Call (805) 497-9400
By Talia Emery, M.D.
BOTOX, BOTOX, BOTOX. The name is ubiquitous, especially in Southern California. You’ve seen the good (you probably didn’t even realize they’d been treated), you’ve seen the bad (I’m sure you’ve seen that “frozen” or “surprised” look), and if you haven’t tried it, chances are you’ve thought about it. BOTOX is a simple, safe and relatively inexpensive cosmetic procedure that has been used by men and women from age 20 to 70.
Since its 2002 FDA approval for relaxing the muscles that cause frown lines, BOTOX injections have overwhelmingly become the most popular non-surgical cosmetic treatment in the U.S. More than 2.4 million patients were injected in 2008 alone. And despite the country’s recent economic woes, the number of patients seeking BOTOX injections continues to grow. BOTOX has made its manufacturer, Irvine-based Allergan, a darling of Wall Street.
BOTOX’s active ingredient, botulinum toxin type A, works by temporarily inhibiting the impulse that causes muscle contraction, thereby relaxing the treated muscles and preventing them from forming facial wrinkles and furrows. The most commonly treated areas are the “frown” lines between the brows, horizontal forehead lines, and “crow’s feet” lines around the eyes. BOTOX is the most widely studied drug worldwide, and has an unparalleled safety profile in cosmetic use. In experienced hands, BOTOX treatments consistently produce desired, natural-looking results.
If BOTOX is so great, why all the interest in DYSPORT? Because it’s the first competitor to BOTOX Cosmetic. DYSPORT is a product of Ipsen Pharmaceuticals, a French company that has partnered with Medicis, the makers of Restylane, to market DYSPORT in the United States. Both DYSPORT and BOTOX were developed as medical treatments for muscle spasms and other movement disorders. Like BOTOX, DYSPORT is a protein complex containing botulinum toxin type A. But DYSPORT differs from BOTOX in its protein complex size and in its inactive ingredients, which accounts for the slight differences in the way each works.
For years DYSPORT has been used overseas both medically and cosmetically, with a safety profile similar to that of BOTOX. U.S. studies have been ongoing since 2002, and data has thus far been collected on 3,148 patients. While there have been no large-scale, head-to-head studies, the data has allowed for comparisons to be made between DYSPORT and BOTOX in terms of safety and efficacy.
So what does the approval of DYSPORT mean for you? Is this ho-hum? Or is this the Holy Grail? Following are the top five questions my clients are asking:
Q: Is DYSPORT safe?
A: Yes. It’s been used extensively in Europe for many years and has proven to be nearly identical to BOTOX in terms of side effects, tolerability, predictability of results and consistency of batches. U.S. studies confirm those findings.
Q: Is DYSPORT cheaper than BOTOX?
A: The answer is a bit complicated. BOTOX and DYSPORT are typically sold by the unit, which is how the dose of a treatment is measured. Yes, DYSPORT units are significantly cheaper than BOTOX units, but DYSPORT units and BOTOX units are not equivalent, and patients require more DYSPORT units to achieve the same results.
Physicians agree the conversion rate between the two may differ from patient-to-patient, and in some cases even muscle-to-muscle in a single patient. Most DYSPORT users require 2.3 to 3.3 times the number of BOTOX units previously received. So, if a patient typically received 20 units of BOTOX for her frown lines, she may require 46 to 66 units of DYSPORT. At the lower dose, her treatment may be less expensive than BOTOX, but at the higher dose, it will be more expensive.
Q: Does DYSPORT work faster than BOTOX?
A: There have been no head-to-head studies comparing onset of action, but for some people, DYSPORT seems to work more quickly. Whereas BOTOX typically begins to work in 3 to 7 days, studies have shown that 30 percent of DYSPORT patients noticed the product starting to work within 48 hours. Clinically it seems that DYSPORT’s onset occurs about 24 hours sooner.
Q: Does DYSPORT last longer than BOTOX?
A: Again, there have been no scientific head-to-head studies comparing the duration of DYSPORT to BOTOX. Some studies showed DYSPORT lasting slightly longer than is typical for BOTOX, but most of these studies used a large DYSPORT dosing ratio (3:1, DYSPORT:BOTOX). Other studies found no significant difference. Further studies are needed before any definitive conclusions can be drawn.
Q: Which drug is right for me?
A: This is a question that is best discussed with your individual provider, who can take into account your personal experience and current goals. This is my general advice: If you currently use BOTOX and have experienced great results, there’s no reason to switch to DYSPORT. If you’ve tried BOTOX and haven’t seen the results you would like, or if you simply want to check out the new product on the market, consider trying DYSPORT. And if you’ve never used either, consult an experienced provider to help you make the decision. Given the different dosing characteristics, be sure your provider is well-versed on the use of DYSPORT.
The bottom line? We should celebrate the arrival of DYSPORT on the U.S. aesthetics market. Even if this is another Coke versus Pepsi rivalry and DYSPORT doesn’t offer significant benefits over the veteran BOTOX, its arrival brings competition to the marketplace, which is always positive for the consumer. We can now make a choice between products brought to us by two manufacturers with great reputations, Allergan and Medicis, and we’re likely to see ongoing rebates and other incentives offered by both while they battle for your business.