Episode 176 hosts Dr Stephania Roberts (Phlebologist & Cosmetic Physician from Melbourne, Australia) & Dr Niamh Corduff (Plastic Surgeon from Geelong, Australia) In this episode we discuss the poorly understood topic of toxin resistance. In what was one of our most engaging podcasts to date, our expert guests debated the topic and we covered: What we mean by ‘resistance’? Whether there's a difference between being resistant and being a ‘non-responder’?  What’s a primary non-responder vs secondary non-responder?  The incidence of toxin resistance - and the difficulty in quoting this rate  The main steps in how Botox (Allergan brand) is manufactured and why this is relevant to the topic How this differs from the manufacture of Xeomin (Merz brand) Accessory proteins and their role in the body's immune response Neutralising antibodies vs non-neutralising antibodies Does a higher dose create a higher risk of resistance If so, what do we mean by ‘high’ dose?   The role of dose frequency and risk of resistance    What steps an injector should go through to review a patient complaining that their toxin 'didn't work' How to explain a less than satisfactory toxin outcome to to a patient Should you swap your patient to a different brand of toxin if you don't see results? The phenomenon of post-lockdown 'failed' toxin treatments globally - was this real or just perceived? What tests can you do for a true primary non-responder and whether these are practical in an every day injectors clinic Show your support for IA via Patreon Follow IA on Instagram Visit our website  Subscribe to IA on Apple Podcasts Subscribe to IA on Spotify Contact Dr Jake & David  More about Dr Jake Follow Dr Jake on Instagram  Follow David on Instagram Follow Stefania on Instagram Follow Niamh on Instagram