Why is the effect of Botox less? The mystery that worries aesthetic medicine Society

This is a recurring question in aesthetic medicine consultations, and a visit to the discipline’s forums on the Internet reveals that doctors and patients have been asking this for years: Is it true that the effect of Botox, the commercial brand that produces two Botulinum toxin is becoming a common and popular name for decades.

The answer to this question is much more than the doubts posed in front of the mirror. First of all, because of the economic consequences. Botulinum toxin is the most used treatment in aesthetic medicine: according to data from the specialized consulting firm Equia, last year 332,000 vials of this drug were sold in Spain for aesthetic purposes, worth 79.3 million euros. And second, because the debate has become scientific, with dozens of articles published in medical journals and many hours of questions at industry conferences.

“It is true that the effect of poison is sometimes less than expected. But, in general, the reasons should be sought not so much in the substance itself, but in the characteristics of the patient or inadequate administration, “says Fernando García Monfort, a doctor specializing in the discipline and co-author of the study recently published in the journal Scientific. Happened beauty therapy with title botulinum toxin. Why does it remain low? A review from our experience.

This substance is a protein that is produced in nature by bacteria of the species Clostridium botulinum. Because of its potent neurotoxic effects, it poses a risk in the food sector, where it can cause serious poisoning such as botulism when these microorganisms contaminate preserved foods. “It causes paralysis of the muscles by blocking the release of acetylcholine, which is a transmitter used by neurons to communicate with each other. In practice, this causes the nerve endings to stop giving commands to the muscles,” explains Francisco Zaragoza, professor of pharmacology at the University of Alcalá de Henares (Madrid).

The same effect that makes it dangerous – someone intoxicated will drown when breathing muscles stop working – gives this toxin tremendous potential in the medical field if applied locally in small doses. Juan Antonio López Pitalua, president of SEME, explains that in aesthetic medicine, it is widely used to “eliminate or reduce facial wrinkles such as those on the forehead, between the eyebrows and around the eyes.” In other areas of medicine, the venom is used in various muscle diseases – dystonia, spasticity… and in some cases migraine.

García Monfort’s article takes issue from the first paragraph: “Complaints about the short duration of the toxin’s effect in patients are a cause for concern among doctors,” because “it is common to hear this when trying a new treatment with the same brand”. Like last time, this time too the duration of the effect of poison has been less.”

In response to EL PAÍS, the author reveals several explanations that shed some light on this apparent mystery. “Some of them have to do with the way the toxin is delivered, which is a protein that if not handled properly can degrade, which will reduce its effectiveness and, therefore, reduce its duration of effect. I generally say that venom has a shorter shelf life in some hands…,” he says. For example, shaking it should be avoided in all cases. You should also follow the manufacturer’s instructions in detail when reconstituting the venom. It is sold in vials with a powder that must be diluted in physiological saline and then kept at a low temperature.

“If it is used too often, the body will develop antibodies that will also reduce the effectiveness,” says García Monfort. To avoid this, injections should be spaced far apart from each other for aesthetic purposes, but also keep in mind that the venom is also used in the health care system for various neurological, muscular or pain related ailments. “The person often does not agree that the medicine given to him in the hospital is the same or similar to what we use. That is why all information including the brand should always be requested. Not all toxins are the same and if we keep all these in mind, we can achieve better results,” explains this doctor.

Ultimately, experienced professionals know that there are other factors that can play a role. For example, the effect of poison is less in summer. This is due to the heat and sun which warms the skin and contributes to the reduction of toxins. People who experience stress also have less lasting effects. In general, anything that involves a lot of activity, stress or movement can cause them to shorten,” continues García Monfort.

With so many questions on the table, it is “normal that there is some disparity in the results obtained,” concludes the study’s author, who says that “although it is said that the toxin lasts for six months, in reality we have Have to think that it lasts until three and, from there, treat it as a gift that can be received with precise use.

The Chairman of SEME explains it in other words. “The use of this medicine should be evaluated within six months. In the first two, the paralysis is complete. In the next two, the muscle regains mobility. And in the last two, although it has almost completely healed, wrinkles are less visible due to the time the muscles have to relax,” explains López Pitalua.

Patient preferences are also not always the same. “There are some who like the results obtained in the first weeks better. Others, however, look better one and a half or two months after the puncture. It depends on each person’s taste, there is a lot of variability,” he adds.

According to the article published by García Monfort, “Those responsible for the manufacture and distribution of the toxin deny that there is a cause dependent on the manufacturer regarding the reduction in effectiveness of the toxin.” This newspaper has asked Merz and Allergan, the two largest manufacturers of pharmaceutical preparations used in aesthetic medicine, for their version, but both have declined to respond.

The experts consulted acknowledged that the debate would be very difficult to close, partly because of the large number of influencing factors and partly because there is a significant subjective component that “makes each person and each treatment unique.”