Botox Immunity:

Can I become immune to Botox or Dysport?

Immunogenicity (developing immunity) to BoTN does occur, but it is very rare. If treatment is not working, it is first important to ensure that your dosage was high enough and that treatment was performed correctly. Those who do not see an effect of treatment are either classified as primary non-responders (PNR) or secondary non-responders (SNR). PNR patients are those who have never experienced good results, with under a 25% improvement at their first treatment. SNR patients are those who used to experience results but no longer do in at least 2 repeated treatments.

Since BoTN is a foreign substance, the body can develop antibodies to resist it. The body may form antibodies against the core neurotoxin itself or against accessory components of the medication. Not all patients who develop antibodies stop responding, and not all patients who stop responding have antibodies, but they can cause a lack of response. Approximately 3.5% of those who do see response to treatment have antibodies, and 53.5% of patients with SNR have antibodies. Most who develop SNR at first see a loss of effect and slowly progress toward no effect over the next 2 to 3 treatments (Bellows & Jankovic, 2019).

As per package inserts, 1.5% of cosmetic Botox (2023) patients developed binding antibodies, while only .19% of cosmetic Dysport (2023) patients developed binding antibodies in trials. Neither company had any patients that developed neutralizing antibodies in trials. Binding antibodies are able to attach to the protein in BoTN and may or may not have an impact on its effect while neutralizing antibodies would render treatment ineffective. The reported rate of actual neutralizing antibody formation and complete resistance in cosmetic patients appears to be under 1% (Choudhury et al., 2021). As per Bellows & Jankovic (2019), multiple studies were unable to find any antibody formation in cosmetic patients, including a pooled analysis of 1968 patients over a 13 to 17-month period. It appears that the rate of immunogenicity increases with the amount of product used at each treatment, and it is generally believed that a shorter time between treatments also contributes (Truong et al., 2023; Bellows & Jankovic, 2019).

What happens if a patient develops immunity?

If a patient does develop immunity, there are still options. As noted previously, Xeomin lacks the non-active proteins found in other formulations. Multiple studies have shown that many patients who have developed resistance to other formulations found success with switching to Xeomin (Bellows & Jankovic, 2019). This is likely because many patients have developed antibodies to the non-complexing proteins found in other brands rather than the BoTN itself. Original formulations of Botox, which contained more complex proteins, led to up to 17% resistance in patients being treated for cervical dystonia, further indicating that this may be the case (Shtefan et al., 2022). A study by Wanitphakdeedecha et al. (2020) found that 30% of non-responders responded to treatment with Xeomin. Antibodies also drop with time, so a long break could allow non-responders to return to treatment in the future (Shtefan et al., 2022).

At Allure Aesthetics, we have only encountered non-responsiveness once. In that particular case, the individual had already developed immunity before seeking treatment with us, and they had a long history of autoimmune issues.

Overall, the concerns about atrophy and immunogenicity lead to the same recommendations—only use as much as you need and wait for the treatment to wear off before being retreated. If these guidelines are followed, the risk should be low, and you should have more natural-looking, cost-effective results

Neuromodulator/Neurotoxin Treatments at Allure Aesthetics

At Allure Aesthetics, we offer a range of advanced neuromodulation treatments, including Botox, Dysport, and Xeomin. In some cases, we may also use Jeuveau and Daxxify. While we provide several options, Dysport is our top recommendation. Backed by both reliable research and our extensive experience treating thousands of clients, Dysport delivers faster results, longer-lasting effects, and a natural, refreshed appearance at a reasonable cost.

Whether you’re looking to smooth fine lines, enhance your confidence, or achieve a more youthful look, we’re here to help you feel as beautiful as you deserve. Our personalized, non-surgical treatments are designed to bring out the best version of you.

For more information about our services and how we can tailor them to your goals, please email us at [email protected] or book your appointment directly with us here!

References

AbbVie. (2023, November). Botox. Prescribing information. http://www.allergan.com/assets/pdf/botox_cosmetic_pi.pdf

Bellows, S., & Jankovic, J. (2019). Immunogenicity associated with botulinum toxin treatment. Toxins, 11(9). https://doi.org/10.3390/toxins11090491

Choudhury, S., Baker, M. R., Chatterjee, S., & Kumar, H. (2021). Botulinum toxin: An update on pharmacology and newer products in development. Toxins, 13(1). https://doi.org/10.3390/toxins13010058

Galderma. (2023). Dysport. Prescribing information. Dysport. https://www.dysportusa.com/PI

Shtefan, V., Fletcher, J., & Duclos, O. A. (2022). Causes of botulinum toxin treatment failure. Clinical, Cosmetic and Investigational Dermatology, 15, 1045–1049. https://doi.org/10.2147/CCID.S363321

Truong, D., Dressler, D., Hallett, M., Zachary, C., & Pathak, M. (2023). Manual of botulinum toxin therapy (3rd ed.). Cambridge University Press.