One of the current debates in the non-surgical aesthetic world remains: Botox or Dysport? Why or when would a physician choose one over the other?
First a little background: Both fall into the category of botulinum toxin type A, which means they have the same mechanism of action. They prevent the release of acetylcholine into the neuromuscular junction by cleaving SNAP-25. Both are indicated for the treatment of glabellar frown lines. Botox® was FDA approved for cosmetic use in 2002 but its use was popularized well before. Dysport™ was just recently FDA approved in the spring of 2009 but has been widely used in Europe since the early nineties. Since the release of Dysport™ in the United States, new names have been given to each. Botox is now labeled as onabotulinumtoxinA and Dysport is labeled as abobotulinumtoxinA. Both have a shelf life of 24 months unconstituted and stored in the refrigerator. Manufacturers recommend use within 4 hours of reconstitution, although many studies have been performed showing efficacy beyond 5 weeks after reconstitution. Manufacturers recommend dilution of both with non-preserved saline, although most physicians use preserved saline.
Botox® comes in 100 unit vials whereas Dysport™ comes for cosmetic use in 300 unit vials. One important point to note is that dilution is different between the two products. One unit of Botox® does NOT equal one unit of Dysport™. Rather, one unit of Botox® is equal to about 2 to 3 units of Dysport™. I reconstitute my Botox® with 2 to 2.5cc of preserved saline, making the dilution 5 or 4 units per 0.1cc, respectively. I reconstitute my Dysport™ with 3cc of preserved saline, making the dilution 10 units per 0.1cc.
Botox® is a slightly heavier weight compound (900kD vs ≥ 300kD). Botox® is vacuum dried in NaCl and albumin. Dysport® is freeze-dried in lactose and albumin. Given this compounding with lactose, there are trace amounts of cow milk protein in Dysport™ so one must be careful in patients with a cow milk allergy. In this instance, I would consider Botox™ over Dysport™ .
The remaining questions that may play into your decision to use one over the other are: what is the onset of action? It has been said that Dysport ™ has a quicker onset of action; some seeing results in as little as one day. Does one last longer than the other? Unknown, really. Does Dysport have a greater dispersion area? Also controversial. One other consideration may be price point. A vial of Botox® is a little more expensive than a vial of Dysport™ .
Bottom line: both products are very similar and both are very effective.
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