Botox and Dysport are the two most popular brands of botulinum toxin used in aesthetics to treat wrinkles. They can also both be used to treat migraines, teeth grinding (bruxism), and excessive sweating in the palms and armpits (hyperhidrosis). We have been using both of these for all these purposes for many years. In this post I will explain what they have in common and what are the differences.
Both Botox (onabotulinumtoxinA (ONA)) and Dysport (abobotulinumtoxinA (ABO)) are derived from the botulism toxin made by bacteria. They both have the identical active neurotoxin– consisting of 2 protein subunits stuck together. This active toxin is what has the desired effect in the body. Botox has a big protein coat around it. Dysport has a smaller protein coat. They both come as a powder in sterile vials. Both must be reconstituted with saline (sterile salt water). When reconstituted, the protein coats separate from the active part of the toxin. Both must be kept in the refrigerator before being used. Both toxins temporarily paralyze the small muscles that cause certain wrinkles in the face.
The units of Botox and Dysport are not the same. They are not measured with the same assay, so they cannot even be properly compared. When studies have been done, they have found that 1 Unit of Botox is about equivalent to 2.8 Units of Dysport. Does this mean that Botox is stronger? Not really! Each vial of Botox contains 100 units of toxin. Each vial of Dysport contains 300 units of toxin. If you measure the active toxin in each vial, it turns out that the Dysport vial has a little bit more toxin, by weight, than Botox. Most places that use both Botox and Dysport use a ratio of 3U of Dysport to1U of Botox. The two products are diluted, drawn up and injected in exactly the same way. So in fact, the amount of active toxin is almost the same between the two, with a little bit more in a vial of Dysport.
For the vast majority of people, Dysport lasts longer by about a month. Botox on average lasts about 3 months and Dyspoprt lasts 4 months. Dysport also tends to set in quicker– with full results in 3-5 days, compared to 1-2 weeks for Botox. So this averages out to be one less visit each year for Dysport. Not only have some studies shown this, but our experience over many years has borne this out. When our patients have tried both, the overwhelming majority who try Dysport (19 out of 20) say that it lasts longer.
The possible side effects and complications are the same for both Botox and Dysport. The main risk is bruising. Any time you go through the skin with a needle, you risk bruising. We try to keep that to a minimum by using an Accuvein– it is a device that shows us the vessels under the skin– so we can avoid them. Our rate of bruising at Glow is very low. The likelihood of bruising with Botox or Dysport is the same.
The same is true of any other complication. The thing we worry about the most is getting a droopy brow or eyelid. We take great pains to prevent this, but it will happen rarely. The risk is the same regardless of which toxin you use.
Allergies to Botox and Dysport are extremely rare. Both of these toxins are proteins that are not natural in the body, and you can possibly develop an allergy to any protein. Theoretically, because Botox has a larger protein coat, you might imagine you could see more allergies to Botox, but this has not ever been shown. Allergies are just that rare. I have seen one true allergy in the many years I have been injecting toxin (and that happened to be Xeomin – which has no protein coat at all).
This is the only weird difference that actually affects the experience of getting Botox or Dysport. The protein in Botox makes the solution more frothy, with more bubbles. Even if you are very gentle with the vial and never shake it– bubbles are more common with Botox and harder to flick away. Why does this matter? If you have a hidden tiny bubble in the syringe it will cause dripping after you inject. Though not dangerous, it freaks people out to think they might have a drop of toxin on their clothes– and much worse– it wastes product! That stuff is so very expensive! So we are very careful to get every single bubble out– but every once in a while a tiny one can sneak by. We hate bubbles. So, Botox is a little bit annoying that way.
These two neurotoxins can be used for all of the same things. Treatment of facial wrinkles: glabella (11’s), forehead, crows feet, bunny lines, brow lift. They can be used to soften lip lines and do a lip flip– with great care. They can also be used to treat downturned corners of the mouth and puckered chin. And as mentioned above, they can both be used to treat migraines, teeth grinding, and excessive sweating. Many of these uses are off-label. What are off-label uses? Both Botox and Dysport are FDA-approved (Botox Cosmetic in 2002 and Dysport in 2009). The FDA approves drugs for particular uses. Any other use is considered off-label. Botox has been approved for forehead, frown lines and crow's feet. Dysport was approved for frown lines. Much of how these toxins are used is considered off-label. They have however, been used for these purposes on millions of people for many years.
This will depend on what center you choose. At Glow Botox costs a little bit more than Dysport with current pricing. We managed to keep the price the same for many years, but a recent price increase from Allergan (the maker of Botox) made that much harder. Most centers will either charge the same or offer Dysport for slightly less.
There are two additional neurotoxins that are FDA-approved in the US. Xeomin was FDA-approved in 2010. It is made of the active toxin (2-protein subunits) with no protein coat around it. The name Xeo- (meaning foreign) and -Min (minimal) was used to show it is the least “foreign” toxin available. Unfortunately, Xeomin does not last as long as botox, but takes the full 1-2 weeks to set in. The most recent toxin to join the crowd is Jeuveau. Jeuveau was FDA-approved in 2019 has a protein coat almost the same size as Botox, and seems to have a similar profile in the body. Because the studies were cut short as the company rushed to market, the FDA approval only allows them to claim that it lasts 30 days. In real use though, it appears to last about the same as Botox.
Both Botox and Dysport are excellent choices for the treatment of wrinkles, teeth grinding and excessive sweating. Dysport has a bit of an edge in time to onset and longevity of results. The most important thing is to find a professional you trust!
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