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3/26/2010
Dysport Versus Botox
Several practitioners sound off about using Dysport, as well as similarities and differences to Botox Cosmetic
Dysport Versus Botox

Now that Medicis' wrinkle remover Dysport has been on the market for a few months, how does it compare to Botox Cosmetic? Both products are derived from botulinum toxin Type A, both are used to relax muscles in patients, both must be injected every 3 to 4 months, both have gradual onset, and both have been in use for yearsBotox in the United States, Dysport in Europe (as Reloxin).

Botox and Dysport are both FDA-approved for cosmetic uses in the glabellar frown lines and can also be used for other parts of the face and body.

Recently, PSP spoke with several physicians about the differences between the two products both from a clinical perspective and in how their patients have responded to the choice they now have between Dysport and Botox.

"As Dysport is a smaller-sized molecule, the unit measurement is different from Botox. The conversion ratio is usually between 2.5 to 1 and 3 to 1. We use a 2.5-to-1 ratio, so we inject 50 units of Dysport into an area where we would have used 20 units of Botox," according to Terry Perkins, MD, a veteran cosmetic surgeon who has been practicing for more than 30 years and is the founder of the Cosmetic Surgery Center and Evolutions Medical Spa, both of which are based in Santa Barbara, Calif. In 1999, Perkins was one of only 16 doctors in the United States to conduct a study leading to the FDA approval of Botox for cosmetic uses.

"In terms of the cost to the physician, Dysport is about 10% less per vial than Botox ($475 versus $525)," Perkins continues. "Dysport is also a better value because with the standard conversion2.5 units of Dysport per 1 unit of Botoxyou receive 20% more product per vial. That is enough to treat an extra patient."

Some physicians noted that Dysport's introduction has been good for competition in a marketplace in which Botox Cosmetic has monopolized the toxin-based injectables field for some time.

"Dysport has recently entered the market, and there are three to five other neurotoxins in the FDA pipeline. The bottom line is that doctors and patients will have numerous options in the future when it comes to administering and receiving a neuromodulator," says Joseph Niamtu III, DMD, a cosmetic surgeon in Norfolk, Va, and a Diamond Level provider of Botox.

THE CLINICAL SIDE
"There is a quicker onset of action using Dysport," Perkins says. "One to 2 days versus 3 to 4 days using Botox. The patients note that when injected there is less stinging with Dysport than with Botox."

Although there are subtle differences between Dysport and Botoxprotein coats, molecular properties, etcthey are essentially the same drug, Niamtu says. "Coke versus Pepsi is the way that many surgeons explain the difference to inquiring patients. The main difference is that the effective unit measurement between these two products is different."

Botox units and Dysport units are not equivalent measurements, according to Niamtu. "Initially, surgeons were told that it takes 2.5 units of Dysport to equal 1 unit of Botox. I personally disagree with this equation, and my clinical experimentation has shown 3 Dysport units to equal 1 Botox unit. So, in areas where I give 20 units of Botox, I would inject 60 units of Dysport," he says. "It is important to realize this ratio, as many surgeons and patients will want to try new products and they must have an equipotent dosage to compare apples to apples' for clinical effect. If a surgeon uses smaller quantities of Dysport, the comparison is unfair. Just remember, 3 to 1 will get it done."

Steven H. Dayan, MD, a cosmetic surgeon in Chicago, says, "The most well-done head-to-head trials have shown a unit conversion ratio of less than 1 to 3 Botox to Dysport. The products, both being serotype A, act quite similarly. Controversy regarding different diffusion properties, time to onset, duration of efficacy, and unit-conversion ratios has resulted in multiple publications and discussions, but still no consensus."

The two products have very similar profiles, according to Laurie A. Casas, MD, clinical associate professor of surgery at the University of Chicago Pritzker School of Medicine. "Dysport appears to be slightly less painful at the point of injection," she says, "and Dysport appears to have a slightly quicker onset, especially in the forehead wrinkles. Both appear to have very similar duration. There is definitely a learning curve that is needed, just like there was for Botox Cosmetic. The products are packaged differently300 units per vial of Dysport versus 100 units of Botox per vialand dosed differently. In my first 150 patients, it appears that the patients who have had Botox previously need 2.0 to 2.6 units of Dysport to every 1 unit of Botox. Because I always have patients return 10 to 14 days after their first injection with a product to assess their outcomes, I have had the opportunity to develop this conversion."

Although not all of the physicians contacted for this article agree on the exact unit conversion, all said that Dysport is as safe and effective as Botox. However, are they the same in terms of how long they last? "The length of time that the Dysport treatment lasts seems to me to be comparable," Perkins says. "I have had some patients find that Dysport lasts longer and others who feel that Botox lasts longer. We typically tell patients that we expect similar results with both neuromodulators, educate them about the differences in terms of onset of action and price, and then let them decide which product they prefer. I am not actually trying to push someone one way or the other. That said, most of our patients decide to try Dysport at least once to see how it works for them."

None of the physicians contacted for this article reported anything but mild side effects in patients who received Dysport injectionsor Botox Cosmetic, for that matter.

Perkins has not seen any substantial negative effects from the use of Dysport. "Other than localized stinging during the injection itself, occasionally you will get someone who will get a bruise," he says. "However, the majority of people have very little in the way of downside. Brow ptosis or upper lid ptosis is a possible side effect, but that is typically not an issue if the neuromodulatoreither Dysport or Botoxis injected into the right area with the right dose."

When it comes to definitive clinical proof of Dysport's effectiveness versus Botox Cosmetic, the jury is still out. "A large, randomized, well-controlled, designed, and evaluated head-to-head trial comparing the cosmetic clinical efficacy of the two remains to be done," Dayan says. "However, it will likely be via clinical experience and its use in our practices that the differences between the two will best be highlighted. While Botox, the most popular cosmetic medical procedure in the world, has proven its benefits and has well-defined dosing parameters, Dysport's efficacy and ideal dosing requirements outside the glabellar area are still yet to be clearly defined."

To read the entire story, click on the following link:

http://www.plasticsurgerypractice.com/issues/artic...

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