Botox, Dysport or Xeomin: Are all Botulinum Toxin-Based Injectables Created Equal?
Being over 40, I’ve been invited to my share of Botox parties - AKA ‘Come to my house, get a shot of Botox and then we’ll celebrate with champagne!’ parties. Everyone and their mother (especially their mothers) swear by the power of Botox and its almost magical ability to shave years off your forehead, eyes and mouth. In my opinion Botox seems to be my generation’s temporary fountain of youth. And after a little exchange with my 10 year-old son, I am beginning to think it might be time to seek out a wrinkle remedy that will help me to look less angry, (getting rid of my permanently furrowed brow).
It went a little something like this:
Son: “Mommy, why are you angry?”
Me: “I am NOT angry.”
Son: “Then why do you have all the lines on your forehead like you are mad at me?”
The good news is that there are now three injectable neuromodulators derived from botulinum toxin —agents which block the nerve impulse from the nerve and paralyze the muscle so it doesn’t contract and cause wrinkling—that one can use to stave off wrinkles. Botox, Xeomin and Dysport are three versions currently available.
Botox (manufactured by Allergan and FDA-approved since 1989), Dysport (manufactured by Medicis and FDA-approved since 2009), and Xeomin (manufactured by Merz and FDA-approved since 2011), all temporarily alter the nerve impulses to their muscles, therefore reducing or eliminating contraction-induced wrinkles.
So what are the differences, if any, between these three injectable neuromodulators? According to New York City-based board-certified plastic surgeon, Steven G. Wallach, MD, they probably all work pretty well, given that he’s used Dysport and Botox quite frequently, but acknowledge not trying Xeomin just yet.
“Botox is made with an added protein which separates from the botulinum toxin after injection as opposed to Xeomin which is purely the toxin or naked toxin,” says Dr. Wallach. “I think that they are pretty equivalent, however most physicians have used Botox and are more comfortable with the dose needed and the results obtained with Botox.”
Studies show that all three products are equivalent in terms of their efficacy and the duration of their results.
“In many instances if the animation lines are not deep, they will efface with use after the first treatment. It may take repeated use over time to get the desired effacement of the lines,” says Dr. Wallach. “The effects usually last about 4 months, sometimes, a bit longer.”
Of course we all need to have realistic expectations, notes Dr. Wallach, who adds that patients with a heavy brow or severe brow ptosis may not be a good candidate for any of these agents. Risks include minor bruising, swelling and sometimes post treatment pain. Other issues include potential allergic reactions, and eyelid or eyebrow ptosis.
A brow lift is an additional option for patients with a heavy brow. The brow lift raises the brow, softens the transverse forehead lines, and softens the "11" lines that occur with corrugator hyperactivity. It can also be performed to shorten or elongate the forehead.
Dr. Wallach uses Botox more frequently, because of brand recognition and the fact that his patients know about Botox more than the other products.
So what does that mean for patients? Since there is not that much of a difference between these botulinum toxins, as a patient, the most important thing is to seek out a doctor who has a solid injection technique and experience, and let them decide which medication they feel comfortable using until further evidence of a significant difference or an advantage becomes proven.
Additionally, Dr. Wallach notes that Botox parties are typically not appropriate in a non-medical office especially if alcohol is being served. “If you are going to undergo Botox, it is wise to research one of the core four physicians that have experience with aesthetics; board-certified plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists,” notes Dr. Wallach
Ultimately, I’m open to any of the three if it means looking a little friendlier to my little ones and shaving a few years off of my 40-something face. Good to know that they’re all pretty much comparable and likewise, I can do a bit of cost-comparison shopping.