Meet Botox Alternatives From Topical Ointments to Surgery

When Botox Isn't Right for You

Whether you’re one of those rare people who has developed an “immunity” to Botox, you’re getting tired of facing the needle every three months to maintain your results, or if you just don’t like the idea of regularly injecting poison into your face, you may wonder what alternatives you have for keeping your face youthfully smooth. So just what is a Botox-resistant person with stubborn frown lines to do?

Woman getting Botox alternative facial injection
Win McNamee / Getty Images

Topical Preparations: Safer Alternatives or Snake Oil?

We’ve all seen the ads announcing the newest miracle serum that is supposed to be “Better Than Botox.” Often, there is a side-by-side before and after picture accompanying the ad, and the results depicted are nothing less than astonishing. If you were to believe your eyes, you would think that these magical elixirs could erase twenty years in a matter of minutes. But don’t be fooled. In the corner, in tiny, light-colored print, appear the words “photo dramatization." Even more insidious are some of the “real” photos—the ones that show only a close-up of an eye. What they don’t show is that in the before photo, the person is smiling (which makes the crows feet show up). In the after photo, no smile means no crinkling around the eyes. If you look really closely, you’ll notice the difference.

Though some of these products do seem to deliver a certain measure of very temporary results, they can in no way be compared to the results achieved with Botox injections or with surgery. If they could, wouldn’t we all be using them? The real kicker is that most of these products cost almost as much as the real thing. If it sounds too good to be true, it probably is. Most doctors worth their salt will tell you to save your money and skip the lotions and potions.

Myobloc (Botulinum Toxin Type B)

It seems that some doctors who are aware of the problem are offering Botox-resistant patients another option in the form of botulinum toxin type B (which is sold under the brand name Myobloc). This form of the botulism toxin has proven effective in patients suffering from cervical dystonia (a painful neuromuscular condition affecting the head and neck), pediatric urinary incontinence, migraine headaches, and other medical problems – even in patients who have developed resistance to botulinum type A (Botox). Although it is not approved for cosmetic use, some doctors do offer this off-label use as an alternative for Botox-resistant patients.

Besides its non-approved status, one concern is this: For Botox-resistant patients, what’s the likelihood that they will develop antibodies to other types of the toxin? The same type of toxin-blocking antibodies which are responsible for Botox-resistance have shown up in patients participating in clinical studies with Myobloc. However, no studies have been done on the off-label cosmetic use, which uses much smaller doses than are used to treat patients with cervical dystonia (the only condition for which the use of Myobloc is currently approved). The only answer anyone seems to have at this point is that it could certainly happen, but the use of careful (minimal) dosing may be able to prolong its usefulness in cosmetic patients.

Dysport (Abobotulinumtoxin A)

Like Botox, Dysport is a neuromodulator, which means that it blocks a nerve. And while the two work the same, they are different at a molecular level. The molecule of Dysport is smaller than that of Botox, and as a result, tends to spread away from the injection site. This spread appears to be more of an issue when larger volumes of the product are used, especially in the forehead. Excess spread here can lead to a heavy eyebrow temporarily. Because of this, it may be paired with Botox or another filler to corral it and prevent the risk of spreading and weakening the forehead.

Collagen (Bellafil)

Another popular filler is inspired by our own skin: collagen. This semi-permanent filler tends to be a mixture of collagen and PMMA microspheres. Polymethylmethacrylate beads, or PMMA microspheres, are not absorbed by the body though they are made from cow or bovine collagen. The results may last five years and are usually used for acne scars.

Snip the Muscle

One more invasive (surgical) option is available for those who would use Botox solely for the vertical frown lines which appear between the brows. The procedure is called a corrugator myectomy or corrugator excision. The basic idea is to surgically disable (either by cutting or completely removing) the muscle that draws the eyebrows down and together, rendering it unable to create those pesky lines in the first place. In a less extreme approach, corrugator myotomy, the muscle is merely cut into, not removed (which results in a decrease in furrowing of the brow, as opposed to total elimination of furrowing).

Of course, some risks come with this procedure, including a decrease in sensation in a small area of the forehead, and a cosmetically undesirable depression in between the brows which may need to be filled with some sort of dermal filler. In addition, some doctors warn against this procedure, saying that it can result in the face taking on an exaggerated, artificial, perpetually “surprised” look. Patients should also be aware that unless the corrugator muscle is completely removed during the procedure, the results may not be permanent.

Surgical Procedures

If none of the above options appeal to you, you may wish to consider a facelift, brow lift, eye lift, and/or laser resurfacing combined with injectable dermal fillers. Although these procedures will not address the repeated facial movements that cause expression lines to appear, they can help significantly with their appearance.

Next Steps

We've shared what's out there about alternatives to Botox, but the elephant in the room is whether you really wish to have plastic surgery or not. Take a moment, step back, and consider these 10 things you should know before having any plastic surgery. In addition, take a good look at your diet and exercise plans. Some of the time eating healthy and exercising your facial muscles may be enough, but a healthy diet is even more important as part of the healing process should you have a procedure performed. Plus, it's likely to last longer if your cells receive the nourishment they need. As a final note, try to get those nutrients through food rather than supplements whenever possible as some herbal supplements and plastic surgery may not mix.

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  • Pao, K., and R. Mancini. Nonsurgical Periocular Rejuvenation: Advanced Cosmetic Uses of Neuromodulators and Fillers. Current Opinion in Othalmology. 2014. 25(5):461-9.