Is Myobloc a Good Alternative to Dysport or Botox if Your Immune?

Many of us with a long experience in injecting Botox and Dysport (I have been injecting Botox for aesthetic purposes since 1991) have encountered patients who at first responded well, but after one or more additional treatments seemed to react less favorably. While only special laboratory tests (mostly used for research purposes) can document the development of immunity (antibody production) against these neuromodulators, the presumption has been that this may play a role in the observed loss of response to treatment. 

Myobloc, a different category of botulinum neuromodulator, has been around for quite a few years. However, it has not enjoyed much popularity in large measure due to the fact that its effects are quite short-lived. Hence, it makes a poor alternative in cases of presumed Botox or Dysport resistence. 

Xeomin, a neuromodulator that can best be described as Botox without attached proteins (the proteins believed to stimulate an immune reaction), is the newest kid on the neuromodulator block. For most people who respond well to either Botox or Dysport, my response is essentially that of the old commonsense adage,  "If it ain't broke, don't fix it." 

However, in cases where it is clear that the degree of response to Botox or Dysport has waned with time, I usually recommend a treatment with Xeomin. In most cases, I have had success with this approach. 

You have not had very many treatments to imagine being immune to botulinum toxin. Possibly there is a medication or herb that you take that affects the result (not that we have good information about such an interaction) and certainly you may just need many more units than someone else. There are some women who need 25 to 35 units of botox in the glabellar region between the eyebrows but their former doctors wouldn't inject more than 12.

I don't know if Myobloc is currently available. I don't know any colleagues who use it. The theory with Myobloc was that it was of a different serotype than Botox and Dysport so that if there were an immune situation with one serotype, there might be less of a problem with the other. If your doctors are convinced you have had a maximum number of safe units of Botox and Dysport, and although Xeomin is of the same serotype as these products, your doctors might wish to consider a treatment with Xeomin.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs. 

It is not accurate to state that if you have neutralizing antibodies to botulinum toxin A that you will also have neutralizing antibodies to botulinum toxin B (myobloc).  I would also be the doubting doctor camp that you are in fact immune to Dysport or BOTOX.  The antigen exposure from cosmetic treatment is so low, that it is overwhelming more likely that you are not being treatment with enough agent rather than you are immune to its activities.  Myobloc was a big disappointment which is why no one uses it cosmetically any more.  It doe not last very long and it seems to be associated with more systemic side effects.  So I think you would be better off see a more experienced injector for BOTOX or Dysport rather than searching out Myobloc treatment.