Inside Aesthetics Ep 176 The Tox Talks (Chapter 3): Toxin resistance | Dr Stefania Roberts & Dr Niamh Corduff
Episode 176 hosts Dr Stephania Roberts (Phlebologist & Cosmetic Physician from Melbourne, Australia) & Dr Niamh Corduff (Plastic Surgeon from Geelong, Australia)
In this mini series 'The Tox Talks', we feature expert injectors who have significant experience in using botulinum toxin. These episodes explore our guests experiences using particular brands, the evolution of their injecting techniques and we get special insights into the subtle nuances of getting the best our of toxins.
In chapter 8 we discuss the poorly understood topic of toxin resistance. In what was one of our most engaging podcasts to date, our expert guests debated the topic and we covered:
- What we mean by 'resistance'?
- Whether there's a difference between being resistant and being a 'non-responder'?
- What's a primary non-responder vs secondary non-responder?
- The incidence of toxin resistance - and the difficulty in quoting this rate
- The main steps in how Botox (Allergan brand) is manufactured and why this is relevant to the topic
- How this differs from the manufacture of Xeomin (Merz brand)
- Accessory proteins and their role in the body's immune response
- Neutralising antibodies vs non-neutralising antibodies
- Does a higher dose create a higher risk of resistance
- If so, what do we mean by 'high' dose?
- The role of dose frequency and risk of resistance
- What steps an injector should go through to review a patient complaining that their toxin 'didn't work'
- How to explain a less than satisfactory toxin outcome to to a patient
- Should you swap your patient to a different brand of toxin if you don't see results?
- The phenomenon of post-lockdown 'failed' toxin treatments globally - was this real or just perceived?
- What tests can you do for a true primary non-responder and whether these are practical in an every day injectors clinic
00:00 Introduction 01:03 Meet our Guests: Dr Stefania Roberts & Dr Niamh Corduff 04:55 What Toxin Resistance Actually Means 10:59 Primary Versus Secondary Non Responders 18:27 How Common Resistance Really Is 26:25 Role of Antibodies and Immune Response 33:29 Differences Between Toxin Formulations 41:37 Protein Load and Why It Matters 48:53 Dose, Frequency and Long Term Risk Factors 52:09 High Dose Treatments and Therapeutic Use 61:45 Real World Incidence in Clinical Practice 68:49 Managing Patients When Toxin Seems to Fail 76:38 Importance of Technique, Records and Follow Up 80:09 Patient Expectations and Communication 86:34 Preventing Resistance Through Smart Treatment Planning 90:43 Key Takeaways for Safe Long Term Toxin Use