I was asked this question three times this week. These are the 3 neurotoxins that are FDA approved in the US as of this date. Botox is the number one toxin in the US and Dysport is the number one in Europe. How do they differ? Does it matter which one you use? Do I have a preference?
All 3 are made from the toxin produced by the bacterium clostridium botulinum. Yes– that’s the one that causes Botulism! The 3 companies (Allergan makes Botox, Galderma makes Dysport and Merz makes Xeomin) then make proprietary changes to produce their own product. The active part of the toxin consists of 2 protein subunits that are at the center of each of these. Botox has a large protein coat that gives it some of its chemical properties. Dysport also has a protein coat, but it is smaller than that of Botox. Xeomin has the 2 protein subunits with no protein coat.
How they act
Because the toxins have different proteins, they have slightly different properties in the body. Botox takes 1-2 weeks for its full effect and lasts about 3-4 months in most people. Dysport acts faster (3-5 days) and last a little longer (4+ months) than Botox. Dysport also spreads a little farther in your skin (about 1 cm for Botox and 1-2 cm for Dysport). Xeomin takes just as long as Botox to set in (1-2 weeks) and does not last as long as Botox. (For this reason, many doctors, including myself, have stopped using it.)
Because of the protein coat, both Botox and Dysport are prone to breaking down at room temperature so they must be shipped and stored cold. Xeomin is stable as a powder and does not need to be kept cold. Xeomin is popular for injectors who travel around with the toxin, since they can drive or fly with it without its losing efficacy.
Allergies to these toxins are very rare. But any protein can be targeted by our immune system. Because Botox has the most protein, in theory there is the highest chance of an allergy with it; however, because allergies are so rare, this has never been demonstrated in any study.
People can also develop antibodies to the toxins, which results in their bodies clearing the toxin so it has no effect. In theory, if you have an allergy or antibodies to Botox, then there is a chance you won’t be allergic to Dysport or Xeomin. In fact Merz touts how they have “minimized the foreign material (xeo)” and hence the name “Xeo-min” rests on the idea that there is the least chance of allergic reaction. Because allergies are rare this is hard to prove.
How are the Units different?
This part is sometimes confusing for people. Botox and Xeomin have units that are essentially equivalent. The units of Dysport are different, about 3:1 equivalent to Botox. So one vial of Botox or Xeomin is 100U while one vial of Dysport is 300U. They are all diluted exactly the same way, and the volume of fluid used is exactly the same. The number of units is different. Some Botox advocates post ideas out there that “Botox is 3x as strong as Dysport.” This is a very misleading idea. The Units are different. If you normally get 20U of Botox, you will get 60U of Dysport for the same treatment. The cost is comparable or slightly less for Dysport in most offices.
Do I have a preference?
As I already mentioned, I no longer use Xeomin because it just doesn’t last long enough. I like both Botox and Dysport, and use them both daily. I do like Dysport because it acts faster and lasts longer in most people (including in me– so that’s what I’ve got in my corrugators right now!). For those who see no difference, they are both fantastic options.
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