Botulinum toxin works by inhibiting the release of a neurotransmitter, acetylcholine, by the nerve cells. This prevents the nerve signals from being released by the cells, and hence, neuromuscular blockage. Cilnically, what we see is reduced muscle movements- and reduction of dynamic wrinkles. The wrinkles are “erased”.
Botox: The First Approved Botulinum Toxin
In 2002, the USA FDA approved the use of BOTOX® Cosmetic to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). It ushered in a new era for medical aesthetics.
The second BoNT to be approved for the same purpose was Dysport, in 2009, followed by the 3rd, Xeomin, in 2011. Equivalence studies have shown that all 3 brands of BoNT work on reducing wrinkles. However, there are some significant differences between the 3.
Executive Summary BOTOX vs DYSPORT vs XEOMIN
The manufacturing process is slightly different with all 3, which leads to some potential, subtle differences in clinical practice.
Xeomin® is the only one of the three (Xeomin®, Botox® and Dysport®) injectables that does not need to be refrigerated before use, due to its lack of additives.
The cost of Xeomin® is roughly the same as for Botox at $5.00-5.40 per unit.Dysport® is about $3.99 per unit.
Patients average 20 units of Xeomin® per visit, vs. 20 units of Botox and 40 units of Dysport®.
The average retail cost to a patient in the US, for a Xeomin® treatment, is between $300.00 – $400.00 every 3 months based on the recommended dose of 20 Units per treatment session.
Xeomin® might have the slowest “onset” of action of the 3 (Dysport® onset in 24 hours, Botox onset in 72 hours, and Xeomin® onset in 4 days.)
Xeomin® may be “mildly more convenient” than Botox® or Dysport®, as the “product’s lack of complex proteins will help prevent antibody formation, or resistance to neuromuscular treatment with botulinum type A toxin, in patients being treated for neuromuscular conditions.”
Neurotoxins diffuse differently, in part because Botox® and Dysport® have protective proteins clustered around the active part of the molecule, while Xeomin® has no protective proteins.
Botox® has a full complement of protective proteins and weighs about 900 kD. Dysport® is a mixture of 500 kD and 300 kD complexes of protective proteins and botulinum toxin A. Being heavier, these complexes migrate more slowly than Xeomin/NT-201, which is BTX-A without protective proteins. Conversely, you will have less precision.
Dysport® has been shown to “drift” or diffuse more than Botox, increasing the chances of an accidental droopy eyelid or unintentional relaxation of a neighboring muscle due to diffusion of the product.
Botox® and Dysport® are not interchangeable because the products are dosed and injected differently.