The advantage of Dysport over regular Botox is that it takes affect faster and may last longer and spreads a little more to cover more creases than regular Botox but that may also cause some more heaviness to the eyebrows for 2-3 weeks if it gets too close to the eyebrows. Neither should have much effect on the eyelids at all as far a drooping goes.
Botox and Dysport are both great products and are often used in fact for brow elevation. Reasons for ptosis include:
1. poor injection techniques - getting too close to the eyebrow for example; one must know about anatomy of muscles and be able to recognize already exisiting asymmetries. None of us are perfectly symmetrical!
2. extreme dilution of the material - both come in a powder and are "reconsitituted" into an injectable solution; too much saline can dilute the product and cause diffusion and unwanted spread. Beware of too good to be true sales on cosmetic products
3. Products purchased from different manufacturers other than Allergan (Botox) or Medicis (Dysport). Who knows what is in that bottle and what is its strength? They are cheaply imported and sold at a fraction of the cost; while very tempting to save money one must be careful of these traps.
4. Underlying muscle weakness (palpebral) that can be enhanced with either injection.
Basically, when used correctly, they both work very well -- no difference.
It is important to distinguish between Eyelid ptosis and Eyebrow ptosis.
Eyelid ptosis occurs when the eyelid excursion (ability to open and close) is diminished and the upper eyelid begins to cover the pupil, interfering with the upper visual field.
Eyebrow ptosis is when the eyebrow position is too low, and falls below the bony rim of the eye socket. This can make a patient appear as though the eyelid cannot open, when in fact there is nothing wrong with the eyelid muscles.
Both conditions can occur in patients who have had botox injections. The best way to prevent either of these from happening is:
1) Have a doctor inject you who is very familiar with the pertinent anatomy of the face.
2) Do not rub any area for 24-48 hours after injection. Doing so can cause the botox to migrate.
3) Avoid excessive exercise for 24 hours after injection.
Dysport works in the same manner as botox and can therefore exacerbate both of these conditions as well.
Studies of BOTOX and Dysport initially suggested an incidence of upper eyelid ptosis of 3 to 5%. These are actually alarmingly high numbers. However in practice the actual incidence of upper eyelid ptosis is much less common. Andectodally the actual incidence is more like one or 2 per hundred treatments (1-2%). However, this does vary by injector. In my last 1000 BOTOX treatments there were no cases of upper eyelid ptosis. The take home lesson is the doctor you go to does make a difference.
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