Are we immune to Botox? What’s behind the loss of effect that worries experts

The arrival of botulinum toxin for aesthetic purposes in Spain is 20 years old and it seems that time is also passing by. More and more patients complain that the effect of Botox lasts less, something that bothers doctors. The duration of this medication, popularly known by the trade name Botox, can be influenced by many factors, including the characteristics of each patient, the technique or the hands that inject this precious and popularized elixir. In a recent study published in the journal of the Spanish Society of Aesthetic Medicine (SEME) – ‘Botulinum toxin. Why does it last less? A review from our experience’ -, two experts in the field have analyzed the scientific evidence and their own experience to determine what is happening with this treatment, the most used in aesthetic medicine at the moment. Related News standard No Botox and hyaluronic acid, the aesthetic medicine treatments that are most in demand in Spain Araceli Nicolás standard Yes ‘Botox’ arrives that lasts twice as long Nuria Ramírez de Castro The authors highlight that, as the toxin is a protein, it has the capacity Immunogenic resistance can develop, meaning patients can become immune to Botox. However, “non-immunogenic causes are more decisive in the loss of effect,” says Dr. Justo M. Alcolea, co-author of the study and editor-coordinator of the journal Medicina Estética (SEME) and medical director of Clínica Alcolea. Currently there are four toxins authorized in Spain for aesthetic applications and all are type A (TB-A), but at the beginning there was only one approved and it was used for both therapeutic and aesthetic treatment. For Carmen Lorente, director of the aesthetic medicine area at The Beauty Concept (TBC), there is not so much a loss of effect but rather that less is applied than before, which causes those touch-ups to dissolve sooner. «My opinion is that right now they are not using the neuromodulators that were used before. “Patients ask for naturalness, so now the trend is to put a smaller amount, which is kinder,” explains the expert, although Alcolea does not agree with her on this. More than the quantities used, it seems that the problem lies in the non-immunogenic causes. Specifically in those that refer to the characteristics of the patient such as age, sex, his gesticulation and even the month of the year in which it is applied. In addition, how the toxin is reconstructed, the technique used and the wait between one injection and another also influence. Factors inherent to the patient The duration of botulinum toxin is longer in women than in men, who tend to have more developed muscles than women, so they may be undertreated. Regarding age, two aspects must be highlighted. Several toxins are approved for use in people under 65 years of age and this limit is not respected in many cases. And this is important because strength and muscle mass decline with age. Therefore, younger patients need a larger amount to notice the effect. It must be taken into account that treatment with botulinum toxin is recommended for hypertonic people, those who gesticulate constantly and in a way not linked to emotional expression. “Now we do a lot of sports and physical exercise puts a strain on these neuroregulators because you contract the muscles more and they wear out sooner” Carmen Lorente According to Lorente, they can also influence stress, which has increased in the population in recent years, and the physical exercise. “Now we do a lot of sports and physical exercise puts a strain on these neuroregulators because you contract your muscles more and they wear out sooner,” she points out. However, Alcolea considers that this can occur whenever we talk about a very high intensity and frequency of exercise, but it is not decisive. What is certified in the study is that stress in the patient induces a shorter duration of the Botox effect because the facial muscles contract for a longer time. Additionally, we must take into account the time of year in which we perform the treatment because heat and prolonged sun exposure can shorten the effect of this treatment. Application by the doctor It should be noted that aesthetic treatment with Botox is something that only a doctor can perform because its application has to be very precise. The first factor to take into account is the reconstruction of the toxin. The way this process is done (which involves mixing a powder with saline) can help preserve potency and prolong the duration of the effect. According to the study, rough manipulations at this point can cause a loss of effectiveness of 42%. The technique used is also key because both speed and pressure, the type of syringe, the position of the bevel and the size of the needle can influence. “There is no way to end intrusion despite the efforts” Justo M. Alcolea For all this, the two experts consulted by ABC focus on being extremely careful with the hands that are going to treat us. «Now there are many places where a patient can have the toxin applied and it can be purchased through the web. Nobody knows where, how they are manufactured or what guarantees they have. And of course the personal doctor who is injecting it is not the right one. And there is no way to end the intrusion despite the efforts,” Alcolea denounces. «You have to be super careful. Technique is essential. A well-placed neuromodulator is the most difficult job we do. Only practice makes you sense the end of the treatment and what is important is the precision of both the product used and that of the doctor,” says Lorente. Frequency Finally, it should be noted that the frequency with which it is injected can increase the chances of the patient developing an immunity to Botox. «In some clinics it is now divided into three treatments and each month they treat one area. If injections are being performed without respecting the minimum time intervals, the chances of antibodies blocking the toxin increase. And they are selling it like that,” criticizes Alcolea. In this sense, doctors should try to ensure that interventions are carried out with a maximum time interval. “If we respect the intervals and inject the patient two sessions a year, I have not seen any problems of shorter duration,” explains the expert, among whose patients only a small proportion have detected a reduction in the effect of Botox.