Can using 2 different neurotoxins at 1 appt (e.g. Botox & Daxxify) increase or decrease the risk of resistance?

Using 2 different botulinum toxin products simultaneously is probably not a good idea since doing that was not formally studied and it may cause unknown or increased side effects.To overcome resistance(if it develops) I would simply switch to a different botulinum toxin product.

The use of two different neurotoxins, such as Botox (onabotulinumtoxinA) and Daxxify (daxibotulinumtoxinA-lanm), at the same appointment is an interesting consideration, especially in the context of potential resistance.

Resistance to Neurotoxins:

Mechanism of Resistance: Resistance to botulinum toxin can occur when the immune system develops antibodies against the neurotoxin, potentially reducing its effectiveness over time. This is more likely when higher doses or more frequent treatments are used.

Different Formulations: Each neurotoxin formulation has unique properties and may vary in terms of protein load and formulation, which could influence the immune response. For instance, Botox and Daxxify have different accessory proteins and stabilization techniques.

Risk of Resistance: Using different neurotoxins theoretically might reduce the risk of resistance to one specific type, since the body is exposed to varied formulations. However, this is not fully established in clinical studies. The risk of resistance is generally low with appropriate dosing and frequency.

Clinical Considerations: There is limited direct evidence regarding the simultaneous use of different neurotoxins and its impact on resistance. Some practitioners may opt for alternating between different products to potentially mitigate resistance, though this strategy is more anecdotal than evidence-based.

Professional Guidance: It is crucial to discuss this approach with a healthcare provider experienced in neurotoxin treatments. They can provide personalized advice based on your medical history, treatment goals, and any previous responses to neurotoxin therapy.

Ultimately, the decision should be guided by clinical judgment, individual patient response, and ongoing consultation with a healthcare professional.

Resistance to neurotoxins is rare. We do sometimes find that patients feel one neurotoxin provides more of the results that they are wanting. If a patient has developed resistance they may find that they can use a different neurotoxin effectively as they are each formulated slightly differently. Mixing two neurotoxins would not impact future potential resistance.