Now Allergan, the manufacturer of Botox, has fired another shot with the unveiling a new program called Brilliant Distictions.  This new program allows certain offices to give additional rebates to patients.  After every Botox treatment an enrolled patient will receive 200 points into their account.  Every 200 points can be redeemed for a $25 coupon that is good for Botox, Juvederm or even Latisse.  Patient need only enroll in the program on the Brilliant Distinctions home page.

Dysport is an injectable protein that was approved by the FDA in April of 2009. It works much like Botox in order to relax facial wrinkles. Like Botox it can also be used to help with excessive sweating (hyperhidrosis) and muscle spasm.

How much do I need?

Although Botox and Dysport are two different products the approximate conversion is around 2.5 units of Dysport for every one unit of Botox. If for instance you normally use 20 units of Botox to treat the wrinkles between the eyes you would need about 50 units of Dysport.

Does Dysport Last Longer Than Botox?

It depends on how many units you use. There are some studies that show Dysport lasting slightly longer than Botox but in most of the those studies a larger ratio than 2.5:1 (Dysport:Botox) was used. When comparing 50 units of Dysport to 20 units of Botox most studies show that their duration of effect is almost identical.

Does Dysport Work Faster Than Botox?

For a small percentage of patients the answer is likely yes. In studies about 35% of patients noticed that their Dysport started working within the first 48 hours.

Does Dysport Cost Less Than Botox?

It depends on how much you use. If you use the equivalent dosing the cost of Dysport is almost exactly the same as Botox.

Is Dysport Safe?

Yes, Dysport has been used in Europe for many years and has an almost identical side effect profile to that of Botox.

1. Which one works faster?
2. Which lasts longer?
3. Are there different techniques needed to do the procedure well?
4. Are there any safety issues?
5. Which one is one is a better value?

1.)   In most patients Botox takes about 3 days to start working but in some patients can take up to two weeks to achieve full effect.  Faster onset was noted in about 30% of patients who used Dysport with some seeing effects in as little as a single day.

2.)   Most studies on Botox show that it lasts about 3 to 4 months and there is a direct correlation between the amount of product used and the duration of effects.  Many posts and websites assert that Dysport lasts longer and some studies do indicate a slightly longer duration of effect, but not all of them. In fact some clinical trials indicate exactly the opposite, that Botox last longer.   Clinical experience in the U.S. over the next several months will help guide consensus on this.  For providers who follow the current injection guidelines, expect either product to last about 3-4 months.

3.)  Both dosage and injection technique are product dependent.  The conversion is approximately 2.5 Dysport units to 1 Botox unit, but there is some variation between the upper and lower face.  Another technical issue is that Dysport seems to spread more during injections in most studies.  This can be both a good and a bad thing.  It is good in that large areas that need injection (forehead, armpits) would require fewer injections due to the spreading.  However, it can also be a bad thing if the physician is an inexperienced injector and does not have a good understanding of more complex musculature (around the eyes, between the eyebrows).  In these cases the Dysport could spread into unwanted areas causing untoward side effects such as droopy eyelids and brows.

4.)  Botox has been used for over 20 years starting with cerebral palsy patients and has a truly excellent safety record.  Dysport has been used for several years in Europe and Canada and at this point has shown no safety issues.

5.)  After a thorough review of the current literature we have determined that Dysport is a safe and effect alternative for Botox.  The cost of Dysport to is about 5-10% less than Botox and we will pass that savings on to our patients.  Dysport will run between $4 and $5 per unit.  Give us a call at 303.683.3235 to find out more or schedule an appointment to decide which product is right for you.

As always competition is a good thing.  The emergence of an alternative drug to Botox should spur on pricing competition that will benefit both patients and physicians alike.  Also new research and development is already under way to provide the next big product such a as Purtox.  Time and good clinical based studies will determine which products are truly clinically effective and which are more marketing hype.

Avoid:

Before any invasive procedure or other treatments that may alter the integrity of the skin such as Botox or Fillers make sure you should avoid certain vitamins and supplements.  Stop taking all of the following for at least one week:

NSAIDS (Advil, Motrin, Aleve)
Omega 3 fatty acids (Fish Oil)
Flax Seed Oil
Vitamin E
St. John’s Wart
Garlic
Ginko
Ginseng

A special note about aspirin:  It would need to be stopped for 10-14 days before a procedure but check with you prescribing physician first to see if it is ok to stop this medication.

Most minor bruising lasts a couple days to a couple weeks so be patients.  Keep firm pressure on any area that is obviously swelling for at least 5 minutes.  Place cool packs over the area immediately after treatment and for the first 24 hours (no hot packs).  Keep the area elevated for the first few days, especially at night.

Supplements:

There are two main supplements that have been proven to reduce the healing time of bruising and swelling.  In some studies healing times have been decreased by as much as 40%.

• Arnica Montana can be very effective, the oral forms like SinEcch are much more effective that topical gels. It is even more effective when both forms are used together. Take the tablets as directed and apply gel 4-6 times a day.
• Bromelain (an enzyme found in pineapple) also helps to minimize the bruising by helping to digest the proteins that trigger bruising and swelling. Take 250-500mg four times a day until the bruise heals.

Make-up Tips

Remember that green tinted make-ups will help decrease redness and yellow make-up will help absorb bluish discoloration.

When treating chronic daily headache or migraines with Botox, most doctors will use a modified “Follow the Pain” approach.  Simply stated, that means if your migraines start out as tension in the middle of your forehead and between the eyes, then these are the areas that will receive some Botox. Treating these areas will also help upper face wrinkles. 

However, if your headaches normally start in the occipital area (back of the head) or temporal area (side of the head), then there may not be any clinical justification for putting Botox in those muscles of the upper face.

Due to the fact that these specific muscles (which cause the wrinkles in the upper face) are not being treated, you should not expect to see any improvement in those wrinkles.

Botox is extremely effective for Hyperhidrosis.  According to a study published in The Journal of Drugs and Dermatology this year that compared Aluminum Chloride deodorants (Drysol) to Botox, patients had 92% satisfaction with Botox vs. only 29% with the Aluminum Chloride deodorant after 4 weeks. 

Injections done by a qualified practictioner cause minimal discomfort and effects normally last about 3-6 months.

The DEA makes it illegal to import Botox or any other injectable from another country because they cannot monitor the product.  The other issue is that of counterfeiting, which has become big business around the globe.  This is especially true of Botox coming from Canada, Mexico, and France. 

• The only way to assure yourself that you are getting the real thing is to copy down the lot number and call Allergan (the manufacturer of Botox) to double check that that particular lot number was delivered that the doctor who injected it. 

• Another tip, make sure that your provider is willing to mix the Botox in front of you (it comes as a dry powder) that way you are assured they are not over-diluting their product.

A vial of Botox cost all physicians about the same and contains 100 units of Botox. The vial comes as a dry power which is reconstituted with sterile saline. Different providers use different amounts of saline. This is usually anywhere from 1-4ccs. This means you could be getting anywhere from 25 to 100 units of Botox per cc if you paying buy the cc.

Studies suggest that the higher potencies (i.e. less dilute) of either 1-2ccs tend to work the best.  Botox should normally cost between $10 – $18 per unit, depending on the injector.  Any less and the Botox is most likely from outside the country which is both illegal (The FDA cannot monitor it) and highly suspect for counterfeit.  If you buy it by the unit, you understand exactly how much your provider is using over which areas and make sure you get a fair price.