Ask-An-Expert

This is an old thread reopened by Dr Johnny, for whatever reason eludes me. But Dr Klein expounds on the scientific side of this issue in very well representative medical studies. Thus (more)

This is an old thread reopened by Dr Johnny, for whatever reason eludes me. But Dr Klein expounds on the scientific side of this issue in very well representative medical studies. Thus from Dr Klein's perspective BOTOX is better to use, as I understand his points. And in fact I agree, but for more "in practice" reasons. In my opinion yes, Dysport has a faster onset at the equal dose levels to Botox (in my hands 4:1). But it also has , again in my personal clinical observation a shorter longevity than Botox, by almost 1 month. Fee charged are close to equal. But to me the "big" separation between the two is the "name recognition" that BOTOX has!! In my private practice I have NEVER been asked for Dysport! It is always do you do Botox?, what do you charge for BOTOX?, do you like BOTOX?. So in my view I prefer BOTOX more for clinical and ease of practice reasons. (less)

The purpose of this study is to evaluate the real-world dose utilization of Dysport and BOTOX for cervical dystonia and blepharospasm. Six investigational sites (five countries) were (more)

The purpose of this study is to evaluate the real-world dose utilization of Dysport and BOTOX for cervical dystonia and blepharospasm. Six investigational sites (five countries) were identified. Investigators abstracted utilization data for patients who received Dysport before switching to BOTOX or BOTOX before switching to Dysport. Patients were identified during scheduled clinic visits and selected if they met study criteria, which included treatment for at least 2 consecutive years (at least 1 year with Dysport or BOTOX, then switched and maintained on BOTOX or Dysport for at least another year). A total
of 114 patients were included in the assessment. Ratios of mean dose for Dysport to BOTOX ranged from a low of 2:1 to a high of 11:1. Thirty-one percent of patients fell into the Dysport-to-BOTOX ratio grouping of 5:1 to less than 6:1; 30% of patients had a mean ratio of Dysport to BOTOX of 4:1 to less than 5:1; and only 21% of all patients evaluated fell into the Dysport-to- BOTOX ratio grouping of 3:1 to less than 4:1. Results are consistent with United Kingdom labeling for botulinum toxins stating that units of different serotype A toxins are not interchangeable and simple dose-conversion factors are not applicable.
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Essentially both products do the same for the patients. Onset of action is also patient dependent as well the longevity of the effect.
In the right hands both products produce and (more)

Essentially both products do the same for the patients. Onset of action is also patient dependent as well the longevity of the effect.
In the right hands both products produce and esthetically pleasing results.
Good luck from NYC (less)

One needs to look at the literature on Dysport today and compare it with the literature from Europe 10 years ago. Suddenly they want one to believe Dysport and Botox act in an identical (more)

One needs to look at the literature on Dysport today and compare it with the literature from Europe 10 years ago. Suddenly they want one to believe Dysport and Botox act in an identical manner. Why do earlier and current studies show that Dysport acts more quickly than Botox? It is a scientific fact that smaller molecules diffuse further than larger molecules (spread from the point of Injection.) and Dysport is a smaller molecule than Botox. This is why injecting the frown with Dysport usually will affect most of the forehead area above the frown. I shared over 35 articles with Medicis about
this, but they just don't want or care to
understand the truth. Their theory, espoused by Dr Monheit for Medicis is that when toxins, including Dysport, are injected into the body they suddenly reach the pH environment of the body and they loose their protein envelope releasing the pure botulinum molecule. And this is why all type A toxins diffuse equally. However Dr Monheit* obviously does not realize that Dysport and Botox are both stored at the same pH as the body and there is no pH change upon injection. Well, there goes Monheit's* theory; yet Medicis and much of the derm literature still supports Moneheit?s ridiculous
theory to this day. There was recently an article (Neurol Sci. 2011 Jun 28. )that was a
?Retrospective evaluation of the dose equivalence of Botox(®) and Dysport (®)? in the management of blepharospasm and hemifacial spasm: a novel paradigm for a never ending story.? As the authors stated Botox(®) and Dysport(®) are the preparations of botulinum neurotoxin most widely used for
therapeutic and cosmetic purposes. Several studies have addressed the topic of the equivalency ratio (D/B ratio) to be used in clinical practice. Whether a reliable value exists is a matter of debate and unlikely. To this purpose, the authors retrospectively examinined patients affected by hemifacial spasm and blepharospasm. They compared the pairs of treatments with a switch from one brand to the other undergone by the same patient in consecutive sessions with overlapping clinical outcome. Out of 2006 treatments, they found 51 treatment pairs. D/B ratio was extremely variable (range 1.2-13.3) and in most cases (65%) it was between 1:3 and 1:5. In conclusion, even if the 1:4 ratio might be reliable for clinical purpose, a true bioequivalence between Dysport(®) and Botox(®) might not exist due to the intrinsic pharmacokinetic properties differences between Botox andDysport. Furthermore, as stated in the insert, the potency Units of Dysport are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of Dysport cannot be compared to or converted into Units of any other botulinum toxin products. Recommended dose and frequency of administration should not be exceeded. In regards to the crows-feet study one must remember it was sponsored by Medicis who distributed Dysport so the results cannot considered to be objective and furthermore this is an unapproved indication. Why the FDA allowed Medicis to promote the results of this off-label study is a question Peggy Hamburg at the FDA needs to answer

