Which Neuromodulator Product is Better? Should I choose Botox or Dysport?
This is a common question among new patients that come to my office. I answer alot of specific questions about these products. Some ask for Brand X or Y because they saw an ad or because a friend or family member recommended it. Some of our patients have been told to avoid certain products. I hope to dispel some of this misinformation and allow you to become a more informed consumer of neuromodulator products by answering a series of questions for you.
What is the difference between these two products?
Botox (onabotulinumtoxin A) and Dysport (abobotulinumtoxin A) are different at a molecular level but act via the same mechanism. They block communication between nerve endings and the facial muscles that those nerves control. The clinical effect is softening of contraction of specific facial muscles. The effects are temporary and any muscle weakening resolves once new nerve endings have sprouted and connected with the muscle. This typically requires two to three months.
Of note, Dysport is a smaller molecule and thus has some tendency to "spread" from the site of injection. In my experience this is an issue when higher dilutions (larger volumes of injection) of the product are used. This is mainly a concern during injection of the forehead, where excess "spread" can lead to temporary heaviness of the eyebrow. The best option when treating forehead wrinkles in a person who already has heavy brows is to use a lower dilution of the product (we always do) or using Botox to minimize the risk of "spread" and excessive forehead weakening.
Are Botox and Dysport safe?
Yes. Both Botox and Dysport are FDA-approved for the treatment of dynamic facial wrinkles. They have both undergone significant study demonstrating their effectiveness and safety. The doses used for aesthetic treatments are significantly lower than those used for treatment of medical problems such as cervical dystonia.
Do the risks or side effects differ between the two products?
Both Botox and Dysport have similar side effect profiles. The most common risk is a bruise at the site of injection. This is uncommon but can be camouflaged with makeup immediately. Most complications with neuromodulator products result from injection technique. If the wrong muscle is injected or if the target muscle is overtreated, inadvertent or excessive muscle weakness can result. For example, overtreatment of the forehead can result in drooping of the eyebrows and increased fullness in the eyelids. Temporary headache, allergy and lack of effect have also been described but are unusual.
Can these products be used together or sequentially?
Botox and Dysport can be used at the same time. For example, for a woman with drooping eyebrows, Botox might be used in the forehead to minimize the risk of spread which could result in further drooping of the eyebrows. In this case, Dysport might be used to treat the remainder of the upper facial areas. This is typically not necessary as an experienced injector who does not over-dilute Dysport should not have significant difficulty preventing drooping of the eyebrows. These products can also be alternated - Botox today and Dysport in three months when the wrinkles need to be re-treated.
What's the deal with the "units" of Botox and Dysport? Are they the same?
No, units of Botox and Dysport cannot be directly compared as these are similar but different medications. Most injectors will agree that roughly 2.5 to 3 units of Dysport are required to achieve results equivalent to 1 unit of Botox. If Dysport seems like a "steal" on a per unit cost basis, there's a very good reason for this. You will need alot more units of Dysport to achieve the same effect. In practice, I find that the cost is roughly the same when achieving a similar result.
Is there a cost difference for either product?
No. I do not believe so. In our hands, 2.5 to 3 times the number of Dysport units is required to achieve the same results as Botox. In most practices, ours included, the cost of Botox is about 2.5 times higher per unit than Dysport. Given the need for more Dysport to achieve equivalence with Botox this results in a similar cost. Of course, this is practice specific.
Which should I choose?
This is a great question! The answer does differ from person to person. Some of our patients prefer one product over the other for reasons including a more natural effect, longer duration of effect or better response to X over Y. Some patients will request Botox specifically after having had a previous issue with drooping of the eyebrows after Dysport treatment. As mentioned earlier, this issue is probably related to the manner in which the product was injected rather than the product itself. Most importantly, the practical consideration of cost is highly important to our patients. Because of this, we'll perform more injections with a given neuromodulator product if the manufactured is offering a special that month. As both products are safe and effective and well-researched this makes perfect sense.
I hope that this post answers some questions you might have had about Botox and Dysport. I will be updating this post as our experience with Xeomin, the newest neuromodulator product, grows. Feel free to contact me if you have specific questions that this brief article did not address.