On many occasions I have been asked to discuss the difference between the three main brands of facial neuromodulators (Botox, Dysport and Xeomin). A neuromodulator is a medication that can be injected into a muscle and temporarily prevent the muscle from moving. This is how Botox, Dysport and Xeomin reduce wrinkles. I am fortunate in that I have conducted a large research study looking at the differences between these medications.
Most people have heard of Botox (onabotulinum toxin). However, many have not heard of Dysport (abotulinum toxin) and Xeomin (Incobotulinum). In the most basic terms, each of these medications are different ‘brands’ of the same medication. There are unique differences between these medications and the companies that sell each of them often will promote their medication by highlighting their unique features. However, like everything in business, it is often difficult to determine how much of this is marketing and how much of it is based on research and facts.
A Patient-Centered Approach
I pride myself on taking a patient centered approach to Facial Plastic Surgery. What I mean by this, is that my goal is to make the patient happy, not the drug company. I search out new research and new evidence to ensure I am providing people with the best options to look and feel their best. I am fortunate to have a background in research and thus I can find my way through the cloud of poor research and marketing in order to figure out what really works and what doesn’t.
To answer today’s question, I will discuss a large research study that I recently completed. This study looked at the differences between the medications mentioned above that are used by Plastic Surgeons to get rid of wrinkles. This study was the largest study ever conducted on this topic and was published in the top Plastic Surgery Journal in the World, Plastic and Reconstructive Surgery.
Along with my team of researchers, I conducted a Meta-analysis which is considered the highest level of evidence in Medicine. The higher the level of evidence, the more power and believable the results are. So, this study provides very powerful results and conclusions.
What we did was identify every study looking at the effect of Botox, Dysport and Xeomin that was ever published. We then identified only the highest quality studies, specifically randomized controlled trials (the next highest level of evidence after a Meta-analysis). Choosing randomized controlled trials helped get rid of research studies that were biased or had bad results. We did this systematically, which means, we didn’t just randomly choose studies. Studies were included in our big research study if they met our pre-defined definition of a good study. This again, helps to prevent our own bias.
Once we identified all these studies, we then took all results, lumped them together and then looked at the results as a big group. So, in essence, this takes all the small studies and turns it into one big study. This allowed us to compare the three medications to each other, which has never been done before.
So, I am sure by now you are asking, “well, what is better Botox, Dysport or Xeomin?”
Let me start off by saying that all the medications are better than placebo (injecting salt water into the muscle). I am sure this is not surprising to you, but nevertheless, you can rest assured that you will see a positive effect with each medication.
When we asked “which medication is better, Botox, Dysport or Xeomin,” we wanted to see which one lasted the longest and worked the best. We looked at three different doses of each medication, Low dose, the standard dose and a High Dose. We also looked at the effect the medication had on the patient at 1 month, 3 months and 4 months.
The first thing we noticed when looking at the results, is that there were very few studies that compared each medication to each other. The second important point, was that all the studies were funded by the companies that own the medications. Does this cause bias? It is hard to know, but it raises this question.
Due to all these issues, it was difficult to draw firm conclusions. However, as mentioned, all the drugs were better than a placebo drug.
Another interesting finding was that a high dose of Botox demonstrated the best results which lasted the longest. The low dose of each drug did not last as long as higher doses. This tells us that it is important not to under-dose or give too low a dose of Botox, Dysport or Xeomin. If the dose is too low, the results will not last as long as you would have liked.
We also looked at side effects. Importantly, there were no reported serious side effects or deaths in any of the studies. The most common side effect was a headache and bruising.
In the end, it is difficult to determine what medication demonstrated better results. The key take away from this study is that all medications work. However, researchers need to perform studies that compare more than one medication.
Based on my research and experience, I am still most comfortable using Botox. It has been around the longest, I am comfortable with the use of the medication and research supports its effectiveness.
James P. Bonaparte, MD, MSc, FRCSC
Facial Plastic and Reconstructive Surgery
Department of Otolaryngology – Head and Neck Surgery
University of Ottawa
Ottawa, Ontario, Canada