— From the pages of FLL#35 • Information provided by Medical Cosmetics
In our country, the short answer is, “No, there is not.” However, there is a substantial amount of confusion regarding alternatives to Botox. You see, Botox is Allergan’s trade name for botulinum toxin-A (for our purposes, BTA) product, and is packaged in 100 U vials in Irvine, California. Right now Botox has about 73% U.S. market share for BTA products.
So what are the other BTA products? Dysport is the next most frequently utilized BTA product which is FDA approved for U.S. use. It is produced by Ispen Pharmaceuticals in England, and marketed by Galderma. Dysport has about 24 to 25% U.S. market share. This product has been available to us for about nine or ten years. The only structural difference between Botox and Dysport is that they each contain different aggregating proteins which surround the active portion of the BTA protein. The aggregating proteins have no physiologic or biologic action once injected into the muscle. In fact, just seconds after injection, the active portion of the BTA splits away from the aggregating proteins and is taken up by the axon portion of the motor nerve.[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]I see no discernible superiority of any one of these competing agents over the others.[/pullquote]
It is within the axon of the nerve that the BTA inhibits the release of acetylcholine by binding to the SNAP- 25 enzyme. This is how BTA works, by chemically disconnecting the motor nerve communication with the expression muscle. This causes the injected muscle, and therefore the overlying facial skin, to relax. The relaxation can last as little as two months or as long as six, but will typically last for three to four months.
There is one final U.S. FDA-approved BTA product. The name for this is Xeomin. It is made and marketed by Merz Aesthetics of Germany. Xeomin is the most recent of the BTA products to come to our country and has only two to three percent U.S. market share. Each of these products contains the exact same biologically-active 150 kilodalton BTA protein… the exact same and identical protein.
It could even be said that of the three products, Xeomin is the most advanced since it is the only one without any extraneous aggregating proteins surrounding the active BTA. Xeomin has the lowest market share because it was the last to come to our shores and costs have been kept down by not spending much on advertising. In fact, it costs practitioners significantly less to buy Xeomin than either of the other two products. Most offices will therefore put in Xeomin for a BTA treatment at a significantly lower price point than the other two competing products.
90% of all patients will not be able to tell any difference in effectiveness or duration of benefit between these three products. However, inexplicably, five to ten percent of my patients identify that one of these BTA products works better for them than the others. From my experience with over 15 years of use, I see no discernible superiority of any one of these competing agents over the others. They all work the same. They are brand name products of the same thing— harvested BTA from the clostridium botulinum bacterium.
Often one company or another will have an incentive program in place to encourage the consumer to select their particular BTA over the others. Always ask your practitioner if there is any such program in place for any of these agents at the time of your treatment. In this way you could save considerable money over time. At Medical Cosmetics, we carry all three of these products.