The U.S. Food and Drug Administration has approved a few different injectable neurotoxins. So how do we decide which is the best choice? While the training and experience of your injector should hold priority to the product choice, a quick comparison of Botox, Xeomin and Dysport, the only three botulinum toxin injectables approved by the FDA for treating facial aesthetics, may simplify this decision.
Botox, Dysport and Xeomin are made from the purified neurotoxin, botulinum toxin type A, that forces muscle relaxation. These nonsurgical injectables are FDA approved to treat frown lines between the eyebrows, cervical dystonia, blepharospasm (uncontrollable blinking), strabismus (misaligned or lazy eyes), chronic migraines and axillary hyperhidrosis (excessive sweating in the armpits) among other things. Off-label, Botox, Dysport and Xeomin are used for treating crow’s-feet, horizontal forehead lines, down-turned corners of the mouth and skin bands on the neck. All have minimal downtime and results generally lasting about three to six months, with Botox typically delivering results lasting from three to four months; Dysport, up to four months; and Xeomin, up to three months, however, the effect may last significantly longer, or shorter, depending on the patient.
Botox has the longest history of use and safety. It contains additional inactive neurotoxin proteins or “additives” that may increase the likelihood of antibodies [rejection of the neurotoxin]. Dysport is formulated with a smaller molecular structure than its competitors so many physicians feel that it acts faster. Dysport also contains additives, although in a reduced amount. Xeomin, approved in summer of 2011, is the most recent injectable approved for treating facial aesthetics. Because neurotoxin is the only active pharmaceutical ingredient in Xeomin, it is known as the “naked” neurotoxin and is believed to offer the shortest duration of results. However, this product has not been used for long in the United States and the information available about efficacy and patient satisfaction is still preliminary.
Choosing among Botox, Dysport or Xeomin mainly comes down to personal preference. As Richmond, VA, facial plastic surgeon Michael S. Godin, MD, says, “All three essentially treat the same thing, may have similar duration and yield comparable results. The important thing to understand is that the same basic molecule interacts with the muscle but is delivered in slightly different ways.” However, these small differences can mean slightly different responses. “It is nice to have three different treatment options because some patients may do slightly better with one treatment than another,” Dr. Godin adds. For example, patients with sensitivity to additive proteins, which can trigger the formation of antibodies and cause the neurotoxin to lose efficacy, could possibly see a greater benefit from Xeomin, which is reported to be free of these proteins.
Ask a skilled physician which injectable will be most suitable for your particular concerns. “Since all three options may give satisfactory results, the more important issue is the experience, knowledge and skill of the individual performing the injections,” says La Jolla, CA, plastic surgeon Robert Singer, MD. “They should only be done by a fully trained, board-certified plastic surgeon, facial plastic surgeon or dermatologist in an appropriate medical facility.”
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