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One needs to look at the literature on Dysport today and compare it with the literature from Europe 10 years ago. Suddenly they want one to believe Dysport and Botox act in an identical (more)

One needs to look at the literature on Dysport today and compare it with the literature from Europe 10 years ago. Suddenly they want one to believe Dysport and Botox act in an identical manner. Why do earlier and current studies show that Dysport acts more quickly than Botox? It is a scientific fact that smaller molecules diffuse further than larger molecules (spread from the point of Injection.) and Dysport is a smaller molecule than Botox. This is why injecting the frown with Dysport usually will affect most of the forehead area above the frown. I shared over 35 articles with Medicis about
this, but they just don't want or care to
understand the truth. Their theory, espoused by Dr Monheit for Medicis is that when toxins, including Dysport, are injected into the body they suddenly reach the pH environment of the body and they loose their protein envelope releasing the pure botulinum molecule. And this is why all type A toxins diffuse equally. However Dr Monheit* obviously does not realize that Dysport and Botox are both stored at the same pH as the body and there is no pH change upon injection. Well, there goes Monheit's* theory; yet Medicis and much of the derm literature still supports Moneheit?s ridiculous
theory to this day. There was recently an article (Neurol Sci. 2011 Jun 28. )that was a
?Retrospective evaluation of the dose equivalence of Botox(®) and Dysport (®)? in the management of blepharospasm and hemifacial spasm: a novel paradigm for a never ending story.? As the authors stated Botox(®) and Dysport(®) are the preparations of botulinum neurotoxin most widely used for
therapeutic and cosmetic purposes. Several studies have addressed the topic of the equivalency ratio (D/B ratio) to be used in clinical practice. Whether a reliable value exists is a matter of debate and unlikely. To this purpose, the authors retrospectively examinined patients affected by hemifacial spasm and blepharospasm. They compared the pairs of treatments with a switch from one brand to the other undergone by the same patient in consecutive sessions with overlapping clinical outcome. Out of 2006 treatments, they found 51 treatment pairs. D/B ratio was extremely variable (range 1.2-13.3) and in most cases (65%) it was between 1:3 and 1:5. In conclusion, even if the 1:4 ratio might be reliable for clinical purpose, a true bioequivalence between Dysport(®) and Botox(®) might not exist due to the intrinsic pharmacokinetic properties differences between Botox andDysport. Furthermore, as stated in the insert, the potency Units of Dysport are not interchangeable with other preparations of botulinum toxin products and, therefore, units of biological activity of Dysport cannot be compared to or converted into Units of any other botulinum toxin products. Recommended dose and frequency of administration should not be exceeded. In regards to the crows-feet study one must remember it was sponsored by Medicis who distributed Dysport so the results cannot considered to be objective and furthermore this is an unapproved indication. Why the FDA allowed Medicis to promote the results of this off-label study is a question Peggy Hamburg at the FDA needs to answer

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We use both in our practice they are both very good neurotoxins. We don?t believe one is better than the other one.

more information : http://www.drjsalomon.com/botox/ (more)

We use both in our practice they are both very good neurotoxins. We don?t believe one is better than the other one.

more information : http://www.drjsalomon.com/botox/ (less)

Hello,

Both Botox and Dysport are great products with essentially the same formula. I like Dysport a little better, as it lasts slightly longer. Sculptra works well also, but falls in (more)

Hello,

Both Botox and Dysport are great products with essentially the same formula. I like Dysport a little better, as it lasts slightly longer. Sculptra works well also, but falls in a different category than Botox and Dysport and would be used for different issues. It especially works well with HIV patients to restore fullness to the face. It is not a real filler, it is an injectable suture. I think fillers are more predictable. Sculptra causes irritation of the dermis and collagen formation. It takes time for the collagen regeneration, and it is not quick like a filler. Thanks, and I hope this helps answer your question.
Dr. Nassif
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Love the explanations by Dr Klein. Especially about the Sculptra/Radeisse issues of nodules. As for the D/B ratios and experience, I agree with the faster onset of action with Dysport (and (more)

Love the explanations by Dr Klein. Especially about the Sculptra/Radeisse issues of nodules. As for the D/B ratios and experience, I agree with the faster onset of action with Dysport (and the reason seems to be molecular size particles). But with faster onset I see faster loss of reaction than Botox, my personal clinical observation. As for an exact ratio D/B, I agree the 1.5/1.0 seems to be minimally acceptable. I personally use a 2.25/1.0 ratio and find that better to being a more even comparison, again just my impressions. Thanks again Dr Klein. (less)

