Botox vs. Dysport vs. Xeomin

Timothy Mountcastle, MD

Article by
Ashburn General Surgeon

Many patients ask me "What is the Difference between Botox and Dysport?  Does Dysport really work?"

Well, it does,  and there is even a new kid on the block, Xeomin. All these drugs are made by large companies, Allergan, Medicis and Merz respectively.  Botox just happened to be the first of these medicines which paralyze the tiny muscles of the face to try and prevent the worsening of wrinkles of the forehead, crows feet and glabella. 

Botox and Xeomin are injected at the same strength, however Dysport is injected at a different strength.  For example, a forehead injected with 20 units of Botox would need the same amount of Xeomin, but would need around 50 units of Dysport.  A 2.5-to-1 ratio of Dysport to Botox is typically needed to achiever similar results.

All, however, do the exact same thing - paralyze the little muscles in the face to prevent those muscles from making you furrow your brow or wrinkle your forehead or squint. Thus, this prevents wrinkling of this skin that over time keeps that skin in better condition.

The cost to the patient is pretty similar. Where they get you is a plastic surgery office will market the Dysport for $5/unit ,whereas botox is $12/unit.  You think you are getting a good deal till you show up and realize your need twice as much Dysport.

This said, all the different botulinum toxins do the same thing.  But you will find different patients swear by different medicines. One will say only "Botox works for me," while the next will say Dysport works a lot better for her.

There is no scientific evidence to back this up, but people are very adamant about their flavor of Botox they use. There is, however, a difference on onset of action, with Dysport working quicker (around two-three days) while Botox takes around 7-10 days till full effects of medicine are felt.

Dysport (abobotulinumtoxin A), Botox (onabotulinumtoxin A) and xeomin(incobotulinumtoxin A ) all work very well at what they are - FDA-appoved paralyze the muscles of the face to prevent dynamic wrinkles.

Oddly enough, they are really only FDA approved to treat the glabella, the area above the nose; all the other uses are off-label uses that have been proven to be safe by millions of treatments.

Whichever product you like to use, they all work great. Sales of Botox and alternatives are still growing. Botox sales were up 12 percent in the fourth quarter of 2011. Hopefully this is another good sign of the recovery.

I would love to hear from anyone about your experience or your opinion on which is the best type of botulinum toxin.