Botox resistance is real ‒ and it’s growing

You may have heard patients say their anti-wrinkle injections don’t seem to work as well as they had before, or they need much more to get the same effect.

This is because anti-wrinkle injections resistance is real, according to three leading experts who discussed the growing problem at a seminar held by Merz Aesthetics in Sydney this month.

Professor Michael Martin,  a full time professor of immunology in Germany, Dr Jurgen Frevert, a global expert in the development of botulinum toxin products, and Dr Niamh Corduff, an Australian plastic surgeon who is an expert in non-surgical rejuvenation with a strong interest in the science of botulinum toxin, said there were several factors that could influence anti-wrinkle treatment longevity and effectiveness.

The trio, who led a panel discussion at the seminar, said that the use of botulinum toxin A as an anti-wrinkle treatment had increased dramatically since its arrival in the aesthetic medicine industry several decades ago, with Australians spending more than $1 billion on cosmetic treatments per year, one of the highest spends globally per capita.

However, they said many consumers were unaware there was potential for some botulinum toxins to stimulate an immune response as a result of unnecessary proteins, which remain in the product at the end of the manufacturing process.

“These unnecessary proteins in some formulations of botulinum toxin may mimic the mode of action of an adjuvant in a vaccine, which can have a higher potential to cause an immune response,” they said.

The consumer or patient effectively becomes “vaccinated” against the botulinum toxin or resistant to its effects.

“In one study conducted, 13.9 percent of patients had developed antibodies against the botulinum toxin with their ongoing treatment identified as a major risk factor,” they said.

The experts stressed the consequences of developing resistance to botulinum toxin, especially when it came to treating medical conditions.

“If a patient develops resistance to a toxin, future aesthetic treatments as well as therapeutic or medical treatments, may become ineffective, and the patients may have to wait more than five years to have botulinum toxin again,” they said.

“This could narrow the treatment options available to a therapeutic specialist, who may be treating conditions including; musculoskeletal disorders, blepharospasm or spasticity after a stroke.

“As a result of the formed resistance, the patient may respond sub-optimally to treatments, which may affect the ability to relieve symptoms and improve their quality of life.”

The panel said the three anti-wrinkle treatments currently on the market [Botox, Dysport and Xeomin] all had different compositions and manufacturing processes.

Dr Frevert said he had spent years producing a new generation botulinum toxin with Merz Aesthetics.

He said he had created a purified product for both aesthetic and therapeutic indications to ensure the toxin would be effective for repeated treatments over an extended duration of time.

The panel reiterated it was important for consumers to understand what options were legally available in Australia and to request the products and procedures that best suited them.

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