There has been a lot of controversy recently about which is the best "botulinum" toxin to use for paralysis of annoying muscle movement, particularly in the area of the 11 lines and the horizontal lines of the forehead as well as crow's feet. The original toxin used in the United States was Botox and this has been used for over ten years. More recently, there has been an introduction of Dysport and most recently Xeomin. All three of these are versions of botulinum toxin A.
Botulinum toxin A serves to cause paralysis of the muscles in the area of local injection. Having used all three toxins in my practice, they all work very similarly. What is important for the consumer to be aware of is that the Xeomin is the most pure of the toxins. There is generally a 1:1 ratio of units used between Botox and Xeomin. Dysport requires three times the number of units as either Botox or Xeomin to create the same effect. It seems that Dysport can migrate much further from the injectable site than the other two with Xeomin producing the least amount of migration of the three. Botox is the most sensitive to temperature and the Botox in fact must be shipped in a powder form on dry ice to the physician and user.
Good results can be obtained with any of them and the comfort level of the injector is probably the most important aspect of the selection of botulinum toxin. It is important to note that after many injections of botulinum toxin, some patients can develop antibodies to Botox and it simply stops working. This is something to be aware of when making the decision to start injecting Botox at a young age with the realization that it may or may not continue to work throughout the patient's lifetime over the course of decades.
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