Botulinum toxin type A (BoNT-A) has been used since the 1970s,1
and these anti-wrinkle injections are one of the most popular
cosmetic treatments in the world.2
With estimates of nearly seven
million injections per year globally,3
it’s no wonder that the discussion
surrounding BoNT-A resistance and concerns of its effectiveness,
have become more prevalent. The issue of antibody-induced
treatment failure is well-known in the therapeutic setting, but with more
use cosmetically we are seeing more reports of resistance.4,5 At the
time of writing, I have just had my first experience with a patient who
seemed to be resistant to all FDA approved toxin brands, which were
tried with no effect.
Firstly, to understand how/why resistance happens we must
understand how botulinum toxin works. BoNT is composed of a core
neurotoxic protein and nontoxic accessory proteins (NAPS) that have
a light chain…
