Author Bio: Dr. Sanusi Umar MD is the author of this article.
There is now a new botulinum toxin injection, similar to Botox, Dysport and Xeomin. This brand is called Jeuveau, also referred to as Newtox, the latest product to be considered the new Botox alternative. It is manufactured by Evolus and manufactured in South Korea. Botox is made by Allergan and produced in Ireland. Approved by the FDA in 2019, Jeauveau is made from a slightly different variation of botulinum toxin type A called prabotulinumtoxinA. Botox, on the other hand is made from onabotulinumtoxin A. And like Botox, Dysport and Xeomin, it relaxes facial muscles to improve the appearance of wrinkles such as frown lines, horizontal forehead lines and crow’s feet wrinkles. Also, Jeauveau has a comparable onset, efficacy, molecular structure, size, and duration as Botox. A major difference is that Jeauveau undergoes a more extensive purification process using what is called Hi-Pure Technology, endowing the product with a very high safety profile. Also the manufacturers of Jeauveau, Evolus, developed this injectable exclusively for aesthetic applications only. Botox, on the other hand can be used for a variety of medical treatment purposes such as migraines and excessive sweating. Due to its more limited range of applications, Jeuveau can be offered at a much lower price point.
What Are Botox, Dysport and Xeomin?
Botox, Dysport and Xeomin are neuromodulators used by dermatologists and plastic surgeons to non surgical reduce upper facial wrinkles. Over the years, Botox procedures have become extremely popular as a wrinkle treatment that offers men and women a way to instantly look younger. It only takes days for patients to see results. And with the lack of downtime, there is no need to take off time for work. More recently, comparative injectable neuromodulator drugs, Dysport and Xeomin have also emerged on the market, giving consumers additional options to choose from, aside from just Botox alone. All three of these drugs share the same active ingredient, botulinum toxin A, derived from the Clostridium bacteria. However the actual molecules for Botox, Dysport, and Xeomin, each have a different overall structure due to the number of “buffer” proteins surrounding the botulinum toxin component.
Botox, Dysport, and Xeomin are primarily used to treat “contraction-induced” wrinkles in the upper part of the face. These lines are formed over time by different facial expressions such as squinting and smiling which contributes to crow’s feet, expressions of anger which creates vertical glabellar lines (also known as frown lines) between the eyebrows, and worrying or feeling surprised which leads to horizontal creasing on the forehead. Additionally, these injectables can also be applied to lift sagging eyebrows and minimize severe underarm sweating.
How Do Botox, Dysport and Xeomin Work?
Injection treatments like Botox, Dysport, and Xeomin block a chemical signal called acetylcholine which is released from the nerves to the muscles. Without this input, the targeted muscle is no longer able to contract and crease the skin. This is how botulinum toxin injections cause wrinkles to relax and soften.
No anesthesia is required during this procedure, but a topical anesthetic cream or cold pack 10-20 minutes before the injection is sometimes used to numb the area. The injections will usually take only 10 to 15 minutes.
There is no recovery time or downtime, though you may see some temporary redness or bruise at the injection site. It typically takes three to five days to start seeing the effects because it requires two to four days for the molecules (of Botox, Dysport or Xeomin) to attach to the nerve ending that would normally stimulate the muscle to contract. Patients are usually able to see a drastic reduction of their wrinkles within a week or less.
What Is Botox?
The original intent behind designing the Botox drug was not to treat wrinkles, but to reduce eye muscle spasms. However in, clinical trials, patients noticed that their crows feet wrinkles around their eyes had significantly improved as a result of their injections. Eventually, Botox received FDA approval for use as a treatment for these wrinkles.
Botox molecules are larger compared to Dysport and Xeomin. This is due several surrounding proteins being attached to the botulinum molecule. These proteins provide a buffering layer, confining the activity of the botulinum toxin to just the treatment area. However, they may also trigger the immune system to form antibodies against the Botox injection. And this may reduce the overall performance level of the drug.
The presence of buffer proteins also slows down the metabolic breakdown of the Botox molecules. Since the drug injection can, therefore, stay in the body longer, this may help patients experience longer lasting results.
Are Botox, Dysport, and Xeomin Dangerous? A Clarification on the Word Toxin
The term, botulinum toxin has many people feeling wary of Botox, Dysport and Xeomin injections and the potential for long-term health issues. The notion of putting a toxin into one’s body would obviously seem dangerous. Should patients worry about these types of wrinkle-reducing injection procedures?
