If Botox didn't work, why is injectionist recommending Dysport?

Thanks for your question. We utilize both Botox and Dysport. Some patients respond better to Botox, whereas others respond better with Dysport. Both are safe and effective.

Creases between the eyes are classified as either “dynamic” (those that are created by frowning and other facial expressions) or “static” (those that are etched in and remain even when the face is at rest and expressionless). Neuromodulators such as Botox and Dysport are great at relaxing the dynamic lines but are not as effective at immediately relieving the static ones. They are equivalent and one will not work any better than the other. There are three ways to potentially address the remaining creases between your eyes. First, a higher dose of neuromodulator may be required if you still have unwanted motion there. Second, repeated treatments evert 4-6 months over a longer period of time can help to alleviate even etched in lines. Third, a touch of filler in that area can also lead to improvement. However, injection of filler in that area is an advanced technique and should only be performed by a Board Certified Dermatologist with specialty training in cosmetic procedures.

We do a fair amount of both in our practice. There are some patients who may be very resistant to one versus another. However, most commonly if you found that it didn't work, then it may be worth going to a more advanced injector to ensure that the placement of the product and the technique is not the problem.   I train a number of injectors on both Botox and Dysport. I find that the most common reason why it doesn't work is technique rather than the product.  I also find, that if the result is the same with both in the technique is adequate, then the addition of a dermal filler may help to soften the crease that is visible without any facial expression.

Not all botox treatments are going to stop movement completely.  Even at very high doses some people only get improvement not paralysis.  I suggest if its working to stay with it, and then add some fillers.  If another neuromodulator is suggested, its because sometimes one works better than another for an individual person.  Best, Dr. Emer.

I recommend getting other opinions.  I encourage you to stay out of the spas and find well respected physician and surgeon injectors for real help.

Although Botox Cosmetic® and Dysport® contain the same active ingredient, their patented (and therefore confidential) manufacturing processes give them slightly different clinical profiles, for example, most aesthetic physicians agree that Dysport®'s effects "spread" a little more widely from each injection site. Because of these subtle clinical differences, I recommend that every patient try each of the currently FDA approved neurotoxins, to find out which one is best to suit their individual style/face/preferences. 

Basically after adding saline to the vial, the 2 products, Botox and Dysport, are the same. Poor response to Botox is mostly the injectors short comings. In rare instances I will switch if someone has been getting a deminshed response or change in duration after years of Botox treatments.

The neuromodulators are very similar. If a patient has a resistance to one over time, then I may suggest they switch to the other for a bit, and then back. But I have never seen one neuromodulator work on a patient when another didn't, the very first treatment. In instances where lines still occur after treatment it may be because the lines are static. Meaning they are there whether you are moving your facial muscles or not. In this case, static lines can decrease over time with continued neurotoxin use, but often they require a filler in addition to the neuromodulator. "This answer has been solicited without seeing this patient and cannot
be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."