Botox, Dysport and Xeomin - what's the difference?

There are 3 brands of botulinum toxin available in Australia:
Botox – produced by Allergan - the American brand.
Dysport – produced by Galderma - the European brand.
Xeomin – produced by Merz - the German brand.

botox vs dysport vs xeomin

The similarities and differences between these products will be outlined below.

Botulinum Toxin Type A
Botox, Dysport and Xeomin all contain the same active ingredient: botulinum toxin A. Click here to learn how botulinum toxin works to paralyse muscles.

Botox was the first of the 3 to gain approval for use - in 1999 in Australia - and almost 30 years ago in the USA. Since then, Botox has become synonymous with erasing wrinkles. Dysport then came along as a slightly cheaper alternative and has steadily gained market share. Xeomin is the newest brand of botulinum toxin on the market.

Accessory Proteins and Resistance
While Botox, Dysport, and Xeomin are all made up of botulinum toxin type A, their composition differs in the amount of accessory proteins that surround them. Botox has the most accessory proteins, so it is considered the ‘heaviest’ injectable. Dysport has a considerably lower amount of added proteins. Xeomin has no accessory proteins, which makes it the purest form of botulinum toxin.

Juergen Frevert was the biochemist heading the team responsible for reducing the protein load of Botox by 6 fold due to resistance issues noted back in 1996. He then transferred to Merz and developed Xeomin, which has undergone additional steps in manufacturing to achieve its pure-form botulinum toxin containing no proteins. Due to the large amounts of accessory proteins contained in Botox, patients may develop antibodies to it, resulting in tolerance. This means you will need higher and higher doses to achieve the same effect. For some patients, the effectiveness can be restored by stopping use of the botulinum toxin for a period of time (generally 2-3 years) and allowing the antibodies to disappear, but for others the immunity is permanent. Unfortunately, once you have developed resistance to Botox, there is no known cure for it. To reduce your risk of developing resistance to botulinum toxin, do not use large doses of Botox or Dysport.

In terms of transport and storage, both Botox and Dysport require to be refrigerated at all times. Xeomin does not have this requirement as there are no proteins that can be denatured, so there is less chance of the Xeomin formulation being weakened during transport or storage due to breaches in cold chain.

Strength and Volume
Botox and Xeomin strengths are interchangeable. For example, 40 units of Botox is equivalent to 40 units of Xeomin. These 40 units are contained in 1ml of saline. Dysport requires 2.5 times more units to be equivalent to Botox and Xeomin. For example, 100 units of Dysport is equivalent to 40 units of Botox and Xeomin. However, Dysport is more concentrated than Botox or Xeomin when mixed correctly. As previously mentioned, 40 units of Botox should be mixed with 1ml of saline, whereas 200 units of Dysport should be mixed with 1ml of saline. There is slightly less pain and swelling with Dysport, as only half the volume is injected to get the same effect. For example, you would only need 0.5ml of Dysport (100 units) to be equivalent to 1ml of Botox or Xeomin (40 units).

There have been concerns raised about the diffusion of Dysport. Some injectors claim that Dysport diffuses into nearby muscles more readily than Botox or Xeomin. This could result in nearby muscles becoming paralysed unintentionally. For example, botulinum toxin injected into the frown muscles diffusing into the eyelid muscles, resulting in a droopy eyelid. In clinical studies, when Dysport is mixed in the correct concentration, the diffusion area was no different to Botox.

Onset of Action
This will vary from person to person, however, you will generally notice the onset of effects from:
2-3 days for Dysport
3-4 days for Botox
4-5 days for Xeomin
The effects peak at around 2 weeks for all 3 brands, before slowly losing effectiveness.

Duration of Effect
This depends on the dosage used. There has not been any significant difference in length of effectiveness amongst the 3 brands shown in clinical trials. Most doctors will agree that all 3 will last between 3 to 6 months. When used in low doses (such as for the lines around the mouth), the effectiveness may only last 2 months.

In general, injectors charge less for Dysport and slightly higher for Botox and Xeomin. Some injectors charge by area, whilst some charge per unit. When priced per unit, remember to multiply the unit price of Dysport by 2.5 times in order to compare it with Botox and Xeomin. You can often get a discount when using high amounts of botulinum toxin, or when treating more than 1 area. The general price ranges are shown below.

$3 to $6 per unit for Dysport = equivalent cost is $7.50 to $15 per unit
$9 to $16 per unit for Botox
$9 to $16 per unit for Xeomin

If you're wondering how many units of botulinum toxin you will need for your treatment, this is covered in a whole new article!

Which one is the best?
There is no clear superior botulinum toxin amongst the 3 major brands. Much of what your injector chooses will depend on how comfortable they are with the product. If you want to stick with what you know and don't mind paying a bit extra, then you may be leaning towards Botox. If you want a less expensive alternative that works a bit quicker, you may be leaning towards Dysport. If you are concerned about diffusion of Dysport or developing antibodies to Botox, you may be leaning towards Xeomin.

Which brand do you prefer?

All of them!

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