite a potent toxin, in small and controlled doses, it has become over the years one of the most popular treatments in medicine. Its most common use today is in aesthetic medicine for reducing facial expression lines, but it also has a range of other medical applications, such as for excessive sweating, migraines, and more.
When the toxin is injected into a specific area, it works by temporarily blocking the nerve signal that instructs the muscle to contract. This causes the muscle to "relax" and stop contracting forcefully—reducing the appearance of wrinkles caused by excessive muscle activity. The effect of the treatment usually becomes noticeable within a few days, peaks about two weeks after injection, and lasts between three to six months.
The main advantage of Botox is the simplicity and speed of the procedure. It is a short treatment that does not require recovery time and is suitable for those seeking a subtle and refreshing change in facial appearance. However, it is important to emphasize that the success of the treatment depends on proper dosage, precise technique, and smart patient selection. When performed by a skilled physician, the result looks natural and not exaggerated or “frozen,” and the improvement blends harmoniously with the other facial features.
The statement "Botox doesn’t work on me" is heard from a small number of patients, but it is important to understand that it is usually the result of a combination of several factors related to the patient or the practitioner, and not necessarily a problem with the quality of the substance itself. Here are a few of those factors:
Botox resistance: This is a relatively rare phenomenon, but it does exist. In such cases, the body develops antibodies against the toxin, neutralizing its effect before it can impact the nervous system. This phenomenon may occur especially when treatments are given too frequently and in higher-than-normal doses. In such cases, switching to a different brand of toxin (among Botox, Dysport, or Xeomin) or taking a break from treatment may be required.
Imprecise injection technique: The accuracy of the injection technique is just as important as the substance itself. Injecting at the wrong depth, into tissue that is not an active muscle, or uneven distribution of the substance—all these can lead to an ineffective result. Receiving treatment from a doctor not sufficiently familiar with facial anatomy may result in muscles continuing to function as usual and wrinkles remaining visible.
Insufficient dosage: A dose that is too low will not effectively relax the muscle, leading the patient to feel that the Botox “didn’t work.” On the other hand, too high a dose can cause loss of expression, asymmetry, and even unwanted effects like eyelid drooping. In this context, it is worth mentioning the “Less is more” approach, which I implement in my clinic. According to this method, a relatively small amount of toxin is used initially and then increased later if necessary. This is an effective precaution against an excessive toxin effect, which cannot be dissolved (unlike hyaluronic acid) and whose impact only fades after several months.
Fast metabolism: Some people break down the toxin faster, or their muscles are less sensitive to Botox—likely due to genetic factors. In such cases, the effectiveness of the substance will wear off more quickly than expected and may barely be noticeable.
Unrealistic expectations: Some patients expect Botox to erase deep wrinkles that have developed over years due to sun exposure or collagen loss. This is not a realistic expectation, as Botox is intended only to treat expression lines. Static wrinkles require different treatment, such as hyaluronic acid fillers or laser treatments. When this distinction is not clear to the patient, they may feel disappointed—even if the toxin worked as intended.
Unique facial structure: A unique shape of the eyebrows, eyes, or cheeks requires a customized treatment plan, both in terms of injection points and dosage. Applying a standard treatment protocol for all patients can miss the target and reduce the effectiveness of the Botox.
In conclusion, when a patient feels that the Botox “doesn’t work,” it is important to consult an experienced doctor to examine the reason and adjust the treatment accordingly. Remember that treatment success depends not only on setting proper expectations with the patient but also on the approach, experience, and skill of the treating physician.
Dr. Inbal Sharon is a surgeon and aesthetic medicine doctor, Shva Clinic.