What is ‘Botox resistance’ and how common is it?

Let’s have a quick chemistry lesson. Botox, Dysport and Xeomin are all neuromodulators (neurotoxins) that inhibit a neurotransmitter that relays nerve signals to muscles. Injecting them with Botox and the like results in a temporary paralysis which stops them contracting and forming wrinkles. As it gradually wears off, the muscles return to normal.

The effectiveness in wrinkle-reduction lies in where the neuromodulator is placed and how much of it is used so you need a highly skilled practitioner to get the dosing and placement just right. The effects of neuromodulators start between two and seven days post-injection and typically last three to four months.

Botox-resistance can occur when a patient either doesn’t respond to the injections or gets less than their three to four months longevity. According to Sydney cosmetic physician Dr Joseph Hkeik, “Botox resistance is extremely rare but can happen when the body develops neutralising antibodies.” These antibodies can develop over time in response to the botulism toxin or the supporting proteins in the formulas. New York based Dr Ramtin Kassir says, “In my practice, I’ve done hundreds of thousands of Botox injections and Botox resistance is extremely rare. I’ve maybe seen it one or two times in the last almost 30 years.”

Rule of thumb: don’t overdose by running back for more before the three-to-four-month period is up, and always seek out a highly qualified injector as they play a pivotal role in how your muscles respond to any neurotoxin. They are the ones determining product placement and dosing, and this really is an art form.

If you feel you are gaining resistance, talk to your practitioner about the possibility of changing your neuromodulator. For instance, Xeomin has the least number of proteins in its formula and therefore the least opportunity for “potential” resistance. After your initial injections, wait at least until the three-month mark to give your facial muscles the chance to get some movement back.

If, for some reason, you have stopped responding to any brand of neuromodulator (and remember, this is incredibly rare), you may be a “nonresponder”. So, take a six-to-18 month break from injections and let your body clear itself of any neutralising antibodies that you may have developed.

Also, keep an eye out for new neuromodulators that are in the process of being developed. RelabotulinumtoxinA is currently being developed by the pharmaceutical company Galderma. Trials show results of quicker onset and the possibility of greater longevity, and it also doesn’t contain the proteins that may cause resistance to develop. Watch out for the newcomer Daxxify (daxibotulinumtoxinA) from Revance Aesthetics, which may last for as long as six to nine months. It also is the first injectable neurotoxin formulated with a novel peptide as a stabiliser, so it does not contain animal byproducts.

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