PASS THE BOTOX® PLEASE

There was a time when we only had to know the name “Botox” when speaking of botulinum toxin products, but not anymore.  Botox was the first botulinum toxin product on the market in the 1980’s, and since that time literally millions of botulinum toxin injections have been performed.  Over time we have come to use the name “Botox” to refer to botulinum toxin treatment in general, much the same as we speak of “Kleenex” when we discuss facial tissues.  Since that first botulinum toxin came on the market, there have been two other comparable products developed and marketed for the treatment of facial wrinkles.  In addition to Botox, we now have Dysport, and the newest of the toxins to be made available is Xeomin.  There are some differences between the products, and those are worth discussing.

First, you might ask what is neurotoxin anyhow, and what does it do?  Basically, botulinum toxin is a purified protein formed by the bacteria Claustridium botulinum.  Because it is highly purified, these approved products used properly will not cause botulism, but they will weaken muscles that they are injected into.  That is why we use them in aesthetic surgery; we inject them into muscles that are overactive and causing undesired creases and folds in the skin.  During the process of manufacturing the toxins, each company uses slightly different methods to purify them, and this results in some chemical differences in the structures of the molecules.  These differences in structure are thought to cause some minor differences in the way each product may act.  Basically, the active part of the toxin molecule is surrounded by a number of proteins when it is found in nature.  During the manufacturing process none, some, or all of these proteins are stripped from the molecule.  Botox still has all of the proteins attached, Dysport has some of the proteins attached, and Xeomin has all of the proteins stripped away.  The active part of the molecule is still the same for all of them, however.

The main considerations are how quickly the product begins to work, how intensely the product causes muscle weakness for a given dose, and how long the effects last.  We are still evaluating the detailed comparisons between these products, and for the time being there is no one of these products that works best for all people.  Some people may respond better to Botox, while some might prefer Dysport or Xeomin.  It is possible that stripping the proteins away from the molecule, or making it more “naked” so to speak, may make it spread a little better through the tissues and give a more even result, but then again, it may make it wear off sooner too.  It may ultimately be the case that one of the toxins is better for one part of the face, while another works better on another part of the face.  As of right now, it appears as though the differences between the products are very small, and most people notice similar onset of activity, similar effects, and similar time course of action.

The good news is that we now have several options in neurotoxins to weaken unwanted muscle contraction and decrease facial wrinkles.  If one doesn’t seem to work as well as we would like, we now have the option to try something else.