• Dysport and Botox Explained

  • What are Dysport and Botox?
    Dysport and Botox are referred to as neurotoxins or neuromuscular blocking agents and are derived from botulinum toxin. They are an effective, no down-time, non-surgical treatment that work by relaxing facial muscles, thereby reducing frown-lines and wrinkles.
    Botulinum toxin was first studied for medical use in the 1960’s. In 1989 botulinum toxin was FDA approved to treat strabismus (imbalance of muscles controlling the eye) and blepharospasm (uncontrollable spasms of the eyelid). In 1992 treatment of glabellar (area between the eyebrows) frown lines was first described.
    In 1997 the present formulation of Botox was approved for distribution for medically indicated purposes. It was not until 2002 that Botox received its FDA approval for the cosmetic treatment of glabellar frown lines. This is the only approved cosmetic treatment, all other cosmetic treatments using Botox are “off label” uses but are widely accepted standards of care. Dysport received FDA approval to treat glabellar frown lines and cervical dystonia (spastic contractions of neck muscles) in April, 2009. Like Botox, other cosmetic treatments are “off label” but are nationally accepted standards of care. Even though it was only recently introduced to the US market, Dysport is not a new product. It was first used in England almost 20 years ago and is now widely used in 76 countries throughout Europe, Asia, and South America.

    How does Dysport and Botox Work?
    The active agent for both products is the neurotoxin Botulinum Toxin Type A which is extracted from the toxin of the bacterium Clostridium Botulinum. This toxin works by blocking the release of the neurotransmitter acetylcholine which is the messager that travels from the end of the nerve to the muscle fiber. Because the muscle fiber does not receive the message to contract it stays relaxed and will not contract.
    Once the toxin attaches to the nerve ending, it never lets go (irreversibly binds). If the toxin binds permanently you may be wondering why does the muscle function return? After treatment, new pathways to release the acetylcholine are made (regenerated) and the muscle’s ability to contract gradually returns. So after treatment it’s really how fast new nerve to muscle communications grow back that determines how long the muscle will stay relaxed.
    Dysport and Botox are both used in the same fashion. The agent is injected into some of the muscles that control facial expression which lie just beneath the skin. Injections are performed at sites where these muscles are too strong or too active. After injection the muscle(s) relax, which helps to restore facial expressions such as helping to elevate sad, angry looking brows or prevent frowning when the individual is not even aware he or she is doing it. Because the skin in the treated area is not being constantly folded, skin creases and furrows gradually improve. Deep creases and furrows are further helped by using dermal fillers. It should always be remembered that there is significant variations in facial muscle strength and the expressions that individuals habitually use. Treatments must be taylored to the individual. Sometimes adjustments are made to the location of the injection sites at subsequent treatment sessions to achieve optimal results. Those with larger, stronger and more active muscles will tend to take longer to see results and see a return of function sooner. They may also need a larger dose. Repeated treatments gradually weakens the muscles and the duration of the relaxation often increases after multiple consequetive treatments.

    Is There a Difference Between Dysport and Botox?
    In both products the active agent, the toxin, is the same and therefore both products work basically the same. However, in both products the toxin is attached to a carrier protein and herein is a difference. The carrier protein is smaller for Dysport than for Botox. Because it is smaller, Dysport tends to spread faster and over a wider area than Botox.The photos below are examples of these two differences between Dysport and Botox.Many feel that Dysport lasts longer than Botox. Studies show some support of these observations. When the results of the studies of Botox are compared with the results of studies of Dysport, Dysport has a slightly higher rate of patients maintaining their results at 60, 90 and 120 days. But it should be pointed out that there have been no good studies that were designed to directly compare the longevity of Botox to Dysport. So it should be considered that the “jury is still out” on this potential difference. Since the toxins are the same for each product and the return of funtion is related to the regeneration of neurotransmitter pathways it makes no sense that the return of muscle function is different between the products. So why do so many contend that Dysport results lasts longer? Based on my brief experience and review of studies I feel that because Dysport spreads better it more thoroughly treats a wider area. So there is less skin motion in that area which maintains the aesthetic result longer even as muscle function returns. For example, look closely at my photos. My contraction is just a little bit stronger at five weeks than at one week. But look at my relaxed photos the creases have continued to improve at five weeks even as there has been a slight return of function.

    To summarize the advantages of Dysport:
    1 Most patients will have faster results than Botox , many within 24 hours!
    2 Most patients treated with Dysport will have the effect spread wider from the injection site for more thorough treatment of the area than with Botox.
    3 Dysport may last longer than Botox.