Alan M. Engler, MD - New York Plastic Surgery and Aesthetics
What’s the difference between Botox and Dysport?
Well, depending on who you talk to, either a lot or very little.
Botox is, of course, better known. It’s been around for years and is actually one of the most consistently effective non-surgical treatments available. It targets those pesky frown lines and grooves on the forehead, between the eyes (the “11” lines), at the sides of the eyes, and nearly anywhere else on the face. It works by weakening the muscles that, when contracted, cause the lines in the first place. Weaken the muscles, you can’t frown as much, and the lines either disappear completely or, at least, are softened. Treatment typically lasts from about 6-9 months, depending on many factors.
Botox is actually botulinum toxin A (there’s a botulinum toxin B, but we’re not going to talk about that – yet). However, there are TWO versions of botulinum toxin A: onabotulinumtoxinA (which goes by the trade name of Botox, and is manufactured by Allergan) and abobotulinumtoxinaA (which goes by the trade name of Dysport, and is manufactured by Medicis).
So, Botox and Dysport are two versions of essentially the same thing. They are injectable treatments that relax muscles. Each comes in a vial that contains a freeze-dried powder that gets reconstituted (mixed with sterile saline) to form a liquid that can be injected.
Here’s where it starts to get tricky, because there are a lot of variables. When considering an injection, you need to know two things: how many units are being injected, and how old is the solution? Some people have been dissatisfied with the level of correction they’ve achieved, but there may be some simple explanations.
The first issue is how many units will be used. Botox is available in bottles of 50 or 100 units, so there’s a certain degree of flexibility. Most people need about 50 units (or, at least, they could benefit from that amount!) depending on how deep the lines are, how thick the muscles are (larger muscles require more botulinum) and how much correction is desired. Some people share a 50 unit vial if they just want a bit. In general, it takes about 20-40 units to get a nice correction between the eyes, 5-15 units at the sides of the eyes, and 10-40 for the forehead. One person can easily use 50 units; larger people or muscles, or a greater degree of correction, may require up to 100 units.
Dysport is packaged differently – it comes in a vial that contains 300 units. However, you generally need more units of Dysport to provide the same degree of correction as compared with Botox. Most people think it’s about 2 to 2.5 units of Dysport per unit of Botox. That means that 300 units of Dysport is ABOUT equal to 120–150 units of Botox.
But you can reconstitute the product (whether Botox of Dysport) with varying amounts of saline. Putting 4 cc’s into a 100 unit vial makes it 25 units per cc; putting 2 cc’s in makes it 50 units per cc. Putting 3 cc’s into a 300 unit vial of Dysport makes it 100 units per cc, which is then the equivalent of 40-50 units of Botox.
Confused? You don’t really need to be. What you need to know is how many UNITS you’re getting – not how many areas are being “treated” (what does “treatment” mean?), or how many “syringes” are being used (how strong is the solution?) or how many “injections” you’re getting. It’s all about the UNITS.
The next issue is how long the reconstituted product lasts after the saline has been added. Unless it’s being made up fresh for each patient, you have to know how old the product is when you actually get it. Botox, for example, says that any product not used should be discarded after 24 hours; the Dysport, packaging says that any product not used should be discarded 4 hours after reconstitution. Studies have actually shown that Botox can last a lot longer than that (up to several weeks) but it’s one of the factors to take into account if you’re considering these treatments.
For that reason, in my office we ONLY use product within the recommended time periods and, in general, make it up fresh for each patient or treatment.
One more issue is how similar the treatments are, assuming an equivalent number of units is used. There is a some disagreement over this. It has been reported that, when compared with Botox, Dysport works faster and spreads out (diffuses) more evenly. There are many possible factors involved in this, including how much saline is used to reconstitute the product (ie, how dilute it is) but this is a feature that has not yet been fully elucidated.
In summary, Botox and Dysport are excellent and equally effective treatments for facial lines, particularly between the eyes, at the sides of the eyes, and on the forehead. There are some differences, and some people prefer one versus the other, but both work well. If you’re interested in these treatments, ask your doctor the following two questions: (1) How many units am I getting, and (2) When was the product reconstituted?
I hope that this helps, and good luck,