April 13, 2022
Two years of Covid restrictions and Zoom Meetings has brought us “up close and personal” to an unobstructed view of facial appearance and lines of expression. As a result, the demand for Botox and Dysport, the most popular neuromodulators, has increased in all aesthetic medical practices. This increase is likened to the “Lipstick Effect” of the Great Depression, 1929 to 1933. The Lipstick Effect is the psychological phenomenon of spending more money on personal appearance products to stay attractive during difficult financial times. In 2021, people of all ages used more Botox and Dysport than ever before to decrease the deep lines of expression that age the face. Could this be the “ZOOM EFFECT”?
Patients may elect to use Dysport instead of Botox because they feel that Botox no longer “works” for them, so they switch to Dysport for greater effectiveness. Others think Dysport lasts longer or “kicks in” faster. But what are the facts?
A recent review by Dover, MD et al. (2018) uncovered the myths that circulate around Dysport and Botox (both Botulinum toxin serotype A neuromodulators) and concluded that the popular myths around these neuromodulators are in fact poorly substantiated.
Myth #1: Different neuromodulators produce different results
When used in equivalent preparations the products have the same effect of relaxing deep lines of expression. Dosing units are not the same for the two products. One unit of Botox equals approximately four units of Dysport. The two products produce comparable results when reconstituted appropriately.
Botox is better than Dysport. Dysport is better than Botox. The authors found no evidence to prove or disprove this myth. In studies, both products work equally well in all areas of treatment.
Myth #2: Differences exist with reconstitution volume
There were no perceived differences in effectiveness among the standard recommended reconstitution volumes. Reconstitution is best using preserved saline which decreases patient discomfort.
Myth #3: Dysport diffuses more than Botox after injection
There is little proof that Dysport diffuses more than Botox. Most diffusion differences are due to reconstitution volume. These volumes also do not affect duration when following manufacturer's instructions. The authors concluded that the dose and the injection technique are the drivers of diffusion, not the product. Proper patient evaluation and treatment are the key to effective treatment results.
Myth #4: Antibodies are the main cause of treatment failures
The authors concluded that antibody formation does not differ in these products. In fact, they show that treatment failures are more likely due to changes in the strength of individual muscles, inadequate dosing, or poor muscle targeting. They recommend using the lowest dose over the appropriate time interval. Dr Parker recommends effective doses three or four times per year to maintain the same “look.” Again, emphasizing the importance of individualized treatment.
Myth #5: Post Treatment Protocols are rigid
Most post treatment protocols are anecdotal or speculative. Patients avoid lying down and bending over for up to 6 hours after treatment. There is no evidence to support this instruction. Studies show that Botulinum Toxin A is in the muscle in five to 10 minutes.
Recent studies of masseter injections have shown that moving muscles after treatment increases efficacy and duration of effect. More studies are necessary to confirm this observation.
Importantly, the authors discourage use of cool compresses as there is evidence that cold may decrease product efficacy.
Botulinum Toxin in Aesthetic Medicine: Myths and Realities.
Dover JS, Monheit G, Greener M, Pickett A.Dermatol Surg. 2018 Feb;44(2):249-260. doi: 10.1097/DSS.0000000000001277.PMID: 29016535
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