Plastic and Reconstructive Surgery, Global Open (Jun 2024)

Real-world Implications of Botulinum Neurotoxin A Immunoresistance for Consumers and Aesthetic Practitioners: Insights from ASCEND Multidisciplinary Panel

  • Niamh Corduff, MBBS, FRACS,
  • Je-Young Park, MD,
  • Pacifico E. Calderon, MD, MBEth, MEd,
  • Hosung Choi, MD,
  • Mary Dingley, MBBS, FACCSM, FCPCA,
  • Wilson W. S. Ho, MBChB, FRCSEd,
  • Michael U. Martin, PhD,
  • Lis S. Suseno, MD,
  • Fang-Wen Tseng, MD,
  • Vasanop Vachiramon, MD,
  • Rungsima Wanitphakdeedecha, MD, MA, MSc,
  • Jonathan N. T. Yu, MD

DOI
https://doi.org/10.1097/GOX.0000000000005892
Journal volume & issue
Vol. 12, no. 6
p. e5892

Abstract

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Background:. As long-term, regular aesthetic botulinum neurotoxin A (BoNT-A) use becomes more commonplace, it is vital to understand real-world risk factors and impact of BoNT-A immunoresistance. The first Aesthetic Council on Ethical Use of Neurotoxin Delivery panel discussed issues relating to BoNT-A immunoresistance from the health care professionals’ (HCPs’) perspective. Understanding the implications of BoNT-A immunoresistance from the aesthetic patient’s viewpoint allows HCPs to better support patients throughout their aesthetic treatment journey. Methods:. A real-world consumer study surveyed 363 experienced aesthetic BoNT-A recipients across six Asia-Pacific territories. The survey mapped participants’ BoNT-A aesthetic treatment journey and characterized awareness and attitudes relating to BoNT-A immunoresistance and treatment implications. At the second Aesthetic Council on Ethical use of Neurotoxin Delivery meeting, panelists discussed survey findings and developed consensus statements relating to the impact of BoNT-A immunoresistance on the aesthetic treatment journey. Results:. Aesthetic BoNT-A patients’ depth of knowledge about BoNT-A immunoresistance remains low, and risk/benefit communications need to be more lay-friendly. The initial consultation is the most important touchpoint for HCPs to raise awareness of BoNT-A immunoresistance as a potential side effect considering increased risk with repeated high-dose treatments. HCPs should be cognizant of differences across BoNT-A formulations due to the presence of certain excipients and pharmacologically unnecessary components that can increase immunogenicity. Standardized screening for clinical signs of secondary nonresponse and a framework for diagnosing and managing immunoresistance-related secondary nonresponse were proposed. Conclusion:. These insights can help patients and HCPs make informed treatment decisions to achieve desired aesthetic outcomes while preserving future treatment options with BoNT-A.