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

By Dr. Stephen Cosentino

While Botox® remains the most popular injectable cosmetic treatment derived from botulinum toxin type A, it now shares the market with alternatives like Dysport® and Xeomin®.

Background and FDA Approvals

To understand the current landscape of injectable treatments, it's essential to know when each product entered the market:

Botox: First FDA-approved for cosmetic use in 2002 for treating glabellar lines (frown lines between the eyebrows). It had been in medical use since 1989 for treating eye muscle disorders.
Dysport: Received FDA approval for cosmetic use in 2009, initially for treating cervical dystonia and glabellar lines.
Xeomin: The latest to join the U.S. market, gaining FDA approval for cosmetic use in 2011, initially for glabellar lines.

Key Differences in Formulation and Mechanism of Action

While all three injectables use botulinum toxin type A as their active ingredient, they have distinct formulations:

Botox: Contains complexing proteins and requires refrigeration.
Dysport: Also contains complexing proteins but has a lower molecular weight, which affects its diffusion properties.
Xeomin: Known as a "naked" injectable because it lacks complexing proteins, potentially reducing the risk of antibody formation.

These formulation differences can impact how each product behaves when injected and how it interacts with the patient's body.

Diffusion Properties and Application Techniques

The diffusion characteristics of these products significantly influence 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 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 essential.

FDA-Approved Indications and Off-Label Uses

While all three products are primarily used for cosmetic purposes, they have different FDA-approved indications:

Botox: Has the most FDA-approved indications, including both cosmetic applications (glabellar lines, crow's feet) and medical applications (chronic migraine, hyperhidrosis).
Dysport: Approved for glabellar lines and cervical dystonia.
Xeomin: Initially approved for glabellar lines, with subsequent approvals for various medical conditions.

However, because all three injectables use the same active ingredient, they are often used off-label for similar purposes.

Cost Considerations

The cost of these treatments can vary based on several factors:

Botox and Xeomin: Generally have similar cost profiles, ranging from $10 to $20 per unit.
Dysport: Typically costs less per unit (starting around $5), but is less concentrated, requiring more units for the same effect. This often results in a similar overall cost for treatment.

It's important to note that costs can vary significantly depending on the provider, geographic location, and specific treatment areas.

Onset and Duration of Results

While all three products produce similar results, there are some differences in how quickly they take effect and how long the results last:

Botox and Xeomin: Results typically appear within 3-4 days, with full effects visible within 1-2 weeks.
Dysport: Often shows results faster, within 1-2 days.

For all three products, results typically last 3-6 months, depending on the individual and the dosage used. Research has shown that Dysport has an 82% success rate after three months.

Safety and Side Effect Profiles

All three injectables have similar safety profiles and potential side effects, which can include:

Temporary bruising or swelling at the injection site
Headache
Drooping eyelids (rare)

Xeomin's lack of complexing proteins may make it less likely to cause allergic reactions or decreased efficacy over time due to antibody formation. However, this theoretical advantage has not been definitively proven in clinical practice.

Choosing the Right Treatment for You

Selecting the most appropriate injectable treatment depends on many factors:

The specific area being treated
Your desired results
Your medical history and any previous experiences with injectable treatments
Your provider's expertise and preferences

A qualified healthcare professional can help you navigate these options and develop a personalized treatment plan. They will consider factors such as:

The size of the treatment area
The depth and severity of wrinkles
Your facial anatomy and muscle structure
Any potential contraindications or risk factors

Conclusion

Botox, Dysport, and Xeomin are all effective treatments for reducing the appearance of wrinkles and fine lines. While they share the same active ingredient, their unique formulations and properties make them useful for different applications and patient needs.

Botox remains the most widely recognized and used option, with a long track record of safety and efficacy. Dysport offers potential advantages in treating larger areas due to its diffusion properties, while Xeomin's "naked" formulation may benefit patients who have developed resistance to other products.

Ultimately, the best choice for you will depend on your individual needs, goals, and the recommendation of your healthcare provider. By understanding the differences between these products, you can have a more informed discussion with your provider and make a decision that best aligns with your aesthetic goals.