Choosing a Neurotoxin
You’ve decided it’s time; you want to start doing some Botox® treatments. So, as everyone does, you ask your friends the important questions that come to mind.
Andrea raves to you about her treatment and begs to go with you for your first time. Jess says you need to go to this particular injector, Dr. Massie or something like that. He sounds pretty handsome. Michelle tells you how many units she gets and tells you to start slow. And then there’s Susan. Classic Susan. She says she “never gets Botox®, it doesn’t work for me”. Susan says she only gets Dysport®, and you should too. She also once told you that you should stop seeing your endocrinologist and see her Chakra Crystal Healer, so you don’t know if you should believe her.
Hopefully in the next few paragraphs, I can help bring some clarity to this common concern of selecting which neuromodulator (Botox®, Dysport®, or others) is the right choice.
In Canada, there are four neuromodulators available for cosmetic treatments. The most well known being Botox, so well known that the brand name is interchangeable with the term neuromodulator for most people (like Kleenex is for tissues). The other three are Dysport®, Xeomin® and the newest arrival, Jeuveau®. While there are differences between them, the most important fact I can state is that the active ingredient in all of them is the same. (Keep reading though, there’s a good Susan joke at the end).
Botox® is the original. It has the advantage of not only name recognition, but reputation and the longest safety and efficacy data. It remains the gold standard to this day. It takes typically 3 to 4 days to start working, 14 days for full effect and lasts 3 to 4 months, though many patients report longer. It has decades of safety evidence not only in cosmetic use but also in its multiple medical uses (migraines, hyperhidrosis, bruxism, and more).
Dysport®, as I mentioned before, is the same active ingredient of Botulinum A, but combined with carrier proteins into smaller molecules. Dysport® has been shown consistently to have a faster onset, typically 1-2 days to start seeing the effect, but studies (and my experience) are continuing to suggest it might not last as long as Botox. It also diffuses more (spreads after injection), so injectors without experience can have more eyelid droops or other negative outcomes. Most studies also compare 2.5 units of Dysport® to 1 unit of Botox®, so if switching injectors and between the two products, remember the units won’t necessarily be the same.
Xeomin® contains only Botulinum A and none of the supporting proteins that the other products have. This gives it the advantage of the very rare case when patients develop antibodies to the additives in other products. (yes, you can become immune to Dysport® and Botox®, but don’t panic, it’s extremely rare). It tends to be seen as the slowest onset, four days at the earliest and 30 days for full effect, and it shows duration similar to Dysport® and Botox® (though doctors, including myself, find it lasts slightly less).
Jeuveau® is still very new. It is the same structure as Botox® and its proteins but from a different initial Botulinum strain. Studies show its onset and duration to be the same as Botox®. Information is still limited.
Are you confused yet? Hopefully not.
In the end, their similarities greatly outweigh their differences. If you want my advice (I sure hope you didn’t read this far if you don’t), choosing a neuromodulator should be a second priority to choosing an injector and clinic you trust. Botox® has the most data behind it, and it is what I trust for the vast majority of my injections. Dysport® does have a slightly earlier onset, so if it’s off to Vegas tomorrow night and you need to look your best at Hakkasan, Susan’s choice might be for you. Just remember when it wears off earlier, not to blame your Chakra Crystal Healer. Xeomin® is a great option if true immunity has developed. However, immunity is very rare, and just because one treatment might not have been ideal, too low of a dose or ineffective injection technique is far more likely to be the reason than immunity. Don’t rush for Xeomin® after one bad experience from an “injector” in a van. Jeuveau® I can’t honestly speak to experience with. I just know I wouldn’t personally use it until the safety data grows.
If you have more questions, come by the clinic. I’m happy to talk in person and get you enough information to feel comfortable starting treatment. I know we need to get your Botox® going before the next lunch with Susan, so we can prevent the automatic scowl when she tells you your hair would look more alive if you cut out all gluten, just like she did.