The botulinum therapy procedure has been the most popular cosmetic procedure for a long time. This injection technique helps to quickly, effectively and safely eliminate mimic wrinkles, and achieve a pronounced effect of rejuvenation. However, specialists in aesthetic medicine in their practice sometimes have to deal with a situation where the patient has insensitivity to botulinum toxin. And if neither the patient nor the doctor sees the result after the – therapy is considered ineffective. Why can insensitivity to botulinum toxin develop, what it is and how it manifests itself – read today's article.
Why does it happen and what is insensitivity to botulinum toxin
Insensitivity to botulinum toxin, in its essence, is an indicator of the ineffectiveness of the botulinum therapy performed.
Treatment failure can be defined as a situation in which a given expected effect is not observed by either the patient, or the doctor, or both.
Treatment failure may be primary if the patient has not previously been treated with botulinum toxin to treat and correct aesthetic deficiencies, and secondary if the patient has already been treated or corrected for aesthetic deficiencies with botulinum toxin and this therapy has been effective . Treatment failure can also be partial or complete, temporary or long-term, subjective or objective.
Insensitivity to botulinum toxin:
- how is the assessment of the ineffectiveness of the therapy carried out;
- theories of the occurrence of primary insensitivity to botulinum toxin;
- clinical signs of secondary botulinum toxin insensitivity.
How is treatment failure assessed
In order to identify insensitivity to botulinum toxin, first of all, it is necessary to assess the ineffectiveness of the therapy. This rating is based on:
- History: it is very important to take a complete history before the procedure, as the processes occurring in the body can play an important role in the effectiveness of the procedures performed;
- clinical study: if the doctor suspects the presence of other diseases – aesthetic procedures may be contraindicated for the patient;
- video documentation: when performing injections into mimic active zones, it is very difficult to evaluate the result without video documentation;
- assessment of the clinical picture on various self-assessment scales;
- testing for the presence of antibodies to botulinum toxin;
- electromyographic testing of the action of botulinum toxin on the sternocleidomastoid muscle (GCS test).
Theories of the origin of primary insensitivity to botulinum toxin
At the moment, there is no unequivocal opinion regarding the cause of primary insensitivity to botulinum toxin. However, there are several theories that can be based on. Theoretically, the causes of primary insensitivity to botulinum toxin can be:
- previously performed prophylactic procedure, in which the patient was injected with botulinum toxoid as part of a complex vaccine for the prevention of anaerobic infections. Anatoxins – these are preparations obtained from bacterial exotoxins, completely devoid of their toxic properties, but retaining antigenic and immunogenic properties;
- previously transferred botulism in a subclinical form, that is, without the manifestation of certain symptoms;
- botulinum toxin is a zinc-dependent endoprotease (the effect of plasma zinc levels on the effectiveness of botulinum toxin has not been fully investigated);
- genetic anomaly of the receptor apparatus with which the heavy chain of botulinum toxin interacts.
At the moment, all these theories are not proven, and there are quite a lot of controversial issues regarding them.
The incidence of primary botulinum toxin insensitivity, according to various authors, is 0.1%.
Clinical signs of secondary botulinum toxin insensitivity
Secondary insensitivity to botulinum toxin has very important features of the clinical picture. Clinical signs of secondary treatment failure with botulinum toxin are:
- subjective complete lack of effect on two or more attempts to use botulinum toxin (complete secondary treatment failure);
- subjective partial failure prior to complete secondary failure (preceding partial subjective secondary therapy failure);
- no other reasons for objective or subjective treatment failure.
Secondary insensitivity to botulinum toxin, in its essence, is the result of addiction to the drug.
If secondary insensitivity is suspected:
- make sure that the injection points are correct, since after the injection of botulinum toxin, a change in muscle patterns occurs, and, with further injections, a reassessment of muscle activity is required;
- repeat the administration of the drug in the standard dose for this zone.
According to various authors, secondary insensitivity occurs in 0.8-3.6 percent of patients injected with botulinum toxin.
Insensitivity to botulinum toxin – this is an unpleasant situation, the result of which is the complete absence of the effect of the botulinum therapy procedure. And the more aesthetic medicine specialists know about it – the easier it will be for them to find a way out of this situation.
The article was prepared based on the report of a dermatologist, head of the training center "Academy for Professional Training of Beauty Industry Specialists", head of the clinic "Academy of Health and Beauty" Anna Gennadievna Funikova at the Congress on Plastic Surgery and Dermatocosmetology "Kolkhida 2017".
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