BOTOX® or Dysport®

What is Botox® or Dysport®?

Botox® and Dyport® are both types of botulinum toxin A, which is one of eight neurotoxins made by the bacterium Clostridium botulinum. In the United States, the 2 main commercially available brands of botulinum toxin used for cosmetic purposes are Botox® and Dysport®.

BOTOX® is onabotulinum toxin A. FDA approved in 2002 for glabellar wrinkles. FDA approved in 2004 for severe underarm sweating.

DYSPORT® is abobotulinumtoxin A. FDA approved in 2009 for glabellar wrinkles.

XEOMIN is incobotulinum toxin A. FDA approved in 2011 for glabellar wrinkles.

How do they work?

Botulinum toxin type A works by blocking the release of acetylcholine (a neurotransmitter) at the presynaptic motor neuron. By blocking its release at the neuromuscular junction, the toxin blocks the nerve from communicating to the muscle to contract, and thereby causes muscle paralysis. The peak of this paralytic effect is seen 4-7 days after injection.

Since the toxin takes about 2-3 days to produce an effect, you will likely start seeing results about 3 days later, and that effects will not be at their full effect until about 7-10 days after treatment. The toxin binding to the receptor is irreversible. Function recovers from sprouting of new nerve terminals and forming new synaptic contacts.

This takes about 3 months on average, which is why Botox and Dysport are said to last about 3-6 months.

What is the difference between Botox and Dysport?

They are both botulinum toxin type A. They differ in the carrier proteins used, and therefore have different characteristics that result in a few differences.

In general, Botox kicks in at around 2-3 days, and Dysport kicks in at around 1-2 days. Botox tends to last 3-6 months, and Dysport tends to last around 3-6 months or possibly a month or so longer.

Theoretically there was a concern that Dysport spreads out more from the site of injection. This can have positive and negative inferences.

Those who prefer Dysport feel it seems like a smoother result, especially at the crows feet area, and those who prefer Botox worry that Dysport may have more risk of causing drooping of the brow.

This has not been seen clinically. In fact, Dr. Patel feels both Botox and Dysport are both excellent and effective in treating facial wrinkles. The only difference is the concentration and dosing of each.

How does Botox® work to stop sweaty underarms?

Botulinum toxin A works not only on the neuromuscular junction to treat wrinkles, but also on parasympathetic and sympathetic nerve endings, such as those controlling the sweat glands. Instead of injecting into facial muscles to combat wrinkles, the toxin is injected into the subdermis of the axilla (approximately 2 mm deep), to combat excessive sweating.

It typically takes 50 units on each underarm for effective treatment, and lasts about 6 months.

Is it possible to become immune to Botox® or Dysport®?

It is possible for your body to form antibodies to the toxin, making it no longer effective. The percentage of patients who become non-responders is low, but there are certain factors that are associated with this phenomenon.

The risk factors are having high dose injections per session (over 200 units), and having frequent repeat injections (less than a month apart).

To minimize the risk of forming antibodies to the toxin, Dr. Patel recommends using the lowest dose needed for the desired effect, and avoiding frequent re-injections.

The antibodies your body makes are for the proteins bound to the toxin. Since the different formulations of botulinumtoxin A have different types and amount of proteins, it is possible if one brand doesn’t work for you anymore, than another brand will. There are also a small percentage of patients (who have not had prior treatments) in whom the toxin simply does not work.

This can be due to individual variations in docking proteins or have antibodies from a subclinical exposure to the toxin.

Are Myobloc and Neurobloc the same as Botox? What about Xeomin?

No. Myobloc and Neurobloc are both botulinum toxin type B preparations. They are not approved for cosmetic use. Xeomin is the latest botulinum toxin type A to be approved for glabellar wrinkles.

Can I do Botox® or Dysport® at the same time as my laser/ massage/ facials?

It is better to do your laser treatments, facial massages, and facials BEFORE the Botox treatment to avoid any potential dislodging or spreading of toxin that has not bound yet. (Otherwise space those treatments out a couple of weeks after the Botox injection.)  

Dr. Patel also recommend not laying down for 3-4 hours after treatment, and not doing strenuous activity or working out for 24 hours after treatment. While massaging the muscles treated is not recommended, actively contracting the muscles treated may help increase the uptake of toxin and decrease chances of diffusion.

What are the risks?

Temporary headache, bruising, asymmetry, drooping of the brow, peaking of the lateral brow, unnatural appearance are the most commonly described potential side effects.

Dr. Patel recommends avoiding blood thinners (such as apirin, ibuprofen, vitamin E, fish oil, flax seed, etc) for 10-14 days prior to injection to minimize risk of bruising. If the patient is unable to do so, the bruising can be minimized by icing the area prior to injection and holding brief pressure at the needlestick sites during injection.

Other described side effects are temporary drooping of the upper lid, nausea, vomiting, or distant spread of toxin.

Who cannot get Botox® or Dysport® injections?

Botulinum toxin should be injected in anyone with pre-existing neuromuscular diseases such as myasthenia gravis, women who are pregnant or breastfeeding, or anyone with infection at the site of planned injection.

Certain medications are also relative contraindications, as they can alter the effect of the toxin, increasing or decreasing its effect.