In a nutshell, Botox is a prescription medicine made from a naturally occurring purified protein that relaxes muscles. It’s Botulinum Toxin and is called a neuromodulator. It is injected into facial muscles or sweat glands. Read on to find out all the finer points…
What’s the difference between Botox vs Dysport vs Xeomin?
Botox®️, Dysport®️ and Xeomin®️ are the brand names of the most reputable of the injectable neuromodulators, used for a variety of conditions such as wrinkles caused by repeated facial expression, headaches, and excessive sweating, as well as a large range of both cosmetic and medical ‘off-label indications.’1
Dr Cat has a simple analogy to explain the difference between them. Compare the overall category of neuromodulators to the category of ‘brown fizzy drink’. Botox is like Coca-cola (Coke), it’s the most widely used and popular, and people use the term ‘Botox’ as a way to refer to the entire category. Dysport is like Pepsi – it’s the same thing with a slightly different flavour. It works the same way as Botox, but has slightly different characteristics. Some people prefer Coke, other people like Pepsi, most people can’t tell the difference. Botox and Dysport are the same – some people prefer Botox, some like Dysport, most people can’t tell the difference. And Xeomin is like Coke Zero because it’s had few things taken out. It’s sometimes sold as a ‘cleaner’ neuromodulator option because it’s had some of the complexing proteins taken out. We’ve tried them all over the years – in our experience, Xeomin doesn’t seem to last as long for most people.
They are all made from slightly different formulations of Botulinum Toxin Type A, one of 9 proteins (A to H) produced by the Clostridium Botulinum bacteria.
Currently, only the Type A proteins (Botox®️, Dysport®️, Xeomin®️, also Jeuveau®️ and some cheaper Chinese and Korean brands) and Type B protein (Myobloc®️) are used in clinical practice.
Myobloc is used more for medical indications such as spasticity, neck spasm, and bladder spasm, and is not generally used cosmetically, whereas the type A proteins are used both medically and cosmetically.
The Type E protein is currently going through trials as a faster onset/shorter duration option, which should hopefully be clinically available in the next few years.
How are Botox and Dysport measured?
It’s important to know that Dysport and Botox are measured differently. Dysport is measured in Speywood units; Botox is measured in Botox units. Xeomin has units that are somewhat similar to Botox units, but not the same. The unit measures for each product are not directly interchangeable. It gets confusing because some people advertise ‘Botox’ at a cheaper price per unit, but when you go for treatment they are using Dysport and need to use more product, so it actually ends up the same price or more expensive.
For example, 10 units of Botox could be the equivalent of between 15 to 50 units of Dysport depending on the individual physiology of the person receiving treatment. Most practitioners use 2.5-3 units of Dysport for every equivalent unit of Botox. So you might have a product advertised at $10/u for Dysport, when you’ve been paying $20/u for Botox. It sounds like a good deal, but when you go for treatment, you need 2.5x more, so you’re essentially paying the equivalent of $25/u. And you still might not get the same result – it might be stronger, or it could be weaker than your usual equivalent Botox treatment. So it’s worth asking the clinic which product they are using BEFORE you book your appointment.
The different products also perform slightly differently. Dysport can spread further for the same dose – for that reason, Dr Cat does not use it for precise work, but she might very occasionally use it on the forehead and or around the eyes if she wanted a specific effect with more spread.
At The Face Place we have used all the major brands over the years, but now only rarely use Dysport or Xeomin. We would use 600-700 vials Botox for every 1 vial of Dysport or Xeomin. We have found Botox to give our clients the best results, in our 20+ years’ experience of using it.
How is cosmetic use of Botox different from medical use?
The doses used for cosmetic Botox are much, much lower than those used medically. For example, eye spasm uses around 300 units of Botox, as does bladder spasm or oesophageal spasm. Neck spasm (torticollis) uses 700-800 units. Dr Cat first used Botox in cerebral palsy kids when she worked in the hospitals – the recommended dose to help these children (as young as age 2) walk is 200-300 units. Compare this to the average dosing for cosmetic treatments which can be 12-30 units for a frown (usually less than 20) and often less than 12 units for the forehead and eyes. Because much lower doses are used, and the Botox result is always temporary, there have been no serious or long-term side effects seen in over 30 years of cosmetic Botox®️ (specifically talking about the brand name Botox®️).
What is Botox?
Botox is a prescription medicine made from a naturally occurring purified protein (derived from the bacteria Clostridium botulinum) which relaxes muscles.
