Botulinum toxins are used for the cosmetic treatment of frown lines between and above the eyebrows, the forehead, and crow’s feet (the lines on the outer part of and beneath the eyes). The three currently available brands, manufactured by different companies, are BOTOX® Cosmetic, XEOMIN®, and Dysport®. The basic principle of the treatment is the same for each. Wrinkles and folds of the face may be the result of muscle motion and/or tissue atrophy. These injectable products reduce muscle motion and can result in dramatic softening or elimination of unwanted lines. They accomplish this by temporarily blocking the release of a neurotransmitter called acetylcholine which is necessary to activate muscles. The dosages are very dilute and localized to the area of desired effect. The results typically last 3 to 4 months.
BOTOX® Cosmetic is probably the best known of these products since it has been on the market in the United States the longest. However both Dysport® and XEOMIN® have had proven track records of safety and efficacy in Europe over many years prior to their FDA approval in the United States. Each is a formulation of botulinum toxin type A. (For the scientists among us BOTOX® Cosmetic is onabotulinumtoxinA, XEOMIN® is incobotulinumtoxinA and Dysport® is abobotulinumtoxinA.) There are some differences in the formulation of the three products but there probably isn’t a great deal of difference in the end results. XEOMIN® does not have an attached or complexing protein, unlike the other two. Whether this makes any difference, good or bad, has not been definitively demonstrated. These proteins have no therapeutic function. It has been suggested that some patients may form antibodies to these proteins decreasing the effectiveness of treatment. This would imply that a patient who begins to see reduced results with BOTOX® Cosmetic or Dysport® may still benefit from XEOMIN® injections. Dysport® may take effect some days sooner than the other products but results with all three are generally seen by 5 days. Longevity of the results has not been shown to be different, but I have found anecdotally that some people do better with one product over another. I have used all three products and may vary which one I use even in the same patient depending on their response.
The use of the botulinum toxins is the most common nonsurgical cosmetic procedure and has, in fact, increased nationwide more than 15% this past year from the previous year. This speaks to both the ease of this approach and the satisfaction with the results.