The filler Sculptra®, or New-Fill?, was at one time considered an important agent in managing facial fat loss in HIV+ patients. Prior to FDA approval, it was used in a clandestine manner. (more)

The filler Sculptra®, or New-Fill?, was at one time considered an important agent in managing facial fat loss in HIV+ patients. Prior to FDA approval, it was used in a clandestine manner. In clinical trials evaluating this agent for correction of fat loss in HIV+ patients although the study patients were for the most part satisfied, up to 50% of the injected individuals developed some degree of lumpiness in the treated areas. Furthermore, these lumps are often far from invisible. Nevertheless, Sculptra® received rapid track compassionate release approval from the FDA for use in patients with HIV. The panelists on the General and Plastic Surgery Device panel were strongly unanimous in limiting approval only for patients with HIV. At the FDA hearing, not one histologic slide showing the fate of Sculptra upon implantation was shown. Again, how can an agent gain approval without scientific data supporting its application? Subsequently Sculptra was approved for use in HIV- patients again with data that did not support its application or problems

According to the European literature the consequences of Sculptra® in the normal host has been very problematic (foreign body granulomas, infections, etc.)

Here is a photograph of a patient who came to me who had an adverse reaction to Sculptra®. Frequently the only way to get rid of these lumpy ridges is to excise (cut out) them from the face.





Nevertheless, the lay press, medical conferences and internet began to promote this substance for soft tissue augmentation in HIV negative patients. Although prospective studies for the use of this agent in individuals with normal immune functioning had not yet been completed in the United States, we did have reports of the European experience.

In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of the treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients.
While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product.

Another product, Radiesse® (BioForm Medical, San Mateo, Calif.) is an injectable filler material composed of synthetic calcium hydroxylapatite microspheres (30 percent) suspended in an aqueous carrier gel (70 percent). At present, Radiesse® is indicated in the United States for correction of moderate to deep nasolabial folds and for correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. Its off-label use in other facial aesthetic indications is widely reported in the literature. While a precise injection technique will supposedly minimize potential effects such as nodule formation and helped avoid persistent overcorrection, livid coloring, and asymmetry, the variation in injection techniques is immense. I personally have seen lumps in the cheeks, tear troughs and lips after Radiesse® use. Some of these lumps were over 2 years duration.

It is a strange time. Everyone wants to publish in the realm of minimally invasive aesthetics. Filler experts are everywhere and yet most fail to report adverse reactions to agents to which they are consultants. As a physician one must remember "everything that is obsolete was once new, which indicates that everything that is new is not necessarily better." Recently consultants have tried to blame bacterial colonization on the filler for adverse reactions. This is negated by what is found when filler problems are viewed under the microscope.

One would assume that the problems of these adverse reactions would be the topic of medical meetings and conventions. These meetings were at one time places where physicians eagerly shared their medical advancements and warned of adverse reactions. The hotels were moderate but ideas were intellectually exciting.

In 2009 medical meetings have become nothing more than trade shows where drug companies discuss and demonstrate their latest wares. The meetings are often held in grand resorts at distant foreign locales. Additionally, much of the medical literature itself has evolved into nothing more than promotional material of questionable accuracy also underwritten by Big Pharma. Presently even continuing medical education (CME) in the USA is no longer a science but a business where the manufacturers of these products promote the use of filler products and even teach off label use (using the product outside of what the FDA has approved it for) without regard for informing doctors of adverse reactions. The manufacturers underwrite the costs of these large conventions and CME courses to the tune of a billion dollars annually. In the world of facial Aesthetics especially this behavior is rampant.
When it becomes your time to fill; do some research beforehand. It could save you pain, expense and ultimately your face. Also find out what is in the needle before the needle goes into your skin.

Furthermore, it is time to keep Industry out of medical education, and prevent them from turning the medical literature into written advertisements. Most importantly you must keep industry away from your face! (less)

Despite that it seems to have a stronger effect, when properly used in terms of anatomical muscle selection and knowing it's predictive difusion pattern, Dysport in my opinion gives much (more)

Despite that it seems to have a stronger effect, when properly used in terms of anatomical muscle selection and knowing it's predictive difusion pattern, Dysport in my opinion gives much more quality per unit applied.
I had an eyelid ptosis during my learning curve 5 years ago, but right now I feel comfortable with the product.
During my residence in Guadalajara with my mentor Dr. Jose Guerrerosantos (1995-98) I started with Botox as the first and only choice and I have been satisfied with it's results by 10 years attending all type of patients in terms of socioeconomical and cultural status .
I continue using both, specially when someone asks specifically for Botox. But, I often use Dysport for me and my wife . (less)