Botox and Dysport are the two most popular brands of botulinum toxin used in aesthetics to treat wrinkles in the US. Most everyone has heard of Botox by now. In fact, Botox has become a lot like Kleenex-- no matter what treatment people are getting for facial wrinkles, we tend to call it all Botox. More and more people are asking for Dysport by name. Dysport is the number one toxin in Europe. But there are currently 5 neurotoxins that are FDA approved in the US.These versions of botulinum toxin are very similar. How do they all differ? Does it matter which one you use? Do I have a preference? In addition to wrinkles, they can all be used to treat migraines, teeth grinding (bruxism), and excessive sweating in the palms and armpits (hyperhidrosis). We have been using both Botox and Dysport for all these purposes for many years. Though I have experimented with the others, I do not prefer them. In this post I will explain what they all have in common and what are the differences.
All of these products are derived from the botulism toxin made by bacteria. They all have the identical active neurotoxin– consisting of 2 protein subunits stuck together. This active toxin is what has the desired effect in the body. The differences have to do with the protein coat around the toxin and what else is in the vial. Botox has a big protein coat around it. Dysport has a smaller one. Xeomin has no protein coat at all. You get the picture. They all come as a powder in sterile vials and must be reconstituted with saline (sterile salt water). When reconstituted, the protein coats separate from the active part of the toxin. Once reconstituted, they must be kept in the refrigerator before being used. All these 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.
In doing research for this article, I found many sites on the internet state that Dysport is more “dilute” than Botox. This is false. Since the amount of toxin is actually slightly more in a vial of Dysport, and the same amount of saline is used to reconstitute Botox and Dysport, they are almost exactly the same, with Botox being slightly more dilute. Even if you were confused about the Unit measurement (it can be confusing) and compared 300U to 100U in the same amount of fluid, then Dysport would be 3x more concentrated, not more dilute!
Because the toxins have different proteins attached, and because there are different amounts of active toxin in each, 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. Many people like Dysport because it acts faster (3-5 days) and lasts a little longer (4+ months) than Botox. 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.) Jeuveau is very similar to Botox-- most people think it lasts as long or almost as long as Botox. What’s the advantage of Jeuveau over Botox? The price-- Juveau is usually less expensive.
Daxxify is the newest toxin to be FDA-approved in the US. They made a splash by claiming that because of some proteins added to the vial, it lasts 5-6 months, rather than 3 or 4. They also charged a much higher price. In practice, most aesthetic providers find that Daxxi (as we call it) does not last longer than the others. Physiologically, you regain movement because your nerve endings reach out and make new connections. For this reason, it is physiologically illogical that proteins added to the vial would alter the timeline of that process. After the product was released, it was found that indeed it doesn’t last any longer.
Because of the protein coat, Botox, Dysport, Juveau, and Daxxify 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 at room temperature without its losing efficacy.
The possible side effects and complications are the same for Botox, Dysport and the others. 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 any toxin 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, and Xeomin has no coat, and thus possibly has less chance of causing an allergy. 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!).
This is the only weird difference that actually affects the experience of getting Botox or Dysport or the others. 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 it on their clothes or skin– 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. I have not seen this with Dysport or Xeomin. I have not used either Jeuveau or Daxxify enough to know if this is a problem with those.
These 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 all be used to treat migraines, teeth grinding, and excessive sweating. Many of these uses are off-label. What are off-label uses? 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 the 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 and Dysport cost the same. Xeomin and Jeuveau tend to be offered at many centers for either the same or slightly less than Botox or Dysport. Daxxify is much more expensive. Because they were selling it as lasting 1 ½ to 2 times as long, the manufacturer charged a premium to doctors, and in turn doctors had to charge more for it. This backfired, because it doesn’t turn out to last longer and patients balked at the price. The maker of Daxxify is now encouraging doctors to charge less for it, but as of September, 2024, they have not dropped their price to buy it. This has been reflected in their stock price. Time will tell whether they can salvage their attempt to take over the market.
This part is sometimes confusing for people (doctors and patients alike!). A unit of Botox is defined as the amount required to kill 50% of mice when injected into the belly. Yes, Botox is measured in Mouse Units. The makers of Xeomin, Jeuveau and Daxxify decided to stick with Mouse Units.
Unfortunately, the makers of Dysport chose not to use Mouse Units. Dysport units are about 3:1 equivalent to Botox (though some people use a ratio of 2.5:1). So one vial of Botox is 100U while one vial of Dysport is 300U. Though many providers vary in their dilutions because they may find it easier to do math, most of us dilute products 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 and the experience and cost will be the same.
There are very few contraindications to having any of these neurotoxins. If you have a neurologic problem, like MS, it is not advisable to use any neurotoxin. You should also not use them if you have a known allergy or if you have an active infection in the area to be treated. And if you are pregnant or breastfeeding, you must wait until you are done. Lastly, you need to have realistic expectations. If you are trying to transform yourself into Angelina Jolie, a botox treatment is not going to make you happy.
Botox, Dysport and the others are all 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. In my opinion the others are not worth offering in my clinic, but any of them can be used to achieve the results you desire. The most important thing is to find a professional you trust!
If you're in the Seattle area and want to try Botox or Dysport, Glow Medispa has 2 convenient locations in Kirkland and West Seattle. Call us or book online here and we'd be happy to help you.
Web design and development by Thrive Design
