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AMM 208: BoNT Dosage: Avoid Resistance for Sculpted Confidence
September 21, 2024
This episode delves into the complexities of botulinum neurotoxin (BoNT) dosages in aesthetic medicine, focusing on the risks associated with higher doses and the potential for developing resistance. The discussion covers the difference in dosages between aesthetic and therapeutic uses, the relevance of immunogenicity, and strategies to mitigate risks, such as opting for purer forms of the toxin like incobotulinum toxin A (incoBoNT-A). Emphasis is placed on the importance of minimal effective dosing and thorough record-keeping to maintain the longevity and efficacy of BoNT treatments, helping healthcare providers and patients stay informed and achieve optimal outcomes.
Quick Takes
- Higher doses of botulinum neurotoxin (BoNT) in aesthetic medicine can lead to both local and systemic side effects, increasing the risk of resistance development.
- The increased dosages of BoNT can make treatments less effective over time, with aesthetic procedures like calf slimming sometimes requiring doses up to 720 units or more.
- Using purified forms of BoNT, such as incobotulinum toxin A (incoBoNT-A), can reduce the risk of an immune response and mitigate resistance development, but it’s crucial to minimize dosage and frequency for optimal results.
Episode Transcript
Today is September 21, 2024, and let’s talk about the intricacies of botulinum neurotoxin (BoNT) dosages in aesthetic medicine. As aesthetic applications of BoNT expand, some patients now receive higher doses typically reserved for therapeutic treatments. This can potentially lead to both local and systemic side effects, and most critically, increase the risk of developing resistance.
What exactly does this mean? In simpler terms, higher doses can make the treatment less effective over time. For example, common aesthetic procedures that involve BoNT, such as calf slimming, can use significant doses—up to 720 units or even more. Compare this to therapeutic uses, like treating migraines or cervical dystonia, where doses are usually similar.
However, with increased dosages comes the potential for resistance through immunogenicity—the body’s immune response to the toxin. Studies have noted that patients sometimes need more frequent injections to see the same results, indicating partial resistance. Dr. Hefter’s work on cervical dystonia patients highlights this troubling trend; antibody positivity was linked with worsened disease severity in those initially responding well to treatment.
To mitigate these risks, healthcare providers should consider using a form of BoNT free of complexing proteins, such as incobotulinum toxin A (incoBoNT-A). This purified form of the neurotoxin reduces the likelihood of an immune response compared to traditional formulations.
Resistance can still emerge, even with purified toxin formulations, especially if neutralizing antibodies (nAbs) develop. Therefore, keeping the dosage and frequency at the minimum necessary to achieve desired results is crucial. For those already experiencing resistance, switching to incoBoNT-A has shown some promise in reducing nAbs and improving treatment response over time.
The knowledge gap among healthcare providers and patients about the current dosage practices and the severity of immunogenic consequences remains significant. It’s imperative that they maintain accurate treatment records and opt for a risk-based approach to prevent and manage resistance effectively. This ensures the longevity and efficacy of BoNT treatments for both aesthetic and therapeutic uses.
Stay informed and prioritize your treatment plans to achieve the best outcomes. Let’s bridge the knowledge gap and ensure sculpted confidence for all our patients.