It has been used cosmetically for over 30 years with no serious long term side effects seen with cosmetic dosing. Cosmetic dosing is much, much lower than medical dosing. Medical conditions usually require from 100 – 800 units per treatment. Cosmetic treatments use around 2-40 units per area.
As a prescription medicine, Botox can only be administered by doctors, a dentist or nurse practitioner, or registered nurses under the standing orders of a prescriber.
Is Botox tested on animals?
The brand name Botox has not been tested on animals. Allergan (the global manufacturer of Botox®) spent billions of dollars to remove the need for animal testing. At The Face Place, we believe in using sustainable and cruelty-free products, and choose to avoid animal products wherever possible.
How does Botox work – and what does it do in my system?
Botox is one of several neuromodulators (commonly called ‘wrinkles relaxers’) which all work by relaxing the muscles that it is injected into, including those that create the lines of facial expression. It works by reducing the messages from the nerve to the muscle by working specifically on the receptors for the neurotransmitter acetylcholine, which is the major messenger from nerve endings to muscles. It’s also the messenger from nerve endings to sweat glands, which is why it is so effective in treating excessive sweating.
Botox has a localised and specific action on the muscles or sweat glands it is placed into, which is why there is an art to Botox – putting it in the correct muscle, in the right place, in the ideal amount. If too much is put in, it can result in a ‘frozen face’ look. This is why we choose to use lower doses, more frequently.
This medication is directly metabolised by the body at the site of injection. The metabolites are processed by the liver and kidney and then secreted. Botox is usually out of your system within 24-72 hours.
The acetylcholine receptors are permanently blocked but the body replaces them over time, which is why Botox ‘wears off’ after weeks-months (depending on the dose used).
Where can you have Botox?
When used cosmetically it relaxes the muscles that create specific lines such as frown lines, forehead lines and crow’s feet. Botox is used very effectively for excessive sweating.
There are lots of safe and effective uses of Botox that can be provided but under Medical Council rules they cannot be ‘advertised’ on a website as they are considered ‘off-label indications’ of a prescription medicine. As we are a best practice doctor-led clinic, we abide by these rules. You may have heard of Botox being used to treat areas other than frown lines, forehead lines and crow’s feet – to find out more, just come in and see us to chat.
Take a look at our Botox Before & After photos to see results
Will Botox make me look frozen?
We believe there is an art to Botox and the wrinkle relaxing treatments. You laugh, you frown, you concentrate and when you do, these facial expressions break down the supporting structures in your facial muscles. The medicine needs to be placed in the right muscle, in the best dose, in the correct place. Our aim is to turn the muscle activity down, but not off, so you still have some facial expression. We use lower doses more regularly, which is why we are renowned for our beautiful, natural-looking results.
How long does Botox take to work? And how long does it last?
You will see results of your Botox treatment in 1-2 weeks. The Botox will gradually soften lines over this period by relaxing the muscles.
We are famous for creating a ‘natural look’ with lower doses more frequently to avoid a frozen face, therefore we generally recommend repeat treatments every 3-4 months to achieve the best results. For some areas, we use even lower doses and recommend treatment every 6 weeks. We charge for what we use (as opposed to per ‘area’), so it works out about the same.
What are the side effects of Botox vs Dysport or Xeomin?
The side effects are similar as they are all neuromodulators.
Some of the potential side effects are mild and temporary swelling, bruising or redness, and sometimes minor headaches for the first week. These are all related to the tiny injections that are used to get Botox into the muscle. Very rarely, temporary weakness of adjacent muscles can cause an unwanted effect such as a heavy eyelid, however, this is extremely rare with an experienced injector, and will usually only last a few weeks.
Botox has been used cosmetically for over 20 years with no serious long term side effects seen with cosmetic dosing, which is much lower than medical dosing.
What is ‘droopy eyelid’ and how common is it?
When Botox migrates to two specific areas, Botox injections can result in a droopy eyelid. This is called ptosis.
On the forehead, this can make the brow descend, causing a brow ptosis or ‘heavy eyebrows’ which make the person look and feel more tired. This is why we start with very low doses in the forehead muscle and increase the dose if needed, as this is the more common form of ptosis.
