Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

Botox is an effective injection method for diminishing certain undesired facial expressions. For the vast majority of patients, it works very well and will continue to do so with endless repeat treatments. But there is a very small percent of patients who either don’t respond well or find that ongoing treatments become less effective. In many of these cases, the source of the problem is how the Botox was reconstituted, its age, and how it was injected. But this doesn’t apply to all of these ineffective patients and the problem likely lies in their receptiveness to the Botox molecule.

A new medication designed to treat these ineffective Botox patients is now available. Zytaze is a zinc and phytase prescription medication that is used prior to Botox treatment. It was studied in the medical condition of blepharospasm which is uncontrolled eyelid twitching and is one of the original FDA-approved uses of Botox from the early 1990s. In a series of 44 blepharospasm patients who responded poorly to Botox injections such that control of their blepharospasma was difficult to achieve. In these patients,  Zytaze was given in oral tablet form four days prior to Botox injections. The study shows that 93% of the patients improved the effect of their Botox injections or how long they last.

No explanation was provided for the mechanism as to why this supplement would be effective or how it works. Furthermore, whether its effectiveness in blepharospasm would translate to the more widespread use for the treatment of undesired facial expressions is unclear. One would assume that it would since it is not only a facial muscle but an associated periocular muscle as well.

For those suffering from Botox ‘fatigue’ or resistance, Zytaze oral medication may be worthwhile to try. But don’t think that taking it will make your Botox last longer unless you exhibiting less effectiveness than what you had shown previously. 

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

It is not rare to hear a patient say…’my Botox seems to be wearing off earlier than usual’…or…’I had Botox but it didn’t seem to work’. Some few patients even suggest that they may be immune to Botox or that they are becoming resistant ot it. Many physicians and even manufacturer reps say that such immunity is impossible. But is it? Is immunity to Botox real?

First and foremost any drug, no matter what its mechanism of action, poses the potential of diminished effectiveness with repeated use. The most classic example is that of antibiotics. (although this really represents resistance of the infecting bacteria not necessarily how the body responds to it) But immunity or developing an immune response to a toxin, an unnatural molecule that the body may eventually recognize as both foreign and harmful, is particularly likely. While I hold most responses on the internet as not a source of absolute scientific information, there is too many patient responses on many different websites that claim a lack of response after injection or a dramatic dropoff in effectiveness after a period of years of successful use. (most common) While some, if not many, of these may be the result of using overdiluted or old Botox or from poor injection technique, all of them can’t be completely drug or injector-related issues. Resistance to serotype A of botulinum toxin (Botox and Dysport) has been reported in some physician series but the incidence is quite low. (usually less than 1%) The point is…it has been reported in professional medical journals in large patient series. Anectodal statements by some physicians such as ‘I have never seen it’ and the like does not count as scientific evidence. Never having seen it does not mean it doesn’t exist. Most of us have never seen a platypus in the wild either, but we know they do exist.

Once you develop Botox immunity, what can you do? There is no absolute answer to this uncommon problem. Perhaps waiting a period of time ( 6 months to a year?) before trying repeat Botox is one option to see if your immune response lessens. The other option is to use a different serotype, type B (Myobloc), and see if you get a response. In theory, different serotypes have slightly different molecules so your immune response may be quite specific to type A only.

Whether someone can be completely immune to Botox, without PRIOR injections, is a different matter. There would be no natural immunity to Botox since most of our immune systems have never seen the molecule before. When a first-time patient of mine calls and tells me they have had no response, actual examination everytime demonstrates that they actually have had a response it is just not as profound as they thought it to be. This is an issue of managing expectations and dosing, rather than some natural resistance to the drug.

By far, the most common patient experience in my practice with Botox is that patients actually develop a somewhat lesser need with Botox over time. After three or four treatments, many patients find that the Botox seems to ‘last longer’ and they may only need injections twice a year as opposed to every three or four months. This is not because the patient has developed greater sensitivity to the drug but because they have most likely ‘retrained’ their expressions. which are learned movements anyway. Once you have not moved or have less movement of any muscle for a long enough period of time, you may have inadvertently retrained your expressions to some degree.

Acquired Botox immunity is a real but uncommon event. It usually presents in the patient who has had Botox for multiple treatments, after a year or two, with a diminished response to a proven dose or sometimes as no response at all. Botox resistance without prior exposure is more likely an issue of expectations and proper dosing rather than a natural immunity.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com/

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis