Cosmetic Dermatology.
Dr. Baumann's new book describes all the various types of botulinum toxins.

Botulinum toxin comes from naturally occurring bacteria—and yes, they are the same bacteria that cause lethal botulism poisoning through ingestion of improperly handled or preserved food. You trivia buffs out there might be interested to know that the word “botulinum” is derived from the Latin word for sausage. Botulism got its name in Napoleon’s time, when it was noted to be triggered by eating spoiled sausages. Don’t worry, though, cosmetic-grade toxins are highly purified and diluted. When used properly, they are perfectly safe!

There are seven types of botulinum toxin, each designated by a letter from A to G. Both Botox and DYSPORT are type A, which is the most potent and the first to be made available in the US for medical use. Botox was developed in the US, while DYSPORT was developed in the UK. For this reason, DYSPORT hit the market first in Europe- about 10 years ago.

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Botulinum toxin type A breaks a muscle protein called SNAP 25, which is necessary for muscle contraction. As the protein breaks, the muscle is unable to contract and therefore relaxes, smoothing the usual lines and wrinkles that normally appear in that area.

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These naturally occurring toxins have been used in humans since 1981 and more is known about this product than many drugs on the market because of the rigorous testing that has been done. (I was part of the testing of Botox and DYSPORT and the 3 year clinical trials that led to FDA approval). It is important to remember that in order for a drug or a biologic agent to get FDA approval, long term safety trials are necessary. (Supplements do not have to do any of these safety trials!)

Any stories you have heard about deaths from Botox have all occurred in very ill children or other ill people who have been given huge doses to treat cerebral palsy or other serious medical conditions. One other incidence occurred when doctors used huge amounts of an illegal form of botulinum toxin. The small doses use to get rid of wrinkles have never to my knowledge been associated with any problems except bruising, flu like symptoms and asymmetry or ptosis; this occurs when the doctor is not skilled. Remember– you get what you pay for!

The toxin doesn’t hang around in your body for long; I have been told by the researchers who developed it that it clears your system in less than a day and can be gone in as few as 30 minutes. The wrinkle-smoothing effects last for several months because that’s how long it takes the body to rebuild the damaged SNAP 25 protein.

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The toxin works best on “wrinkles in motion.” These are wrinkles you can see only when the muscle is moving as you change your facial expression. Wrinkles at rest—such as the nasal labial fold lines between the mouth and the nose—can be seen even when the face is expressionless and are not suitable for this treatment. For those, you need a dermal filler like Juvederm, Restylane or Evolence.

Frown lines, crow's feet and forehead lines are all areas where botulinum toxin can give fantastic results. It can also sometime be used on wrinkles in the lower face or to lift up the tip of the nose.

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For the past three years, my colleagues and I at the University of Miami have been involved in the clinical trials that led to DYSPORT’s approval by the FDA; I also participated in research trials that led to the approval of Botox in 2000. I’m a huge fan of both products but they each have their strengths and weaknesses.

Though there hasn’t yet been a big enough study that directly compares the effects of Botox and DYSPORT, DYSPORT seems to work faster, diminishing creases in just two days instead of the three to seven days it takes for Botox to kick in. Many Brazilian doctors also report that the effects of DYSPORT last a bit longer—five or six months compared to four for Botox.

I’ve also heard colleagues say that DYSPORT has more “spread” than Botox, meaning it breaks the SNAP 25 protein in a larger radius from the point of injection. In some areas of the face such as the crow’s feet, this is a good thing because fewer injections are required, but in others you might want a more targeted approach.

In Brazil, where both Botox and DYSPORT (called Dysport there) are available, DYSPORT is more popular.

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It’s too soon to tell for sure, but the introduction of DYSPORT to the US market could result in lower prices. Currently, the average Botox treatment sets the consumer back nearly $400. Because DYSPORT may last longer, many doctors and patients say it’s significantly more affordable than Botox.

I think we might see a bit of a marketing war between the two products–over five million Botox injections were administered in 2007, generating huge profits for its manufacturer, Allergan. DYSPORT’s makers will work hard to get a share of that money and Allergan is not going to want to give it up!

Like Botox, DYSPORT can cause bruising around the injection site. You should stop taking aspirin, ibuprofen and Vitamin E supplements 10 days before treatment, as they can make bruising worse.

You should also avoid these products if you are pregnant or breastfeeding. In January, the Cosmetic Physicians Society of Australia warned its doctors not to treat pregnant or nursing women with Botox after a link was made between a child who was born deaf and blind and its mother’s use of Botox during pregnancy.

Most doctors would agree with me in refusing to give injections to pregnant women as we just don’t know enough about the effects they might have on a child’s development. However, I have heard stories of doctors who are less scrupulous, or of patients who didn’t know (or neglected to say) they were pregnant. Yikes! Don’t do that!

That said, both Botox and DYSPORT are incredibly safe products, and the results are absolutely worth it! I’ve been using Botox since I was 28, and couldn’t be happier with the results. In fact, the best time to start using them is while your wrinkles are still “in motion” and not too deep. That way, you can prevent them from getting deeper and more noticeable down the road.

As always, just be sure that you get your treatments from a dermatologist or plastic surgeon and make sure your doctor is board certified.

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Wishing you great skin!

Dr. Leslie Baumann