Comparing Botox®, Dysport®, and Xeomin®

When our patients want to reduce wrinkles, our dermatologists frequently recommend neuromodulator injections as a treatment. And for good reason. They’re relatively inexpensive, can be administered in the office, and have few side effects when performed correctly. Most people know neuromodulator treatments by one of the seemingly ubiquitous brand names: Botox®. But there are several others on the market as well. While they all work roughly the same way, there are slight differences between them. In this primer, we’ll compare three of the most well-known neuromodulators: Botox®, Dysport®, and Xeomin®.

Botox

Botox is an injectable treatment for fine lines and wrinkles initially brought to market by Allergan, which is now a part of AbbVie. It has been approved for cosmetic purposes since 2002 but has been around since the 1970s when it was first used as a treatment for an eye condition called strabismus.

How Botox Works

The active ingredient in Botox is OnabotulinumtoxinA, derived from clostridium botulinum, the same toxin that causes a serious condition known as botulism. When injected into specific muscles, OnabotulinumtoxinA blocks nerve signals to the tissue there, relaxing it and releasing the wrinkling. Essentially, it paralyzes the treated facial muscles. If the muscle underneath a wrinkle can’t move, the crease eventually diminishes, creating a smoother look.

What’s Unique About Botox

As the oldest neuromodulator on the market, Botox has several FDA-approved therapeutic uses in addition to aesthetics. For example, it is approved for the treatment of cervical dystonia, a painful condition affecting the neck muscles, as well as for overactive bladder, excessive sweating, and chronic migraines. Botox does not diffuse (spread) throughout the face as quickly as other neuromodulators, so some injectors prefer it for smaller areas of the face, such as around the mouth, where spreading could cause trouble.

One caution: Botox is made with a protein called albumin. If you are allergic to albumin, speak to your injector, who will recommend a different tox treatment. (Note: albumin allergy is uncommon and differs from lactose intolerance.)

What to Expect from Botox Treatment

Like any other neuromodulator, Botox takes some time to work. It can take about four days after injection to see preliminary results and about ten days for full effect. It can be used in all face areas prone to wrinkles, including the forehead, crow’s feet, and marionette lines (the creases around the cheeks and mouth – technically known as nasolabial folds). You can expect your Botox treatment to remain effective for about two to four months, slightly less than some other top brands.

Botox Dosage

Dosage can vary from 10 to 30 units per injection site. Larger areas, such as the forehead, will need more, while more minor treatment areas, like around the eyes, require less.

Dysport

Like Botox, Dysport is an injectable treatment for fine lines and wrinkles made by Galderma. BOTOX was the first to appear on the U.S. market, but Dysport has been used in Europe since the 1990s. It was approved for U.S. use in 2009.

How Dysport Works

The active ingredient in Dysport is abobotulinumtoxinA. Like Botox, this ingredient is derived from clostridium botulinum and blocks nerve signals to the facial muscles. The difference is in the so-called “complexing proteins” used – while Botox uses one type of protein, Dysport uses a different formulation. These proteins help the toxin bind to muscle and may create a more effective treatment.

What’s Unique About Dysport

Dysport also has some FDA-approved therapeutic uses, including chronic migraine and muscle spasms. However, it does not have as many as Botox. Dysport tends to spread more throughout the face than Botox. For this reason, some injectors prefer it for larger facial areas like the forehead, where many muscles need to be treated. Like Botox, Dysport also contains albumin, so those with an albumin allergy should seek an alternative. Dysport also contains lactose and cow’s milk protein, so if you’re lactose-intolerant, choose another neuromodulator treatment.

What to Expect from Dysport Treatment

Some patients and injectors report that Dysport takes less time to become effective than BOTOX (two to three days versus about three to four). A single trial found Dysport to work more quickly and be less painful than Botox, though the degree of effectiveness was about the same. Like Botox, Dysport’s results last about two to four months. One trial found Dysport to work longer than Botox in patients with severe forehead lines; however, this trial was sponsored by Galderma, Dysport’s manufacturer.

Dysport Dosage

Dysport is diluted when compared to Botox, so you will need more units to have a noticeable effect. The forehead, for example, usually requires anywhere from 30 to 60 units, while crow’s feet need about 30 per side.

Xeomin

Like Botox and Dysport, Xeomin is an injectable treatment for fine lines and wrinkles. It is a relative newcomer to the cosmetic neuromodulator market, with FDA approval arriving in 2011. It was approved for use in Europe in 2005.

How Xeomin Works

The active ingredient in Xeomin is incobotulinumtoxinA. This is also derived from Clostridium botulinum and relaxes the facial muscles. Unlike Botox and Dysport, Xeomin contains no complexing proteins and is just a purified form of the toxin.

What’s Unique About Xeomin

The lack of proteins in Xeomin is the underlying reason for some of its advantages. People with allergies or skin sensitivities may react less to a Xeomin injection. Because it contains no proteins, Xeomin does not require refrigeration like Botox or Dysport. Storage at room temperature may allow for a more comfortable injection for some patients. Finally, the proteins in Dysport and Botox may stimulate excess antibodies in some patients, resulting in less-than-optimal results. If your body has ever resisted other neuromodulators, Xeomin may work for you.

What to Expect from Xeomin Treatment

Like Dysport, Xeomin may have a shorter waiting period until the treatment becomes effective and starts relaxing your wrinkles. There have also been reports of Xeomin results lasting longer than other neuromodulators. One study found Xeomin’s duration to be longer than Dysport or Botox, which both fared about the same; however, more studies will need to be done to come to a definite conclusion.

Xeomin Dosage

Xeomin is dosed roughly the same as Botox, with around 10 to 30 units needed for each injection site.

The Bottom Line

As you can see, the difference between tox brands is relatively small but can be significant for certain patients with sensitivities to the proteins in one or the other, for example. It’s also important to remember that these slight differences mean that one brand of tox may work better for you than another, so don’t be afraid to speak to your injector about trying different options at your next visit, especially if you’re seeing the effectiveness of your tox regimen wane. Lastly, always choose a highly experienced injector to ensure you get the best results from your regimen.