If you regularly get neuromodulator treatments (like Botox, Dysport, or Xeomin) and have noticed they seem slightly less effective, don't last quite as long, or require more frequent touch-ups, there may be a surprising reason. A new study has found that neuromodulator injections may be less effective in those who have received the COVID-19 vaccine. But before we go any further, we cannot stress this enough: This is no reason not to get vaccinated or boosted. 1. This study was small. 2. Most people will probably still find a neuromodulator that's effective. And above all 3. Forehead lines are always better than severe illness or death. Now we will continue and share everything we know so far about this phenomenon.
The goal of the study was to see if there was a potential influence from the BNT162b2 mRNA COVID-19 vaccine (that's a mouthful but translates to the Pfizer vaccine, which — like the Moderna vaccine — uses mRNA technology) on Botulinum toxin type A (BTA) injections. The study does not specify a brand of Botulinum type A injection so it could be any of the four brands that use BTA: Botox, Dysport, Xeomin, and Jeuveau. (Daxxify also uses BTA but is just now starting to roll out across the country so couldn't have been included here. )
This was a small study, only 45 subjects, with an average age of 48.3. The group was 89% female. The results found that the average time between Botox injections after a COVID vaccination was shorter than before — 96 days, compared to 118 (that's about three-and-a-half versus four months) — leading researchers to believe that Botox "might be less effective after COVID-19 vaccination."
"The last line is imperative here, as it includes the word 'might,'" says Mona Gohara, MD, a board-certified dermatologist in Hamden, Connecticut and associate clinical professor of dermatology at Yale School of Medicine. "The study raises an interesting possibility, but is not conclusive and calls for additional research."
Shari Marchbein, MD, a board-certified dermatologist in New York City and assistant professor at NYU School of Medicine, also points out that the study shouldn't be considered a definitive answer given its small size. "The most important thing is that it's a very small study and we must do larger studies, multi-center studies, multi-country studies," she explains. "The fact that there were only 45 people ... that's extremely small. I treat more patients than that in a week."
But Dr. Marchbein also shares that she has been noticing this phenomenon in some of her patients who use neuromodulators for awhile now. They have needed higher doses, or more frequent treatments, to see the same response they did before getting vaccinated against COVID, or having the virus itself (more on that in a minute). Patients who get injected "religiously" are calling her for more frequent touch-ups than ever before, though she hasn't changed the technique or number of units she's using on them. "And I have had two or three patients in the last year develop full antibodies against the neuromodulators — all four of them — which has never happened in my 15-year career," she says. "That means the neuromodulators just don't work at all. I treat thousands of patients a year so that's a very small number. But it's still two or three more than I've ever seen before." She goes on to add, "developing full antibodies against one of the neuromodulators is rare but not unheard of. Personally, I stopped responding to Botox many years ago — but I use Dysport and it's fine. Someone not responding to any of the formulas is very, very surprising."
Doctors don't know for sure why some neuromodulator users may be experiencing this, but they have theories. "The mechanism may be that the immune response from the vaccine somehow blunts the efficacy of the neuromodulator," shares Dr. Gohara. "Vaccines create a robust immune response, and robust immune responses could possibly affect neuromodulator treatments one way or another. There may be a link, but to say that definitively needs more data." And Dr. Marchbein adds that it's also important to remember that of course actually having the COVID virus creates an immune response as well. "This study didn't comment on how many of the subjects had also had COVID and when, which could also absolutely give the same response."
Does the study change dermatologists' opinions about the vaccine itself, or neuromodulators in the era of COVID vaccines? Absolutely not. "It doesn't make me feel differently about anything," says Dr. Marchbein. "Neuromodulators are extraordinarily safe and very, very effective, and the COVID vaccines are proven to be very safe and very effective. I would take a vaccine any day over having a severe illness or death." Dr. Marchbein again cites the small subject group in the study, but says she thinks there will be more to follow. "I would love to see studies that take a large group of patients who have failed to respond to neuromodulators or needed higher doses and look at who was vaccinated, who had COVID, and what the timeline was," she says. "This is an interesting study and a good first step in trying to figure this out, because many dermatologists have been talking about it. Those of us who do a high level of cosmetic procedures have seen this firsthand… If your Botox doesn't work as well, this could be why."
More studies and innovations to note:
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Now, watch a dermatologist's entire routine from AM to PM:
