Botox versus Dysport

What is the difference between Botox and Dysport?

Both Botox Cosmetic (manufactured by Allergan Pharmaceuticals) and Dysport (manufactured by Medicis Pharmaceuticals) are highly purified forms of a neurotoxin (botulinum Type A) produced by the bacterium Clostridium Botulinum. The purification processes produce a slightly different chemical form of the toxin (onabotulinumtoxinA for Botox and abobotulinumtoxinA for Dysport) but the effects on the human nervous system are virtually identical.

There are a number of questions that have received a lot of attention and some disagreement:

• Should I be worried that Dysport is a new product?
  Not at all because Dysport is not new. It has been used in fifteen European countries since 1990. However, the injection amounts and techniques are different for the same treatment areas and most practices in the United States have more experience with Botox than with Dysport. Be sure your doctor or nurse is an expert injector, regardless of which medication is being used.
• Which medication takes effect faster?
  In clinical studies, the effects of Dysport consistently took effect one to three days faster than Botox.
• Which medication lasts longer?
  Clinical studies have shown slight variations in both directions but recent studies have concluded that the longevity of both products is the same.
• What is the difference between a unit of Botox and a unit of Dysport?
  Depending on the area being treated, between two and three units of Dysport are equivalent to one unit of Botox. Since the conversions are not the same for all treatment areas, you cannot directly compare units between the two medications.
• Does Dysport have a greater diffusion ratio than Botox?
  The diffusion ratio is another way of saying how fast and how far the medications spread out from the injection points. This is important because, if the medication spreads out too far, it will affect muscles that were not the target of the treatment. When this occurs, it can cause temporary eyelid droop (ptosis), lowering of the lip, or facial asymmetry. Both Botox and Dysport are distributed as tiny amounts of frozen medication that must be reconstituted and diluted, usually with nonpreserved normal saline solution. The manufacturers provide recommended dilution amounts and Dysport recommends about three times more dilution than Botox. This means that three times as much liquid volume is injected for a Dysport treatment than for the same Botox treatment. The greater volume means that Dysport has a greater chance of diffusing into muscles not targeted by the treatment. However, the experience and technique of the doctor or nurse performing the injection is much more important. Also, clinical trials in which a lower Dysport dilution was used (2.5:1 instead of 3:1) produced no significant difference in diffusion ratios between Dysport and Botox.
• Can Botox and Dysport treat the same areas?
  Because of the greater dilution of Dysport, Skin Care By Design does not recommend it for treating fine lines around the mouth or bunny lines near the eyelids. We use either medication for the forehead, glabellar (between the eyebrows), and periorbital (crow's feet) areas. Excessive underarm sweating (hyperhidrosis) can be treated with Botox but Dysport is not currently used for that purpose.
• Should there be price differences for the same treatment areas?
  When Dysport was initially released, the recommended dilutions made Dysport about 10% less costly than Botox. However, many practices found that a higher concentration of Dysport was needed to achieve the same results as Botox and this made the prices nearly identical. Skin Care By Design has the same price for Dysport and Botox treatments. This allows you and your skin care nurse to decide between the medications based on a medical examination and a discussion of your own preference and experience, rather than on price.

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