Ask Dr Heather

Are there any differences between different brands of Botox®?

Anon, Huapai.

Botulinum toxin comes in many forms, manufactured differently by different brands.  “Botox®” was a clever name coined by the company Allergan and is still readily available today.  Other players on the New Zealand market include Xeomin® by Merz and Dysport® by Galderma.  Multiple other brands exist worldwide, however in Aotearoa MedSafe approval only exists for these three players, meaning only they can be used legally in New Zealand.

Every brand will tell you theirs is best, for the simple reason they want people to use their product.  Interestingly, all research around individual brands usually come to the same conclusion: the higher the dose used, the longer the effects last.  So the more frozen you are to start with, the longer it will take for full muscle strength to return. 

Xeomin® is formulated without complexing proteins, so is considered purer than the other brands.  Injectors may prefer this option as it theoretically minimises risk of neutralising antibodies developing over time and hence less risk of resistance to repeated treatments.  Other brands argue this effect is negligible as complexing proteins are released when the product is injected into and metabolised by muscles.

Dysport® is formulated and concentrated differently to Botox® and Xeomin®.  Less volume of Dysport® is therefore needed to achieve the same effect, so injections may be less painful.  This is a subjective advantage however, as many do not notice a difference, especially if certain saline preparations are used to take away the stingy sensation.  Some argue Dysport® is more spready in its effect, so is advantageous for larger treatment areas, however other companies argue against this, claiming all brands spread equally from their respective injection sites. 

So there are many ways to skin a cat.  So long as injectors are aware of the properties, advantages, and disadvantages of the products they use, then it probably doesn’t make much difference at the end of the day.  The most important considerations for injectors are to ensure the products they use are made by legitimate manufacturers (i.e. not counterfeit), are stored and reconstituted correctly, and are used before they expire.  It always pays to ask your injector what they use and why, to ensure you have confidence they understand what they are using, so you receive the best possible care you deserve.

Dr Heather Anderson is a Cosmetic Medicine and Urgent Care/Emergency Doctor who practises in her own clinic at ALLOR Cosmetic Medicine in Whenuapai.  If you have a question for Dr Heather you'd like answered anonymously in the magazine, please email askdrheather@allor.co.nz.