Botox vs Dysport vs Xeomin

What is the difference between Botox, Dysport, and Xeomin?

Botox Cosmetic (manufactured by Allergan Pharmaceuticals), Dysport (manufactured by Medicis Pharmaceuticals), and Xeomin (manufactured by Merz 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, abobotulinumtoxinA for Dysport, and incobotulinumtoxinA for Xeomin) but the effects on the human nervous system are virtually identical. Skin Care By Design currently offers Botox and Dysport because there are situations in which one product is slightly preferable to the other. We do not offer Xeomin because it is administered and acts the same as Botox.

Botox and Xeomin, have exactly the same units, are reconstituted and administered in exactly the same way, and take effect in the same amount of time, which makes it relatively easy for a practice that uses Botox to add or switch to Xeomin. Because everything about the treatment process is identical, Botox and Xeomin prices can be compared directly. The difference between Xeomin and Botox is that the Botox molecule is stabilized with a protein "wrapper" while the Xeomin molecule is "naked". The smaller Xeomin molecule is less likely to stimulate the development of antibodies. However, only about 1 in 10,000 Botox patients develop these antibodies so a small reduction in this rate is not significant.

Dysport has different units than Botox and Xeomin, it is reconstituted differently, and it takes effect one to three days faster. The injection amounts and techniques are different for the same treatment areas, which makes it more difficult for a practice that uses Botox or Xeomin to add or switch to Dysport. It also makes it more difficult to compare prices.

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

• Should I be worried that Dysport and Xeomin are newer products?
  Not at all because neither Dysport nor Xeomin are new. Dysport has been used in fifteen European countries since 1990 and Xeomin has been used in over twenty countries since 2010. However, the injection amounts and techniques for Dysport are different than those for Botox and Xeomin and most practices in the United States have more experience with Botox. 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 or Xeomin.
• Which medication lasts longer?
  Clinical studies have shown very slight variations in each of the medications but recent studies have concluded that the longevity of all three products is the same.
• What is the difference between a unit of Botox, a unit of Xeomin, and a unit of Dysport?
  Botox and Xeomin units are identical. Depending on the area being treated, between two and three units of Dysport are equivalent to one unit of Botox or Xeomin. Since the conversions are not the same for all treatment areas, you cannot directly compare units between Dysport and the other two medications.
• Does Dysport have a greater diffusion ratio than Botox or Xeomin?
  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. Botox, Dysport, and Xeomin are distributed as tiny amounts of 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 or Xeomin. This means that three times as much liquid volume is injected for a Dysport treatment than for the same Botox or Xeomin 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, Botox, and Xeomin.
• Can Botox, Dysport, and Xeomin 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. Any of the medications can be used for the forehead, glabellar (between the eyebrows), and periorbital (crow's feet) areas. Excessive underarm sweating (hyperhidrosis) can be treated with Botox but Dysport and Xeomin are 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. Xeomin has always been priced identically to Botox. 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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