In the frown line area, Botox could migrate into the upper eyelid and the levator palpebrae muscle, causing a heavy eyelid. This is why we recommend not rubbing the treated areas for 3 days after treatment. During Dr Cat’s career, after doing many thousands of Botox treatments, she has only come across this side effect a handful of times – and even less in the last 10-15 years, as her techniques have improved. In the rare case it occurs, droopy eyelid from Botox will not usually last as long as the Botox treatment itself. Ptosis usually resolves with 2-6 weeks, if the treatment is a dose that usually lasts around 3 months.
While this sounds scary for some people, bear in mind that we have 20+ years’ experience of injecting Botox at The Face Place. We know exactly where these two problematic areas are – and how to avoid them. All of our nurse injectors have been highly trained to avoid this rare side effect.
Can you reverse Botox?
No, there is nothing that can reverse Botox other than the time it takes to wear off. This is also why we start with lower doses – it’s dose-related, so the higher the dose, the longer it lasts.
This is different from HA-based dermal filler, which can be dissolved almost immediately with injections of Hyalase.
Read our blog on Hyalase treatment here
At The Face Place, we use small quantities and encourage a less-is-more approach. In our view, it’s better to add more later if needed, than to regret going too far.
Should I worry about counterfeit Botox or other neuromodulators?
If prices seem too good to be true, it pays to question what product you are being treated with. We have been approached several times about purchasing ‘cheap Botox’ but would never do so – all Botox globally is manufactured and distributed by Allergan, so we only get our genuine Botox from Allergan. We are one of their biggest accounts for Botox in NZ, and Dr Cat is a trainer for them. If you ask, we are happy to show you the bottle of genuine Botox we are using before we draw the syringe. It’s a simple step that gives everyone peace of mind.
Does Botox expire?
Yes! Botox must be kept in refrigerated conditions under a ‘cold chain’ and each vial has an expiry date. At The Face Place, we are happy to show you the expiry date before treatment, for peace of mind.
For more tips on best practices, see our blog 7 Things To Look For In a Safe Injectables Clinic
To get even more of your Botox questions answered, come and see us for an Initial Injectable Consultation. These can be done in clinic or via Zoom.
Dr Cat Stone
1 Off-label Indications are areas commonly treated at the discretion of the doctor or nurse providing treatment, but not yet officially approved through MedSafe in NZ, meaning they can only be discussed in clinic, rather than a public platform. If you are curious about what off-label indications we can provide, feel free to contact our team to discuss these.
Mandatory Medical Information
Botox® is a prescription medicine for the treatment of frown lines, horizontal forehead lines and crow’s feet around the eyes. Botox® has risks and benefits. Ask your doctor if Botox is right for you. If you have side effects, see your doctor. You will need to pay for Botox® and clinic fees will apply. For details on precautions & side effects consult your healthcare professional or the Consumer Medicine Information (CMI) at www.medsafe.govt.nz. Botox® treatment lasts about 4 months and further courses of treatment may be necessary. Should only be administered by trained medical professionals. (contains botulinum toxin A 50,100 & 200 units) Allergan (NZ) Limited, Auckland.
Dysport® is a prescription medicine for the treatment of frown lines, horizontal forehead lines and crow’s fee round the eyes. Dysport has risks and benefits. Ask your doctor is Dysport is right for you. If you have side effects see your doctor. You will need to pay for Dysport, and clinic fees will apply. For details on precautions & side effects consult your healthcare professional or the Consumer Medicine Information (CMI) at www.medsafe.govt.nz Dysport lasts about 4-6 months and further courses of treatment may be necessary. Should only be administered by trained medical professionals. Contains 500 units of clostridium botulinum Type A toxin. Galderma (NZ) Limited, Auckland.
Xeomin® is a Prescription Medicine containing 50, 100 units of incobotulinum Type A, purified Botulinum toxin type A complex for injection. It is used for the treatment of frown lines on the forehead, lateral periorbital lines and horizontal forehead lines in adults. It should be administered only by trained medical professionals. Talk to your specialist about the benefits/risks of this procedure in appearance medicine. Xeomin treatment lasts about four months and further courses of treatment may be necessary. Cautions: people receiving blood thinning medicines, care at the proposed injection sites, pregnancy and lactation. Possible side effects: headache, pain, swelling or infection at injection site, local muscle weakness including drooping eye lids, lack of feeling & nausea. Treatment last for up to 4 months. You will need to pay for this medicine. Discuss with your specialist if Xeomin is right for you. For more information or for a copy of CMI please contact the NZ distributor: NZMS Ltd: 2a Fisher Crescent, Mt Wellington, Auckland, Ph 09 259 4062.