Face Off: Comparing Botox®, Dysport®, and Xeomin®

Author

Dr. Stephen Cosentino

Although it’s still the most popular by far, Botox® is no longer the only injectable cosmetic treatment derived from botulinum toxin type A. It now shares the space with alternatives like Jeuveau®, Dysport®, and Xeomin®.

Jeuveau is a relative newcomer, while Dysport and Xeomin are more established in the marketplace, so we’ll focus our comparative analysis on those two. Read on to learn about the differences between Botox, Dysport, and Xeomin — and how to decide which is best for you.

History and FDA Approval

Botox was the first botulinum toxin product to receive FDA approval for cosmetic use in 2002, specifically for treating glabellar lines (frown lines between the eyebrows). This approval came after decades of medical use, as Botox was initially approved in 1989 for treating eye muscle disorders.

Dysport received FDA approval for cosmetic use in 2009, making it the second botulinum toxin product available in the U.S. market for aesthetic purposes. It was initially approved for treating cervical dystonia and glabellar lines.

Xeomin was the latest to join the U.S. market, gaining FDA approval for cosmetic use in 2011. Like Dysport, it was initially approved for glabellar lines.

Botox vs. Dysport vs. Xeomin: Key Differences

While chemically similar, these three injectable treatments aren’t identical. Their key differences include their formulations, indications for use, cost, dosage, results, and risk profile.

Active Ingredients & Additives

Botox, Dysport, and Xeomin all use botulinum toxin type A as their active ingredient. This powerful neurotoxin temporarily paralyzes muscles near the injection site, which can temporarily reduce the appearance of fine lines and wrinkles.

Botox, Dysport, and Xeomin each have proprietary formulations. This means two things:

The molecular weight of the botulinum toxin component varies, with Dysport being significantly more dilute than Botox or Xeomin
They have different nonactive ingredients (additives) or lack thereof — Botox and Dysport both have additives that affect their performance, while Xeomin is a “naked” botulinum toxin formulation

Indications for Use

Botox has been on the market longer than Dysport and Xeomin and thus has more FDA-approved indications. These include cosmetic applications like treatment of glabellar lines (frown lines) and crow’s feet as well as medical applications like chronic migraine and hyperhidrosis treatment.

However, because all three injectables use the same active ingredient, they have similar practical indications. Some providers prefer Dysport injections for treatments covering larger areas of the face because its lower molecular weight promotes diffusion away from the injection site. We’ll dive into these differences in the next section.

Diffusion Properties and Treatment Impact

The diffusion properties of these products play a significant role in their application and effectiveness:

Botox has a moderate diffusion rate, allowing for precise targeting of specific muscles. This makes it ideal for treating smaller areas like crow's feet or for creating a subtle brow lift.

Dysport tends to diffuse more than Botox, spreading to a larger area after injection. This property makes Dysport particularly useful for treating larger areas like the forehead or for patients who want a more relaxed, natural look. However, it requires careful technique to avoid affecting unintended muscles.

Xeomin has diffusion properties similar to Botox. Its "naked" formulation, free of complexing proteins, was initially thought to potentially increase its spread, but clinical experience has shown its behavior to be comparable to Botox.

These diffusion characteristics influence injection techniques. For instance, Dysport may require fewer injection points to cover the same area as Botox or Xeomin. Conversely, Botox and Xeomin might be preferred for more precise treatments where limiting spread is crucial. Practitioners must consider these properties when determining optimal injection sites, depths, and volumes for each product to achieve the desired aesthetic results while minimizing unwanted effects.

It's important to note that the clinical differences in diffusion between these products are often subtle and can vary based on individual patient anatomy, the specific area being treated, and the technique of the injector.

Cost & Amounts Needed

Botox and Xeomin have similar cost profiles. Retail units costs vary by provider and geographic region, but the general range is $10 to $20 per unit for both.

Dysport costs less than Xeomin and Botox. Unit costs begin around $5. However, Dysport is only about half as concentrated as Botox or Xeomin, so the same procedure requires about twice as many units of Dysport (and sometimes more). Therefore, the net cost is similar for all three.

Results & Side Effects

Botox, Xeomin, and Dysport have similar mechanisms of action and thus produce similar results in patients. However, as noted, Dysport is more dilute and is thus more likely to diffuse farther away from the injection site. This is useful for cosmetic treatment plans covering broad areas of the face and neck.

Results last similar lengths of time for all three medications: three to six months, depending on the patient and dosage. Notably, research has demonstrated that Dysport has an 82% success rate after three months. Dysport results typically appear earlier than Botox or Xeomin: one to two days vs. three to four days. For all three, full results generally appear within one to two weeks.

The risk profile is similar for all three medications, with similar reported side effects and complication risks. However, because it lacks additives that can sometimes (though rarely) trigger allergic reactions in patients and may generate immune responses that reduce efficacy over time, Xeomin is regarded as more effective for repeat patients and those who’ve seen unsatisfactory results in the past.

Making an Informed Choice Between Botox, Dysport, and Xeomin

Botox®, Dysport®, and Xeomin® each offer unique benefits and characteristics that cater to diverse patient needs. While Botox remains the most recognized and widely used option, Dysport and Xeomin have established their own niches with distinct advantages, such as quicker onset and a "naked" formulation, respectively.

Choosing the right product for you depends on a variety of factors, including the treatment area, desired results, and individual patient characteristics. You can better understand which one may be the best for you by consulting with a qualified professional. That expert can discuss your goals, explore your options, and develop a personalized treatment plan that enhances your natural beauty while minimizing risks.

Whichever botulinum toxin product you ultimately choose for your next anti-aging injection, be sure to work with a certified provider who has completed a comprehensive, accredited injectables training course. This is the surest way to reduce your risk of adverse effects and/or unsatisfactory results.