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Volume 15
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Communication

Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong

by
Wilson W. S. Ho
1,*,
Lisa Chan
2,
Niamh Corduff
3,
Wang-Tak Lau
4,
Michael U. Martin
5,†,
Clifton Ming Tay
6,
Sandy Wang
7 and
Raymond Wu
8
1
The Specialists: Lasers, Aesthetic and Plastic Surgery, Central, Hong Kong
2
EverKeen Medical Centre, Tin Hau, Hong Kong
3
Cosmetic Refinement Clinic, Geelong, VIC 3220, Australia
4
Independent Researcher, Kowloon, Hong Kong
5
Independent Researcher, 31832 Springe, Germany
6
Merz Asia Pacific Pte., Ltd., Singapore 138567, Singapore
7
Independent Researcher, Causeway Bay, Hong Kong
8
Asia Pacific Aesthetic Academy, Kowloon, Hong Kong
*
Author to whom correspondence should be addressed.
†
Retired.
Toxins 2023, 15(7), 456; https://doi.org/10.3390/toxins15070456
Submission received: 1 June 2023 / Revised: 1 July 2023 / Accepted: 3 July 2023 / Published: 12 July 2023
(This article belongs to the Special Issue Immunogenicity of Botulinum Toxin)
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Abstract

With increasing off-label aesthetic indications using higher botulinum neurotoxin A (BoNT-A) doses and individuals starting treatment at a younger age, particularly in Asia, there is a greater risk of developing immunoresistance to BoNT-A. This warrants more in-depth discussions by aesthetic practitioners to inform patients and guide shared decision-making. A panel comprising international experts and experienced aesthetic practitioners in Hong Kong discussed the implications and impact of immunoresistance to BoNT-A in contemporary aesthetic practice, along with practical strategies for risk management. Following discussions on a clinical case example and the results of an Asia-Pacific consumer study, the panel concurred that it is a priority to raise awareness of the possibility and long-term implications of secondary non-response due to immunoresistance to BoNT-A. Where efficacy and safety are comparable, a formulation with the lowest immunogenicity is preferred. The panel also strongly favored a thorough initial consultation to establish the patient’s treatment history, explain treatment side effects, including the causes and consequences of immunoresistance, and discuss treatment goals. Patients look to aesthetic practitioners for guidance, placing an important responsibility on practitioners to adopt risk-mitigating strategies and adequately communicate important risks to patients to support informed and prudent BoNT-A treatment decisions.
Keywords: botulinum neurotoxin A; immunoresistance; secondary non-response; neutralizing antibodies botulinum neurotoxin A; immunoresistance; secondary non-response; neutralizing antibodies

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MDPI and ACS Style

Ho, W.W.S.; Chan, L.; Corduff, N.; Lau, W.-T.; Martin, M.U.; Tay, C.M.; Wang, S.; Wu, R. Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong. Toxins 2023, 15, 456. https://doi.org/10.3390/toxins15070456

AMA Style

Ho WWS, Chan L, Corduff N, Lau W-T, Martin MU, Tay CM, Wang S, Wu R. Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong. Toxins. 2023; 15(7):456. https://doi.org/10.3390/toxins15070456

Chicago/Turabian Style

Ho, Wilson W. S., Lisa Chan, Niamh Corduff, Wang-Tak Lau, Michael U. Martin, Clifton Ming Tay, Sandy Wang, and Raymond Wu. 2023. "Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong" Toxins 15, no. 7: 456. https://doi.org/10.3390/toxins15070456

APA Style

Ho, W. W. S., Chan, L., Corduff, N., Lau, W.-T., Martin, M. U., Tay, C. M., Wang, S., & Wu, R. (2023). Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong. Toxins, 15(7), 456. https://doi.org/10.3390/toxins15070456

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