Botox or Dysport: Which Option is Better?
In 2002, the United States FDA approved the first botulinum toxin for the cosmetic reduction of movement related facial wrinkles, Allergan’s Botox Cosmetic. Since then it has become one of the most popular minimally-invasive cosmetic treatments in the United States with more than 2.8 million procedures performed in 2008 alone.
On April 30, 2009, Dysport (Medicis Pharmaceutical Corp., Scottsdale, AZ) became the second botulinum toxin approved for cosmetic use. The product has been commercially available in Europe since the early 1990’s and is approved for aesthetic use in 27 countries. While worldwide experience is plentiful, physicians in the United States are eagerly putting the neurotoxin to the test.
So what’s the difference between the two products? Both have a central core molecule which serves as the “active” portion of the neurotoxin and both have the same mechanism of action. The main difference is that the two products have a different array of associated “non-active” proteins which are complexed around the active core. All in all, the two products will function nearly identically and have the same duration of action, however there may be some subtle advantages to Dysport.
The first is that Dysport has a lower protein load than Botox. This means that the body should form fewer antibodies against it. There is a very small population of people in whom Botox does not work as well over time and this has been hypothesized to be due to antibody formation. The assumption is that since Dysport has a lower protein load than Botox, the risk of getting diminishing results after years of injections is less. Less antibody formation has also led many to speculate that Dysport could have a longer duration of effect than Botox, although with my early experience this is not the case.
The second possible advantage is that Dysport seems to “spread” more than Botox after injection. Greater diffusion of the product is an asset when treating the forehead, crow’s feet and excessive sweating because there is a smoother, wider effect of muscle relaxation and a more natural result. This may even be advantageous when treating men because they have stronger, larger facial muscles which can require greater than average doses of Botox for optimal results. Diffusion also means that patients may require fewer injections as each individual poke should cover a wider “halo” of activity or sweating. Fewer injections means less pain and less bruising. So far the product’s increased diffusion has not lead to an increase in unwanted side effects such as droopy eyelids.
Finally, Dysport appears to kick in a little faster than Botox, within one to two days versus two to four. This will be a plus for the patient who comes into the office on Friday wanting to look better for a party on Saturday night.
Dysport is priced roughly the same as Botox; however now that Allergan has some competition on the market, it will likely avoid further price increases.