Movement of the facial muscles such as frowning is a common, unconscious reaction of the face- it even occurs while sleeping. Over time, the lines created from these movements tend to etch into the skin and become a permanent feature of the face. As a result, a person can appear angry when in fact he/she is not. Botox, Dysport, and Xeomin all work by relaxing the muscles they are injected into. Once activated, the injected muscle can no longer bend the skin to cause a "wrinkle." This is why these treatments work well for "dynamic" wrinkles (wrinkles that are produced by flexing a muscle) and cannot resolve "static" wrinkles (wrinkles that are present when the muscles are in a relaxed position.) Treatments using Dysport, Xeomin, and Botox for sweating involve a similar mechanism through the relaxation of the gland muscles. While we provide all these options, the majority of our treatments involve Botox in our office in Encino.
Botox (onabotulinumtoxin A) is a muscle relaxant manufactured by Allergan, who also makes Juvederm Ultra, Juvederm Ultra Plus, Voluma, and Latisse. It was FDA approved for therapeutic use in 1989, and received cosmetic FDA approval for treating frown lines in 2002. There has been extensive research on Botox, with approximately 2500 studies completed so far. Botox is delivered refrigerated, in vials of 50 and 100 units. The company recommends reconstitution with 2.5 ml of normal saline to prepare for injection. At our office, we reconstitute with 2.0 ml of normal saline to increase its
concentration and decrease diffusion of product, hence decreasing risks of unwanted side effects.
Botox has been FDA approved for cosmetic use in the frown lines (glabellar wrinkles) and crow's
feet (wrinkles around the eyes, also known as periorbital rhitids). However, Botox is commonly
used off label for many other areas such as forehead, nose, lips, chin,TMJ (massseters), neck, and
in underarms and palms of hands to treat sweating. Guidelines from the company recommend a
total of 20 units of Botox delivered in 5 injection sites for treatment of the frown area. For crow's feet (wrinkles by the eyes), 12 units are recommended per side in 3 injection sites. The result is noticeable in about 7-14 days, and is aimed to last about 3 to 4 months. Lower doses might not last as long.
Xeomin (incobotulinumtoxin A) pronounced "zee-o-men" is the most recently released muscle relaxant on the market with an FDA approval in July 2011. It is manufactured by Merz Pharmaceuticals, who also makes Belotero and Radiesse. Xeomin is very similar to Botox in that it comes in 50 and 100 unit vials and each unit is equivalent to one unit of Botox. The only important additional step in reconstituting Xeomin is that after the mixture is prepared, it has to be left upside down in the vial
to make sure any loose Xeomin particles that are around the cap areagets dissolved into the solution
(Botox does not require this step as all of the Botox product is at the bottom of the vial). The main
difference between Botox and Dysport is that Dysport does not require refrigeration, and that it is a
more purified version of the active component of the toxin. Some suggest that by removing the
extra proteins, there is less "stuff" going into the body, and that there is fewer antibodies produced
against it. Others suggest that the extra proteins in Botox make the medication work better and
last longer. Currently, there are no good studies or evidence to support either or. What we do know is
that Xeomin has proven effective in clinical trials and is a good alternative to Botox.
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Dysport (abobotulinumtoxin A) pronounced "Dis-port" or "Dice-port" is a muscle relaxing agent distributed by Medicis who also manufactures Restylane, Perlane, Sculptra, and Obagi products. Dysport received its FDA approval in April of 2009. Like Botox, the cosmetic vial arrives refrigerated, but contains 300 units. Each unit of Botox is equivalent in result to 2.5 to 3 units of Dysport. This does not imply that one is stronger than the other, but rather their units of measurement just differ. The company recommends it to be reconstituted with 2.5 ml of normal saline to prepare for injection. At our office, we reconstitute with 2.0 ml to increase the concentration of the solution and decrease the amount of diffusion with the product, which can help decrease risks of side effects. Dysport has been FDA approved for use in the glabellar region
(frown lines). For best results, 50 units are recommended to be delivered via 5 injection
sites in the frown region. As with Botox, Dysport is commonly used off-label for many
other areas in the face including periorbital rhitids (crows feet), nasal lines (bunny lines),
forehead lines, brow lift, lip lines, gummy smiles, masseters (TMJ), chin cobble-stones,
neck lines (vertical and horizontal), neck lift (nephrotidi), underarms (axilla) and palms
(for sweating), etc...
The main differences between Dysport and Botox is that Dysport's onset of action is a bit faster (3 days compared to about 7 days for Botox), and the area of diffusion is higher for Dysport. Otherwise, from our patients who have tried both Botox and Dysport, we have about an equal number of feedback regarding which seems to be stronger or last longer.