Botox vs Dysport Smackdown

Now that Dysport has been released, and Xeomin has been approved by the FDA for medical usage, many people ask about the differences between them and which is the best. Short answer--they are all good products with some differences between them. Long answer (according to my nurses and my daughters I never give anything but the long answer)--see below.

 

Now that Dysport has been released, and Xeomin has been approved by the FDA for medical usage, many people ask about the differences between them and which is the best. Short answer—they are all good products with some differences between them. Long answer (according to my nurses and my daughters I never give anything but the long answer)—see below.
So here is the final post about Botox and Dysport used for step #2 in a dermatologist’s anti-aging plan—Relax muscle action to reduce lines.

Q. How is Dysport different from Botox Cosmetic?

A. Both are carefully controlled pharmaceutical preparations of botulinum toxin used cosmetically for the treatment of muscle related lines on the face. The FDA has recently approved Dysport (abobotulinumtoxinA, Medicis), originally called Reloxin to join the established Botox (onabotulinumtoxinA; Allergan) for these treatments.

Dysport® diffuses over a larger surface area and it requires on average 3 times as many units as Botox® for equivalent effect but this will vary depending on the site injected. The onset of action is a few days quicker. It appears the length of effect will be similar. The technique, dosage and areas injected will differ.

Because of this the two are not interchangeable. Since Dysport affects a larger area, care must be taken not to inject at the same sites as Botox or there is a risk of affecting surrounding muscles. The dosage units are registered differently and it takes more units of Dysport to treat an area. Dysport is a little cheaper for the physician to buy but usually those savings are not passed along to the patient. Therefore price per unit will be lower but the price to treat a specific area in an individual patient remains very similar to that of Botox.

Both Botox and Dysport have a proven track record of years of safety and effectiveness. Each physician will usually have a preference for one or the other and stick with the one they prefer.

A red car is not a red truck, even though both are red and move.

Who should I see to get Botox or Dysport?

It is common to see walk-in Botox clinics, Botox parties, Botox injections on cruise ships as well as nurses, dentists and physicians who are not trained in one of the “core” aesthetic specialties of dermatology, plastic surgery and oculo-plastics injecting Botox and Dysport. Because it is a cash basis medical service not restricted to insurance based reimbursement the incentive by many medical providers to provide treatment is great. If it was an insurance reimbursed procedure, and reimbursed at the typically low rates that insurance companies pay for medically necessary treatments, there would be much less interest in providing it.

I think that Botox and Dysport should be injected by an experienced physician in one of the core aesthetic specialties. Of course I am an experienced physician in one of the core aesthetic specialties so I am biased in that direction. But it is more complicated than it looks, especially to achieve a natural, symmetric look in each individual patient. Even after treating many thousands of patients over the years, and doing it all day long, I still learn on every patient and treat each just a little differently based on their particular anatomy, muscle function, symmetry, condition of skin and degree of aging.

Even though I have wonderful nurses, I perform all of the Botox injections in our office. I do not consider it a nursing procedure.

Would you want your plumber doing your electrical work? Do you really want someone trained in kidney disease taking care of your face?

Why is there a difference in price quoted to me from one office to another?

Botox and Dysport are diluted in the physician’s office before treatment. Sometimes to encourage patients to try it or to win price shoppers, it is diluted more or a smaller dose is given. This decreases cost but often gives a less complete response and shorter duration of effect. Unfortunately since you are not the one diluting the medication you have to rely on the professionalism and honesty of your physician. Some unscrupulous practitioners dilute Botox or Dysport more than they tell you they are and in reality you are receiving a lower dose than the unit dose for which you have paid. Although there is some legitimate variation one sign of this is a price that is much lower than the community norm. That’s why you need to be able to trust your physician.

Remember, it is priced by the unit not by the site treated. The actual price by unit varies very little among physicians. There may be a slight differential for expertise, numbing and additional complimentary treatments. Ask how many units are used and compare price by the unit and the degree and duration of improvement to the cost.

Often in life, you get what you pay for.