Botulinum Toxin Explained: Botox vs Dysport vs Xeomin

Everything you need to know about the different injectable neurotoxins

What is Botulinum Toxin?

Botulinum toxin is a protein derived from the bacterium Clostridium botulinum and can be very dangerous if we are exposed to amounts that are too high. In medical settings, Botulinum toxin is used in minuscule amounts for a vast array of cosmetic and medical uses.

Depending on the brand of Botulinum toxin, it is approved by the Food & Drug Administration (FDA) to treat “frown lines” on the forehead between the eyebrows (an area called the glabella) as well as the “crow’s feet” on the lateral sides of the eyes. However, dermatologists and qualified health practitioners may inject Botulinum toxin off-label to help improve other wrinkles all over the face and even the body.

Table 1. Comparison of Different Botulinum Toxin Injections

 

Botox®

Dysport®

Xeomin®

Botulinum toxin name

onabotulinumtoxinA

abobotulinumtoxinA

incobotulinumtoxinA

Other ingredients

NaCl, human albumin

NaCl, human albumin, and lactose

NaCl, human albumin, and sucrose

FDA-approved wrinkle treatment sites*

Glabellar, lateral canthal, and forehead lines

Glabellar lines

Glabellar lines

Typical Dilution with saline**

4 units/0.1 mL

12 units/0.1 mL

4 units/0.1 mL

Units per area (example)

Glabella: ~20 units

Glabella: ~50 units

Glabella: ~20 units

Time to onset

3-4 days

3-4 days

3-4 days

Full effects

2 weeks

2 weeks

2 weeks

*Physicians can inject the botulinum toxin in other non-FDA approved areas

**Dilution concentrations may vary depending on practitioner preference

Botox®

Botox® Cosmetic is formulated as onabotulinumtoxinA. In 2002, it became the very first brand of available botulinum toxin. It is FDA approved to treat wrinkles of the glabella (frown lines between the eyebrows), lateral canthi (“crows feet” on the sides of the eyes), and frontalis (the horizontal lines across the forehead).

 

Dysport®

Dysport® made its debut in 2009. Dysport® is abobotulinumtoxinA, which is a form of Botulinum toxin that only slightly differs in its manufacturing process in comparison to Botox®. Dysport® is different from Botox® in that it also contains lactose on its ingredient list, so people who are strict vegans may choose to avoid this product. Dysport® has a different unit measurement system, so if you normally get 20 units of Botox® you would not also get 20 units of Dysport®. 1 unit of Botox® is equivalent to roughly 2.5-3 units of Dysport®.

 

Xeomin®

Xeomin® is the newest of the botulinum toxin injections, which became available in 2011 from the company Merz Aesthetics. It is a slightly different formulation of Botulinum toxin called incobotulinumtoxinA. Xeomin® has a similar dosing calculation as Botox®, with a unit conversion ratio of 1:1.

 

Is One Better Than The Other?

Botox®, Dysport®, and Xeomin® are considered similar in their efficacy at treating facial wrinkles.[2] While a clinical study suggested that Botox® is superior to other neurotoxins relaxing facial muscles, they are generally considered to be equally effective.[3] All three neurotoxins have similar time to onset, time to maximal effects, and time of duration. For most people, effects last 3-4 months for all three brands.

 

What Makes Botox®, Dysport®, and Xeomin® Different?

Some say that Botox®, Dysport®, and Xeomin® diffuse differently when injected. Due to this, it can be difficult to simply switch from one product to another and hope for identical results. Dysport® is thought to diffuse or spread, further to surrounding areas after injected. Botox® has been around the longest, which means it has the most data and experience regarding safety and efficacy. This makes it difficult to compare it to the Dysport® and Xeomin®, but we will understand more about their differences as further comparison studies are carried out.

 

Injection Tip

Prior to injection, Botox®, Dysport®, and Xeomin® are all instructed to be diluted with sterile saline (NaCl) to a pre-specified concentration. However, many practitioners may dilute with preserved saline to reduce the pain from injections. Please discuss with your practitioner.

* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.

References

  1. Link to Research. 2016.
  2. Prager W, Nogueira Teixeira D, Leventhal PS. IncobotulinumtoxinA for Aesthetic Indications: A Systematic Review of Prospective Comparative Trials. Dermatol Surg.2017;43(7):959-966; PMID: 28375973 Link to Research.
  3. Wilson AJ, Chang B, Taglienti AJ, et al. A Quantitative Analysis of OnabotulinumtoxinA, AbobotulinumtoxinA, and IncobotulinumtoxinA: A Randomized, Double-Blind, Prospective Clinical Trial of Comparative Dynamic Strain Reduction. Plast Reconstr Surg.2016;137(5):1424-1433; PMID: 27119918 Link to Research.