While botulinum toxin is a known poison in natural form, it is thus the case when the compound is unpurified and present at high enough concentration levels. Researchers have already determined the danger threshold point in order. Not only are Botox, Dysport and Xeomin formulated at low enough concentrations to be considered safe for the body, but also the botulinum toxin that makes up these products has actually been refined into a purified protein within tightly controlled lab settings. The end version has been sterilized and diluted so that it is not a hazard for patients who opt for the injection.
Finally, it should be noted that all drugs are poisonous at high enough concentrations, including over the counter medications like Tylenol and decongestants. And despite the term, toxin (i.e in botulinum toxin) Botox, Dysport, and Xeomin can be regarded as any type of drug in this general regard.
Other examples of highly toxic natural compounds with lower dosages that are commonly used in food and medicine include:
- saffron from the crocus flower
- arsenic found in almonds
- curare which has historically been used in poison darts, but now used in today’s anesthesia
- purple foxglove, a deadly poison that has been modified for use in heart medication
- willow bark whose toxic compound is the model for modern aspirin.
In the hands of a highly qualified practitioner, Botox, Dysport, and Xeomin are safe injectables with no long-term health consequences.
Actual Patient Experiences With Botox in Dr U Skin Clinic Manhattan Beach Los Angeles
The high demand for Botox is largely due to the fact that it is minimally invasive and able to smooth out wrinkles within a relatively short time frame and provide an instant sense of gratification. When used for certain patient cases, the net effect can be likened to a liquid face-lift. Here are two patient cases which illustrate the type of natural-looking results that can be achieved using Botox.
What Is Dysport?
Dysport is another type of botulinum toxin A injectable neuromodulator. It is available to patients as a Botox alternative. Dysport was approved by the FDA in April 2009 to treat glabellar frown lines between the brows.
Is Dysport a Good Botox Alternative?
Although it’s active ingredient, botulinum toxin A is the same as Botox, Dysport has a slightly different molecular structure with a fewer number of attached buffer proteins. The body is less able to interfere with the drug by forming antibodies against them.Therefore, Dysport is less susceptible to immune system attacks and more likely to be accepted at the injection site to produce more optimal results. That said, antibodies do form and resistance is possible. Since the molecular structures differ between botox and dysport, a patient who develops resistance to one, may be responsive to the other.
Some individuals who have been treated with Dysport may notice a faster onset compared to Botox. Additionally, patients may also experience a longer duration as well.
A Study Comparing Dysport to Botox
In 2011, The Archives of Plastic Surgery published an intriguing study comparing the effects of Botox and Dysport on the treatment of crow’s feet wrinkles. Participants had Botox injected on one side of the face and Dysport on the other. As a double-blind study, neither the subjects nor the researchers knew which side of the face received each of the two drugs.
The study found that the appearance of crows feet wrinkles on the Dysport side was noticeably reduced compared to the side that received Botox. The participants, therefore, rated the side treated with Dysport more favorably in terms of wrinkle reduction, compared to the side injected with Botox.
Researchers have yet to learn about how Dysport compares to Botox when it comes to other types of wrinkles and the overall long-term effects of both drugs.
What Is Xeomin?
Xeomin is another prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines, crow’s feet, and forehead wrinkles. Xeomin, or Incobotulinumtoxin A, is made from the bacteria that causes botulism. Botulinum toxin blocks nerve activity in the muscles, causing a temporary reduction in muscle activity.
How Does Xeomin Compare As A Botox Alternative?
Xeomin has no buffer proteins, just botulinum toxin type A. Therefore, the drug consists of just a naked active ingredient molecule. This creates a much lower risk of developing antibodies against Xeomin than Botox. It also means there is a lesser chance of the body developing an allergic reaction to Xeomin. At the same time, having a complete lack of buffer proteins means that the effects of the botulinum toxin can spread beyond the treatment area.
Xeomin doesn’t require refrigeration prior to administering it to a patient, making it easier for transportation and storage. This contributes to a much lower cost per unit compared to Botox and Dysport. Xeomin received FDA approval in 2010 and is considered to be very safe. More than 84,000 people worldwide have been treated with Xeomin injections.
Based on their observations, some doctors have rated Xeomin to have a faster onset of action compared to Dysport. In turn, Dysport surpasses it’s rival, Botox when it comes to onset of action.
Comparably, Dysport has been observed to have a higher potency (i.e. duration) compared to Xeomin which outperforms Botox for this parameter.
Applications of Botox, Dysport, and Xeomin
Crow’s Feet Treatment
Crow’s feet wrinkles have a branching appearance that appears at the outer corner of a person’s eye. They form as a combination of skin aging and upper facial movement such as squinting of the eyes, laughing and smiling.
Crows feet lines are formed by the contraction of muscles around the eyes known as the orbicularis oculi.
