On the cosmetic market, you can meet a few medications based on botulinum toxin type A. These are Botox, Dysport, Xeomin, Azzalure, Bocouture, and Vistabex. The first 3 medications are the most popular and in-demand remedies in the clinical practice of thousands of doctors globally. But which one to choose is the active substance is common for all 3 preparations? Are they the same or different? If they differ, what differentiates them from each other? What is the dosage ratio? These questions can bother both cosmetologists and people considering beauty injections. Let us figure it out!
What is Botox?
Botox, perhaps the most popular pharmaceutical preparation among the 3 competitors, is a brand name for an injectable solution based on the botulinum toxin type A (a natural toxin produced by bacterium clostridium botulinum) from the Irish-American pharmaceutical company Allergan. By the way, it was the first FDA-approved botulinum medication. But its popularity is explained not just by the fact it was the 1st but also excellent quality, effectiveness, and a high number of research studies.
The composition of Botox is based on purified and refined botulinum toxin type A, albumin human (serum albumin - a protein in human blood), and vacuum-dried by a process involving sodium chloride. The solution works as a neuro block, temporarily paralyzing the nerve endings, relaxing the muscle, and decreasing the tension in the tissues.
Botox has got an impressively wide realm of usage for cosmetic and therapeutic purposes:
- adult bladder dysfunction
- chronic migraine
- cervical dystonia
- primary axillary hyperhidrosis
- cerebral palsy
- erectile dysfunction
- temporomandibular joint disorder
- mimic wrinkles
- gummy smile
- breast lift
What is Dysport?
Dysport is a French analog of Botox from Ipsen Pharma. Except for a purified botulinum neurotoxin type A, in its composition, Dysport contains human serum albumin, and lactose. The medication is used both for smoothing out mimic wrinkles and treating such therapeutic conditions as cervical dystonia and spasticity.
Dysport is often prescribed to patients who have primary or secondary insensitivity to Botox. Because of the difference in composition, it can have a rejuvenating effect where his "older friend" failed.
What is Xeomin?
Analog to Botox, Xeomin botulinum toxin formulation is a product from German pharmaceutical company Merz Pharmaceuticals present on the market since 2008. The manufacturer uses highly purified botulinum toxins compared to Botox. It means that Xeomin does not contain any proteins and other supplements in its composition. It is a pure toxin. Such formulation benefits Xeomin in 2 ways. First of all, it does not cause allergy and is perfect for starting botulinum toxin treatment, and second, it is not afraid of violation of compliance with special storage conditions, mandatory for other botulinum toxins.
Xeomin in clinical practice is used just for cosmetic purposes and the elimination of wrinkles caused by active facial expressions: crow's feet, furrow lines, glabella lines, marionette lines.
Difference between Therapeutic Botulinum Toxin Preparations
So, we have found out that manufacturers and brand names are not the only differences between Xeomin, Dysport, and Botox. The basic discrepancy lies in botulinum toxin formulations, molecular weight, and correspondingly, their effectiveness, penetration rate, potency, and conversion ratios of botulinum toxin serotypes. Let us have a closer look at the key differences.
- Botox: onabotulinum toxin-A (ONA), albumin human, sodium chloride
- Dysport: abobotulinum toxin-A (ABO), human serum albumin, lactose
- Xeomin: pure incobotulinum toxin-A (INCO)
Xeomin's penetration rate is much lower than that of Dysport. At the same time, the drug acts much softer than its counterpart and allows to reduce wrinkles without harming facial expressions. Botox and Dysport have got approximately the same penetration rate what explains their demonstrated therapeutic equivalence, while Xeomin works just for cosmetic purposes and is not a therapeutic botulinum type.
Toxin spread characteristics
Among the 3 preparations, Dysport possesses the highest spread characteristics of the toxin. It can be both a benefit and a drawback of the medication. In certain areas (in the eyes and eyelids), diffusion can lead to muscle prolapse, but in other areas, it may help to obtain a more natural and fresh appearance compared to Botox and Xeomin.
All 3 medications show high efficiency in solving the problems they were elaborated for. However, there is some difference in the mechanism of their action. For example, the patient will see the effect after injection (elimination of wrinkles on the face) approximately after 2-3 days after the treatment with Dysport or Xeomin. Botox will take 10-14 to freeze the muscles and smooth out skin creases.
Botox, Dysport and Xeomin Dosage: Clinical Conversion Ratio
One more crucial question that interests doctors about botulinum neurotoxin medications is the conversion ratio between Botox, Xeomin, and Dysport. Why may you need to know the correlation in dosage between different drugs? Well, there may be various reasons. Firstly, the patient may ask to switch from one brand to another brand for the reason of price, etc. Second, after multiple injections, the organism may get used to a medication, and it becomes not that effective, or it develops botulinum toxin immunogenicity, so you need to choose another product, and so on. So, the question is, where the conversion ratio for Xeomin, Botox, and Dysport the same?
The question is NO. Of course, it is very and very complicated to establish the exact correlation of dosage for botulinum products, it is necessary to do. Multiple clinical trials and practical experiences have shown the following ratios for the 3 medications:
- 1:1 or 1:2 for onabotulinum toxin-A (ONA) Botox and incobotulinum toxin-A (INCO), Xeomin
- 1:3 or 1:4 for onabotulinum toxin-A (ONA) Botox and abobotulinum toxin-A (ABO), Dysport
- 1:3 or 1:4 for incobotulinum toxin-A (INCO) and abobotulinum toxin-A (ABO), Dysport
So, the amount of Xeomin required to obtain excellent results is approximately the same as for Botox. Everything is easy here. Dysport possesses a higher conversion ratio due to a lower concentration of the toxin in the solution, but this issue is still highly debated among doctors, and sometimes, the correlation may reach a ratio of 1:11. There are multiple reasons that influence this number in clinical therapy- the disease condition, number of muscles to be treated, and so on.
Which is Better: Botox, Dysport or Xeomin?
Botox, Dysport, and Xeomin are all remedies based on one active substance, but they are not the same medications. Of course, they may be mutually interchangeable in separate cases, but there are lots of nuances to consider when choosing or switching from one botulinum drug to another.
Xeomin is a perfect choice for beginners due to its "pure" formula, unlike Dysport and Botox botulinum neurotoxin complexed with proteins. It does not cause allergy and provides a subtle effect that does not hurt facial expressions. If a patient needs really fast visible results, then it is better to prefer Dysport or Xeomin as the onset of their action starts on the 2nd or 3rd day after the injection. At the same time, Botox is more preferable for such facial areas as under the eyes and between the eyebrows.
In any case, the choice of a medication is also very individual. There are patients whose organism may be very sensitive to this or that type of botulinum medication when let us say, Botox or Xeomin does not work, and you have to choose Dysport, to the body reacts to the administration of the drug by systemic botulism symptoms, and again, your choice is already determined. Also, the patient may insist on this or that medication due to economic grounds.
The point is that all three remedies Botox, Xeomin, and Dysport, are high-quality injectable solutions with unique compositions, perfectly working for their purposes.
I hope you enjoyed the article and see you in the next posts!!!