What to do when the ‘miracle toxin’ starts to lose its magic on you

November 27, 2024 | 12:00am

HANOI — When it comes to cosmetic surgery, Gen Z is making its mark on the industry in a big way.

From rhinoplasties and lip fillers to botulinum toxin injections (BoNT-A), these 20-somethings would try just about anything in the name of self-love and confidence-building.

“For this demographic, getting a minimally invasive procedure is as common as having their nails done, or buying their favorite lippies,” observes Dr. Niam Corduff, a renowned plastic surgeon from Australia.

But unlike my generation (Gen X) which turned to plastic surgery later in life, Gen Zs are already seeking treatments for wrinkles — that don’t even exist yet.

While the lady doctor sees nothing wrong with Gen Zs getting botulinum toxin injections as a preventive treatment, she expressed concern about its repercussions later on.

“BoNT-A injections are generally safe,” she says. However, she adds that prolonged use at such a young age — and in heavy doses — can lead to a condition called botulinum toxin immunoresistance.

“This happens when a patient does not respond well to treatment anymore because he/she has already developed natural antibodies due to constant use — and abuse — of the substance,” explains Dr. Michael Mar

tin, a retired professor of Immunology from Justus Liebig University in Germany.

 

The ugly truth

Dr. Corduff and Dr. Martin were part of the interdisciplinary panel, Aesthetic Council for Ethical Use of Neurotoxin Delivery (ASCEND), who shared results from recent surveys conducted with consumers and healthcare providers on BoNT-A treatments, at a press conference in Hanoi, Vietnam.

Commissioned by Merz Aesthetics, a driver of innovation in the field of aesthetic medicine, the surveys reveal critical insights and challenges associated with BoNT-A treatment.

While I haven’t tried getting a BoNT-A injection, there are patients younger than me who are already developing immunity from the substance due to constant use.

“And these patients get anxious and frustrated because of the declining results,” shares Dr. Siew Tuck Wah, founder and medical director of Radium Medical Aesthetics in Singapore.

It’s similar to what regular coffee drinkers experience. When the caffeine doesn’t kick anymore, they will consume more cups or switch to stronger variants just to stay alert and functional.

And that’s when the problem starts.

When too much is enough

Botulinum toxin has many therapeutic and cosmetic applications. Aside from smoothing fine lines and wrinkles, it is also used to treat stroke patients, kids who were born with spasticity (abnormal muscle tightness).chronic migraines, hyperhidrosis (excessive sweating), even erectile dysfunction.

“Patients with these kinds of medical conditions require regular and higher doses of BoNT-A shots,” notes Dr. Corduff. “Some get cosmetic procedures, at the same time using off-label treatments (products that aren’t approved by the regulatory board) from a different doctor.”

For a certain number of them, BoNT-A will stop working. And they’ll be in very big trouble.

“BoNT-A immunoresistance can reduce the efficacy of treatments and render patients unsuitable for future aesthetic and therapeutic BoNT-A treatments,” warns Dr. Corduff.

Know the facts

So, what are the factors that increase one’s risk of BoNT-A immunoresistance?

Based on the “Real-world impact of declining BoNT-A treatment effects and immunoresistance” survey, factors include:

• Getting treatments at a very young age. Although BoNT-A is approved by the FDA for use in people 18 and older, getting exposed to the drug early on — when there’s even no visible sign of wrinkles yet — can increase the body’s immunological response, causing antibodies to be produced more quickly.

• Frequent or high doses. BoNT-A immunoresistance also happens when you receive frequent or high doses. “Again, BoNT-A is used for medical, and aesthetic procedures,” explains Dr. Corduff. “Those who have medical problems go to a specialist (neurologist or cardiologist). These patients have good medical records because they are monitored.”

Aesthetic patients are different. “They are calling the shots. When they feel that they are not getting the results they want, they will switch doctors or demand higher doses. Some even opt for off-label treatments (not approved by regulating bodies) which are cheaper,” laments Dr. Corduff.

And that’s why initial consultation with an aesthetic expert is important as it serves as “a vital opportunity for healthcare providers to educate patients on  BoNT-A immunoresistance as a potential side effect, particularly given the heightened risk associated with repeated high-dose treatments.”

• Incorrect administration. Inexperienced practitioners may use the wrong injection technique, the wrong dosage, or an excessive amount of dilution.

• Using traditional toxins. Not all BoNT-A brands are created equal. Traditional toxins have impurities and unnecessary components in BoNT-A formulations that can increase the risk of BoNT-A immunoresistance. That’s why plastic surgeons and dermatologists are shifting to Xeomin, the only pure BoNT-A available in the market today.

Manufactured by Merz Aesthetics, Xeomin contains no impurities. This means that the risk of developing neutralizing antibodies, which may result in secondary treatment failure, is reduced or totally eliminated.

“Choosing a pure BoNT-A formulation right from the start of your beauty journey is crucial to minimizing the risk of developing BoNT-A immunoresistance,” Dr. Corduff points out.

If and when I finally decide to get my BoNT-A shot, I know that pure (toxin) is best.