Botox, Dysport or Xeomin can be used to relax these muscles and reduce the severity of these wrinkles.
Treatment to Get Rid of Frown Lines on Forehead at Dr U Clinic Manhattan Beach, Los Angeles
A frown line is a facial wrinkle associated with anger which causes patients to feel concerned that they appear unapproachable to others. Also known as the “elevens,” frown lines are essentially a vertical crease or depression in the face caused by the glabellar muscles.
Using Botox, Dysport or Xeomin to relax the muscular contractions between the eyebrows is an effective way to smooth the appearance of frown lines and achieve a calmer, more pleasant overall facial expression.
Here are two examples of patients who were treated by Dr. U using Dysport to get rid of frown lines on the forehead.
Rumpled forehead creases are caused by skin laxity as well as muscle contractions in this area. These lines are often known as “worry lines” because when we’re worried, we tend to wrinkle our forehead. Horizontal forehead lines are also associated with the emotions of depression and anger.
Forehead lines are caused by the frontalis muscles. Injecting Botox, Dysport or Xeomin into these muscles can greatly improve or reduce the appearance of unwanted lines in the forehead.
Doctors can treat two types of muscle contractions and improve the appearance of specific emotions expressed on the face. These include:
1. Medial brow contractions present in middle and lower regions of the forehead. Targeting these areas will improve the appearance of anger or worry
2. Lateral brow contractions in the higher regions of the forehead. Addressing these muscle contractions with Botox, Dysport or Xeomin will improve the facial expressions associated with sadness.
A skilled doctor will know how to maintain a natural appearance to avoid the obvious look of a frozen, immobile forehead.
The aging process naturally affects the muscles. In some people, the muscles that control the eyebrows will atrophy or weaken, creating the appearance of sagging or drooping brows.
Injections of Botox, Dysport or Xeomin can be used to help raise the eyebrows. To understand how this works, it is important to first realize that muscles work in opposite pairs. When one set of muscles contracts, the other set relaxes.
When it comes to lifting the eyebrows, the injection needs to target the depressor muscles that pull the brows down. Doing so will activate the opposite set which will lift the brows upwards by several millimeters.
Excessive Sweating Treatment For Underarms AT Dr U Skin Clinic, Manhattan Beach Los Angeles
As neuromodulators, Botox, Dysport, and Xeomin can also be applied to treat severe underarm sweating. The basic principle works the same as addressing wrinkles induced by intense and frequent muscle contractions.
These drugs will block the excitatory chemical, acetylcholine from being released by the nerve fibers which communicate with the muscles that control individual sweat glands.
Without the chemical signaling of acetylcholine, the muscles of the sweat glands will stay relaxed, unable to excrete excessive moisture.
Just like with wrinkle treatment applications, the number of proteins that surround the active botulinum molecule can affect the drug performance for various individuals. Antibodies produced by the body may interfere with the onset and action of Botox, Dysport, and Xeomin.
Results can even be measured through digital imaging analysis. Here is an example of a typical skin mapping image generated by this technology.
Duration of Botox, Dysport and Xeomin Treatments
The average duration of Botox, Dysport and Xeomin treatments lasts between 3-4 months. However, patients may notice a difference in how long each of these injectables lasts for their own individual cases.
Who Is Qualified to Inject Botox and Its Alternatives?
Without a doubt, Botox’s popularity has led to an immensely high demand for its treatment effects.
This has led to it being offered by a multitude of service providers, including physician specialists from unrelated fields like dentistry or orthodontics.
As a treatment being used by celebrities and Hollywood’s elite, Botox is often put into the same category as general beauty treatments. Therefore, it is often made available outside of medical settings, like private homes or even hotels.
Sometimes Botox parties are offered to a group of invited attendees. Although the injections are performed by licensed physicians, non-clinical environments can still pose potential risks. Unexpected emergencies may arise due to adverse reactions. An actual medical clinic will not only have trained and prepared staff members on board, but other forms of equipment and supplies on hand to handle such situations.
For the sake of safety and achieving an overall positive experience, anyone who is interested in Botox and comparable treatments like Dysport and Xeomin must educate themselves on
- Who is qualified to offer these injections
- What to look for when choosing a service provider
It is illegal for Botox to be offered by anyone without a medical degree. This drug and it’s alternatives can be directly injected by Physicians, and under supervision by physician’s assistants and nurse practitioners. The law does not allow physicians to simply serve as directors of establishments who offer Botox and similar injections without their actual involvement during patient sessions.
Although having a medical degree is the most basic requirement, patients must still be wary of doctors from backgrounds unrelated to dermatology or plastic surgery (including facial plastics, Occuloplastics and maxillofacial Plastics) who offer the injection. The ideal doctor for administering Botox should be board certified in one of these areas with an intricate knowledge of the specific nerves and muscles in the face.
