Which Is Best? Botox®, Dysport® and Xeomin®

By Don J. Fontana, MD, PA

Don Fontana, MD

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Which Is Best? Botox®, Dysport® and Xeomin®

Having a choice among three excellent products is like asking which is best Mercedes, BMW or Audi. The fact remains that all three products Botox, Dysport and Xeomin are very effective and perform well. These groups of drugs are called neurotoxins or neuromodulators. A neurotoxin is in theory considered to be a “poison”, influencing the transmission of nerve impulses. We are exposed to many types of neurotoxins or neuromodulators in our daily living; the most common and most popular neurotoxin is ethanol, that is, the alcohol in all adult beverages.

Botox, Dysport and Xeomin are all forms of botulinum toxin type A. This agent is made in the laboratory from bacteria, clostridium botulinum, that produces this chemical. If a human is infected with these bacteria's, the medical condition is called botulism. Botulism, although very rare, is most commonly attributed to home-canned foods contaminated with the bacteria. Botulism can also occur if an open wound is contaminated with the bacteria. One hundred years ago approximately 50-70% of the patients with botulism died due to respiratory failure since the muscles that are used in breathing were paralyzed.

Today, the risks are close to zero. The botulism toxin is diluted to a safe level for humans. Hundreds of thousands of injections have been done with each agent with total safety. The consideration for the patient is not as much the agent as is the skill of the individual administering the agent. Plastic surgeons know facial anatomy and are able to administer the drug safely and accurately. Many other physicians, nurses, nurse practitioners, physician assistants and dentists inject these agents. The consumer must evaluate the qualifications of whomever they entrust to inject these agents into their face. Bargain prices of these agents usually indicate that the injector has diluted the agent so significantly that the effect will be minimal and the duration of the effect will be very short. Some medical practitioners also purchase these drugs through Canadian companies that import “look-alike” drugs from China. The purity, concentration and safety of these “knock-off” drugs are very questionable. If an injection is done incorrectly, problems such as “droopy” eyelids and eyebrows can occur. Abnormal facial movements, a crooked smile, and unnatural facial expressions can result if unskilled medical professionals do injections. These problems will slowly subside over a period of approximately 3 months. There is no therapeutic treatment for incorrectly injected agents.

The question remains. Which of the choices Botox, Dysport and Xeomin are best? A different company manufactures each product and therefore they compete for their share of the market of $1.8 billion. Approximately 5-6 million injections of these drugs are performed each year. Physicians have a preference to their preferred drug. This issue is not which one is best since they are all effective. The issue is the skill of the injecting physician to achieve the desired appearance with a minimal amount of swelling and bruising.