Can i be resistant to botox

If the body does in fact develop antibodies, the patient will not see as dramatic of a result — or any result at all. Frank says. Unfortunately, the only way to tell if you are producing antibodies is with visible evidence i. Biesman says. Most often, the patients who feel they are non-responders require treatment of a different dose or distribution.

Layke says. According to Dr. Instead, we age and our anatomy changes, which limits our ability to get the effect that we want. Every doctor we spoke to for this story agrees that there is no connection between injector technique and product storage and a lack of visible results. Biesman notes. Besides developing toxin-inhibiting antibodies, it is also possible for the body to naturally metabolize the toxin at a faster-than-normal rate.

Other toxins that are just as, if not more so effective are available. All of these foreign proteins are antigens and have the potential to induce an immune response. Antibodies blocking the pharmacological effects of the botulinum neurotoxin are termed neutralizing antibodies.

Most of the information concerning antibody formation relates to the therapeutic use of botulinum toxin, for which there is over 30 years of clinical experience. Based on the former the global incidence according to literature varies from 0. Much lower doses of botulinum toxin preparations are used in the aesthetic field, but as treatment indications require repeated injections, individuals may be at risk for immunologic reactions with possible formation of neutralizing antibodies and secondary treatment failure.

Several papers have reported neutralizing antibodies in this population. There are no published data on the prevalence of nonresponse in the aesthetic field, but as the indications and duration of treatment of botulinum toxin type A increase, likely so will reports of patients who fail therapy after initially responding well. To raise awareness of the possibility of neutralizing antibodies in secondary treatment failure, we report on five patients from our respective centers in whom secondary treatment failure occurred.

She received 6 U over three injection points in each orbicularis oculi, 5 U at one injection point in each corrugator muscle, 5 U at one injection point in the procerus, and a total of 6 U over three injection points in the frontalis muscle one central and two lateral Table 1.

A mild response was observed, which lasted 3 months. The patient was positive for neutralizing antibodies, although the titers were not very high. Case 2 concerns a year-old Caucasian woman who had been receiving botulinum toxin type A preparations for 2 years.

Within the next 4 weeks, she received 50 U over ten injection points in the platysmal bands with two further top-ups in the platysmal bands over the following month Table 2. At this time, no further therapy is planned.

The treatment effect lasted 5 months. In , the woman received a further U of onabotulinumtoxinA for hyperhidrosis and an additional 50 U over ten injection points in the frontalis muscle, four injection points in the corrugator muscles, one injection point in the procerus, and four injection points in each orbicularis oculi muscle.

The treatment effect was 2—3 months. In , she received a repeat treatment for hyperhidrosis with U of onabotulinumtoxinA with clinical effect lasting 2—3 months. The patient was considered a nonresponder, as the treatment effect was very weak and the sweating partially remained. The patient in the fourth case study was a year-old Caucasian woman who had received botulinum toxin type A for facial rejuvenation over a period of 8 years, starting in For the first 3 years, the duration of effect lasted 6—8 months.

However, after , treatment effects could not be observed after 3 months. The final case study involved a year-old European male. The initial duration of effect was 6 months. In , he received U in the same injection points with a duration of effect of only 2 months.

The patients in these case reports all developed secondary treatment failure and tested positive for neutralizing antibodies by the mouse phrenic nerve hemidiaphragm assay HDA , suggesting that the cause of the therapy failure was neutralizing antibodies to botulinum toxin type A. The factors that contribute to neutralizing antibody formation against botulinum toxin type A have not been well characterized.

The data that do exist relate to the use of the toxin for therapeutic indications and suggest that two factors, in particular, are important: protein load per effective dose and frequency of exposure. The results of several retrospective studies suggest that the association between higher protein exposure and increased risk of antibody formation holds true for botulinum toxins. In one retrospective study of patients with torticollis, eight of 76 patients Compared to nonresistant patients from the same cohort, these eight patients had received more frequent injections, had more top-up injections 2—3 weeks after an initial injection, and had received higher doses of botulinum toxin per treatment.

That neutralizing antibodies can directly cause resistance has been shown in a case study in which a patient with severe dystonia, secondary resistance, and detectable neutralizing antibodies was treated with repeated plasma exchange and depletion of serum antibodies; subsequent treatment with the same botulinum toxin type was successful.

However, antibody titers required to cause resistance to botulinum toxin have not been defined, and immune responses can differ between patients. Thus, the formation of neutralizing antibodies may have no effect on treatment or may result in partial or complete clinical unresponsiveness to botulinum toxin type A. In addition to development of neutralizing antibodies, there are several other possible reasons for loss of response to botulinum neurotoxins, including misplaced toxin, suboptimal dosing, administration of toxin that has been denatured by improper storage or handling, and errors in reconstitution.

A declining clinical response to botulinum toxin over several injection sessions, as was the case in our case reports, should raise suspicion and trigger investigation into whether neutralizing antibodies are being produced.

This is important as, if resistance has developed, patients will not benefit from repeated toxin injections or from switching to another botulinum toxin type A product.

An antibody response may develop to any toxin-associated proteins, and studies are required to determine which are the most important. Laboratory screening tests such as enzyme-linked immunosorbent assay and fluorescence immunoassay are not able to distinguish between neutralizing and non-neutralizing antibodies. The only FDA-approved assay for the detection of neutralizing antibodies is the HDA, but few laboratories are equipped to perform this test.

Furthermore, the HDA may result in detection of subclinical antibody titers that do not result in treatment failure. Promising new assay methods are appearing, 23 and should be pursued so that physicians have access to a test that is simple, fast, and economical. Given the limitations of botulinum toxin antibody testing to date, it is likely that the true incidence of secondary resistance to botulinum toxin preparations is significantly underestimated. This is compounded by the fact that few aesthetic clinicians, particularly non-physician injectors, are familiar with the problem of neutralizing antibodies and will continue to treat with a higher dose or by switching to another therapy.

Our report shows that secondary treatment failure can occur with botulinum toxin type A for aesthetic treatment in routine clinical practice. Limited information is available on whether neutralizing antibodies resolve over time and, consequently, whether attempts at reinjection should be made after a prolonged period. These differences can make one product or the other a superior choice for some patients.

After discussing your medical history and treatment goals, we can recommend either Botox or Dysport. Many patients can achieve stunning results using either product. Since its formulation is different than Botox, you may respond to it differently. Come see us to talk about your options. Remember, Botox immunity is rare and only affects a small percentage of the population. As one of the top plastic surgery practices in North Carolina, we offer many surgical and non-surgical procedures to enhance and beautify your natural appearance.

These treatments can also complement your Botox or Dysport treatments. Immune to Botox? Try Dysport instead. Some say it resembles the appearance of cottage cheese. Others say it looks more like the texture of an Anyone can develop saggy skin.

In some cases, significant weight loss can lead to loose flaps of skin. Have you chosen to take the valuable self-improvement to avoid swelling after rhinoplasty? You have reason to be proud What is Dysport? Botox and Dysport share many similarities including: Both products relax muscles that cause active or dynamic wrinkles. Both Botox and Dysport are injectables and require a series of injections to the treatment area.

Both have been used for years.