While Botox Cosmetic may be the most famous of the bunch, Dysport and Xeomin contain the same type of toxin, and work by identical means—blocking the release of a chemical messenger called acetylcholine to lessen muscle contractions for three to four months in most cases. “The overall gestalt of neurotoxins is that there is no one best—they all fill different niches,” says New York dermatologist Paul Jarrod Frank, MD, due to slight distinctions between final formulations.
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Beyond an unrivaled track record— “it is the most tried-and-true,” says New York dermatologist Macrene Alexiades, MD—Botox Cosmetic is famous for its potency. “Patients with very strong muscles, and those wanting a complete block, tend to prefer it because it really gives a precise and powerful correction,” says Philadelphia plastic surgeon Ivona Percec, MD, PhD. Dysport reportedly kicks in faster than its competitors— within a couple days opposed to a week. It also “diffuses a bit more into its surroundings, making it ideal for treating a high forehead or a long stretch of crow’s-feet, or for softening the bands of the neck,” says New York dermatologist Heidi Waldorf, MD. Injectors commonly describe its effect as softer and smoother, “theoretically due to the diffusion,” notes Dr. Percec, “but the data isn’t definitive.” Xeomin is also known for its mild manner, but more so for its peerless purity, as it omits the complexing proteins present in other neurotoxins, “which may play a role in immunogenicity, or the fact that a small percentage of patients don’t respond as well to Botox [and Dysport] after many years of use,” explains Dr. Alexiades. The purpose of the proteins is debatable, but they’re thought to help stabilize the drugs. “While there’s very little evidence of immunogenicity in cosmetic doses, I have had a handful of patients—very few in more than 30,000 treatments—who’ve become inexplicably unresponsive to Botox,” says Chicago facial plastic surgeon Steven Dayan, MD. In those cases, switching them to Xeomin “usually remedies the problem.” Still, he adds, “it’s hard to say definitively if Xeomin is successful because of the lack of proteins, but some speculate it may be.”
Such nuances are largely anecdotal, we should note, and experienced injectors say they can achieve similar results with all three toxins—essentially leveling the playing field between brands. Much comes down to individualized injection technique (a point of pride among doctors) and a little thing called reconstitution—the act of restoring these powdered toxins back to liquid form with saline prior to injection. “This step can differ among injectors, changing clinical outcomes,” says Miami dermatologist Joely Kaufman, MD. A high dilution can beget a quicker onset and more spread— across the board. Boosting the dose of any will give a stronger, more lasting effect. The bottom line: Find a doctor proficient in all toxins, not just one, who can handily manipulate them to suit your unique anatomy and aesthetic goals.