To most Tampa residents it almost seems like a dream come true, but since the release of Botox over ten years, wrinkles can be made to disappear in a safe, effective, and non-invasive manner. Botox, and the recently introduced Dysport, are both different formulations of the protein, botulinum toxin type A, produced by the bacteria Clostridium botulinum. This protein is considered a neuromuscular blocking agent because it decreases the ability of nerves to stimulate muscles and cause subsequent contraction. Currently Botox and Dysport are approved by the United States Food and Drug Administration (FDA) for the treatment of spasms, dystonia, excessive sweating (i.e. hyperhidrosis)and vertical wrinkles between the eyebrows. All other uses are considered off-label even though these alternative techniques represent the most prevalent utilization of Botox.
When injected in small amounts into the upper and mid-face, the underlying muscles are weakened, decreasing their ability to cause visible wrinkling of the overlying skin (click here to learn about Face Lift Surgery and facial aging). These agents have been used effectively for the treatment of vertical lines between the eyebrows (i.e. glabellar lines), forehead wrinkles, crow’s feet, chin wrinkles, vertical neck cords (i.e. platysmal bands), and even for vertical folds between the nose and upper lip (i.e. nasolabial folds). Results are temporary, lasting two to six months depending on the product used and area injected. Though rare and self-limited, side effects consist of pain at the injection site, bruising, and paralysis of unintended muscles if the product diffuses away from the target muscle.
Botox is a 900-kDa formulation of botulinum neurotoxin type A. It has been used to treat facial wrinkles since the early 1990’s and is the best studied neuromuscular blocking agent currently marketed for cosmetic applications. Botox comes packaged in 100-unit bottles and is reconstituted in 4 cc of saline prior to injection. Average doses vary on a patient to patient basis, but typically twenty to thirty units are used for vertical wrinkles between the eyebrows (i.e. glabellar lines), thirty units for the forehead, and ten to fifteen units per side for crow’s feet. Results are visible within three to five days and last for four to six months depending on dose and area injected.
Dysport is a recently introduced 500- to 900-kDa formulation of botulinum neurotoxin type A. It has been available in Europe for several years but was just introduced and approved for use in the United States. Dysport is packaged in 300- and 500-unit bottles and is reconstituted in 0.6 cc and 1cc of saline, respectively. Like Botox, average doses vary, but typically fifty units are used for glabellar lines. Results are variable, but typically are visible in two to four days and last three to four months. In general, Botox is four times more potent than Dysport and doses of Dysport must be two to four times that of Botox to achieve a similar effect. Differences in the effectiveness of these toxins likely relates to the strain of bacterium used for production, preparation, and the addition of inactive ingredients. One added protein, albumin, and carries the theoretical risk of virus transmission, though this has not been documented in the literature. Additionally, although high-quality clinical trials are currently lacking, initial studies suggest that Dysport is more likely to diffuse to nearby muscles when injecting the small muscles of the face; thus, there is a theoretical increase risk for unintended effects.
In summary, both products produce the same result with the onset of action of Dysport slightly faster than Botox (2-3 days vs. 3-5 days), while the duration of effect is slightly longer with Botox than Dysport (4-6 months vs. 3-4 months). Dysport is less potent on a unit-per-unit basis than Botox thus, more Dysport is injected per site than Botox. The cost of the two products is similar, though, manufacturers of Dysport are occasionally offering introductory specials. Call today for more information or to schedule a consultation.
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