He or she should also be able to carefully study the unique needs of specific individuals to determine proper dosages and injection strategies that will make patients happy and produce the most natural-looking results.
Common Side Effects of Botox, Dysport, and Xeomin
All drugs are associated with potential adverse complications. Botox, Dysport, and Xeomin are no exceptions. Here are common side effects that are associated with each of these injectables.
- muscle weakness, pain, redness and bruising at the injection site
- minor swallowing difficulties
- eye irritation, tearing, heightened sensitivity to the light, double vision, reduced blinking
- infections in the respiratory system – cold, flu, nausea, pain
The best way to avoid the occurrence of these types of side effects is to disclose the details of any health issues you may have and your full medical history with your doctor. In particular, this would include:
- eye surgeries
- eye health issues, particularly glaucoma
- problems with excessive bleeding
- history or any diagnosis of heart disease
- difficulties swallowing which may be related to a condition known as dysphagia
- breathing issues (e.g. emphysema and asthma)
- disorders related to the muscles and nerves, such as myasthenia gravis and Lou Gehrig’s disease
- past history with any botulinum toxin injections
There are certain conditions and issues people should be aware of if they are considering getting this procedure. Consult your doctor if you:
- Are allergic to the ingredients in Botox cosmetics
- Are pregnant, planning to have a child or breastfeeding
- Plan on having surgery in the near future
- Are on medication or taking certain vitamin supplements
- Have breathing or bleeding issues
- Have an infection/rash in the injection area
Which Wrinkle Treatment is Right for You?
Botox, Dysport, and Xeomin may produce different effects for different patients, particularly in terms of onset and duration. Individuals may want to choose Dysport or Xeomin if they are interested in seeing results as soon as possible if they have to plan for an important event. Otherwise, it is best to observe the specific effects of each of these three injections to make the best decision.
The Cost Differences of Botox, Dysport, and Xeomin
Botox, Dysport, and Xeomin each have their own cost per unit. On a per unit basis, Botox is priced higher compared to Dysport and Xeomin. However, more units of Dysport and Xeomin are generally required to achieve the desired end effect. Therefore, the overall treatment cost for each of these drugs tends to even out to be the same for individual patients.
Which Performs Better, Botox, Dysport or Xeomin?
Although patients and doctors can subjectively rate the outcomes of these three injectables, it is also possible to get a more objective comparison through the use of digital imaging systems like the VISIA skin complexion analysis which issues scores for patient conditions before and after their treatment.
The Office of Dr. U offers free consultations to patients who are interested in getting rid of wrinkles with Botox injections. If you are interested in having your questions answered and learn more about which options would be best for your wrinkle treatment goals, sign up for a consultation today.
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Frequently Asked Questions About Botox, Dysport, and Xeomin
1. Since Botox, Dysport and Xeomin are made of a botulinum toxin, aren’t these injections dangerous? Will they give me botulism?
Botox, Dysport, and Xeomin are technically botulinum toxin products. In other words, the botulinum toxin active ingredient has been processed and modified in lab settings that are safe and tightly regulated.
The concerns about Botox, Dysport, and Xeomin being toxic are related to the fact that they are made from botulinum toxin A which is derived from the Clostridium botulinum bacteria, an organism responsible for causing botulism, a food born illness that leads to symptoms like blurred double vision, drooping eyelids, speech slurring, shortness of breath. However, the concentration levels used for injection products are low enough to be used safely on actual patients.
2. Is there such a thing as a Botox alternative which doesn’t freeze the nerves and muscles?
For patients who feel uncomfortable about using a neuromuscular injection, it is possible to simply use a filler to smooth out crows feet, forehead lines and frown lines between the brows. This can be done using a filler called Belotero which is designed to treat superficial lines. Using Belotero as a Botox alternative is only effective in cases where there are etched lines on the skin formed over time by muscle contractions.
3. Why are Dysport and Xeomin not as famous and well known as Botox?
Botox has been around much longer than Dysport and Xeomin. It was first used to treat cosmetic wrinkles in the 1990s. However, at this time, this was considered to be an off-label (but legal) application. By the year 1997, the demand for Botox became so high that US suppliers could not catch up. Dysport received FDA approval in 2009. And Xeomin was approved by the FDA in 2010. However, in the years up until this point, Botox had developed a household name status due to its immense popularity and its use by celebrities.
There are plenty of ways to improve the appearance of fine lines and wrinkles. To ask Dr. U about Botox, Dysport, and Xeomin restoration, click the button below: