Episode 176 hosts Dr Stephania Roberts (Phlebologist & Cosmetic Physician from Melbourne, Australia) & Dr Niamh Corduff (Plastic Surgeon from Geelong, Australia)

In this mini series 'The Tox Talks', we feature expert injectors who have significant experience in using botulinum toxin. These episodes explore our guests experiences using particular brands, the evolution of their injecting techniques and we get special insights into the subtle nuances of getting the best our of toxins.

In chapter 8 we discuss the poorly understood topic of toxin resistance. In what was one of our most engaging podcasts to date, our expert guests debated the topic and we covered:

• What we mean by 'resistance'?
• Whether there's a difference between being resistant and being a 'non-responder'?
• What's a primary non-responder vs secondary non-responder?
• The incidence of toxin resistance - and the difficulty in quoting this rate
• The main steps in how Botox (Allergan brand) is manufactured and why this is relevant to the topic
• How this differs from the manufacture of Xeomin (Merz brand)
• Accessory proteins and their role in the body's immune response
• Neutralising antibodies vs non-neutralising antibodies
• Does a higher dose create a higher risk of resistance
• If so, what do we mean by 'high' dose?
• The role of dose frequency and risk of resistance
• What steps an injector should go through to review a patient complaining that their toxin 'didn't work'
• How to explain a less than satisfactory toxin outcome to to a patient
• Should you swap your patient to a different brand of toxin if you don't see results?
• The phenomenon of post-lockdown 'failed' toxin treatments globally - was this real or just perceived?
• What tests can you do for a true primary non-responder and whether these are practical in an every day injectors clinic

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