Botox^®
Botox has been used in medicine for over 20 years. It first received FDA approval in 1986 to treat eye muscle spasms and then in 2000 to treat other muscle spasm conditions. In 2002, Botox was approved for cosmetic use, specifically to treat frown lines or so-called "11 lines" in the central part of the forehead between the eyebrows. Since then, its use has been expanded to include crow's feet and wrinkles across the entire forehead. Additional uses include treatment of lip lines and neck bands in select patients. Since its approval in 2002 for cosmetic use, Botox has rapidly become the most popular cosmetic treatment in the United States.

Botox treatments typically take effect within 5 to 7 days and last on average 3 months. A typical treatment area varies in the amount used from 12 to 30 units per area. The average amount used, for example, in the glabella (that area between the eyebrows, or the "11 lines") in my practice is 24 units; sometimes less, sometimes more. For the forehead this amount ranges from 12 to 20 units (the forehead is a larger area but the muscle is a weaker one, so it requires less) and for crow's feet treatment I usually use 12 units per side.

Dysport^®
Dysport is the newest botulinum toxin product on the market and it's the first product to compete with Botox in the United States. It has been used for years in Europe and in South America with good results. To assure safety, FDA approval in the U.S. took several years but it was finally approved in April 2009. It is marketed and sold by Medicis, the makers of Restylane^®.

The active ingredient in Dysport, botulinum toxin-A, is identical to Botox. The difference is in the "complexing proteins" surrounding this active molecule. Dysport has different proteins and fewer proteins attached to the botulinum toxin-A molecule. This is said to account for its quicker onset of action and possible longer duration of action compared to Botox. It also may make it a good choice for long-time Botox patients who have developed antibodies and for whom Botox is no longer effective (very uncommon in my experience).

Since coming to market in April of last year, I have treated well over 300 patients, and I've been impressed with the results. My experience has been that Dysport does begin working quicker than Botox. On average, patients see a result from Dysport within 48 to 72 hours and sometimes as quickly as one day. Like Botox, results continue to improve after the initial onset of action for as long as 2 weeks.  In terms of the duration of effect, the Dysport labeling indicates 3 to 4 months and I have found most patients have results lasting about 4 months. This represents maybe a few weeks of extra duration compared to Botox. Since we have been using Dysport in the U.S. for less than a year, I am not convinced that Dysport lasts significantly longer than Botox.

Units and Pricing
For those who are familiar with Botox dosing, it is important to know that Dysport units are different than Botox units. In my practice, I use an approximate ratio of 2.5 units of Dysport:1 unit of Botox but there is no standard conversion or ratio that is agreed upon amongst practitioners. Dysport units are simply different than Botox units and therefore it's important to find a good injector who is experienced using both products. Like Botox, each Dysport treatment should be tailored to a patient's goals, to the specific area being treated, and to the individual's unique anatomy. The number of units used per area really means nothing in terms of the treatment itself or in terms of price. With the reconstitution (mixing) method I use, the volume I use for injections of Dysport is identical to that of Botox. The number of needle sticks (I use a tiny insulin-type needle) is the same. The per-unit price is such that the cost of a treatment area with Dysport is the same as the cost of Botox.

So Which is Better?
From my perspective, Dysport and Botox are equally effective in treating lines and wrinkles of the forehead, the brows and crow's feet. Both have the same excellent safety records. In my opinion, Dysport has a slight but definite advantage in that it works quicker and may last slightly longer.