BotoxR , Dysport and Xeomin
What is the difference between the three?
What do the studies in the literature say?
There are currently 3 FDA approved Neurotoxins that are used for cosmetic purposes.
The 3 Neurotoxins include:
1)Botox Cosmetic whose generic name is onabotulinumtoxinA.
2)Dysport which is abobotulinumtoxinA.
3)Xeomin is icobotulinumtoxinA.
The above neuromodulators or neurotoxins are all Serotype A toxins.B They are all produced by gram positive anaerobic bacteria called Clostridium botulinum.B There are 7 serotypes in all (A-G).B They work by blocking release of acetylcholine from the neuromuscular junction which in effect causes paralysis of the muscle.
Dr. Scott who was a ophthalmologist working at UCSF and was instrumental in working out the medical application for using botulinum toxin from 1972 to 1989.B B Dr. Jean Carruthers was working with Dr. Scott and starting using the neurotoxin to treat the same conditions.B During her treatment of spastic muscles around the eyes, her patients noticed an improvement of glabellar lines when the procerus and and corrugators were treated.B B These are the muscles that cause frowning and lines between the eyes.B Dr. Carruthers and her husband Dr. Alastair CarruthersB published the first papers on using neurotoxins for cosmetic purposes in the 90b s.B B B I was lucky enough to be trained by Dr. Jean Carruthers on the use of Cosmetic BotoxR B over 12 yrs. ago.
There has been over 20 years of experience using the first 2 neurotoxins with approval in over 80 countries.B They have been shown to be safe and effective.
What are the comparison of Units?
2.5-3.0 units of Dysport =1 unit of BotoxR B from most published studies.1-3
1 unit of BotoxR = 1 unit of Xeomin.
Since 2012 there has been 12 clinical and preclinical studies that directly compared Botox Cosmetic with Xeomin.
Despite the studies were designed differently, had different dilutions and different injectors with different experiences and there were different definitions of response/duration of actions they showed the two to be equal in potency and duration.
These studies compared treatment of Crowb s feet, axillary hyperhidrosis, blepharospasm, glabellar lines and cervical dystonia.
Jandhyala4 B inB 2012 did a meta-analysis in which over 12 clinical studies wereB compared and analyzed.B The firstB analysis was of 8 studies that had 1816 patients, and 11 studies that were relevant to the question of potency. The conclusion to the studies were thatB both BotoxR and Xeomin were effective in achieving response and the difference between the two were not clinically significant.
The weight of the 11 clinical studies and preclinical studies showed no difference in relative to potency of the 2 products.B The two formulations should be considered equipotent based on the above studies.4
I found 10 studies in the literature comparing Dysport to BotoxR.B Like the previous studies, they were designed differently with different dilutions and different definitions of response. The conversion ratios were mostly 2.5:1 or 3:1 Dysport to BotoxR.
The majority of the studies 6 out of 10 studies showed no difference in the potency or how long the effect last between the 2 products.B Three studies showed Dysport to last longer and 1 favored BotoxR .6-15
Kerscher5 compared the spread of the 3 toxins.B This was a double-blinded, randomized single-center comparing the spread of the 3 formulations after forehead injections.B There were equal injection volumes for each one.B The conclusion was that Xeomin and Botox had comparable spread at 6 weeks and Dysport had signficantly greater spread than Xeomin and Botox at 6 wks.B I like to concentrate the Dysport more than the other two to get a more preciseB paralysis of the muscles treated.
In conclusion the studies showed that all three neurotoxins were effective and safe.B At the correct dosages and conversion ratios;B all were equally effective and lasted about the same time. There might be diffuse a little differently based on the dose and dilutions.
1 .Netter KD et al.B Arch Facial Plast Surg. 2011;136(6):380-386.
2 .Hambleton P et al.B J R Soc Med 1994;87:719.
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- Kerscher M. et al. Arch Dermatol Res. 2012;304:155-161.
- Kassir R et al. Dermatol Ther (2013)3:179-189.
- Rappl T. et al. Clin Cosmet Investig Dermatol. 2013 Sep 24;6:211-9.
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