Neutralizing antibodies to botulinum neurotoxin type A in aesthetic medicine: five case reports
A 55-year-old Caucasian woman was initially treated in September 2011 with 33 units (U) of onabotulinumtoxinA (Vistabel®) in the upper third of the face. She received 6 U over three injection points in each orbicularis oculi, 5 U at one injection point in each corrugator muscle, 5 U at one injection point in the procerus, and a total of 6 U over three injection points in the frontalis muscle (one central and two lateral) ().\nThe patient experienced almost no response to the first treatment ( and ). At the second visit, in October 2011, she was switched to treatment with 80 Speywood U of abobotulinumtoxinA (Dysport®; Ipsen Ltd., Basking Ridge, NJ, USA/Azzalure®; Galderma, Paris, France) in the same injection points. A mild response was observed, which lasted 3 months. The patient’s serum was tested after the second treatment for the presence of neutralizing antibodies to botulinum toxin type A at a specialized laboratory (Toxogen GmbH, Hannover, Germany). The patient was positive for neutralizing antibodies, although the titers were not very high.