MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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THE POWER OF THREE 36 APRIL 2014 | Med Esthetics "We have enjoyed double digit growth year after year since we started 12 or so years ago, and we saw the largest growth ever in the last year," says Vic Narurkar, MD, founder of San Fran- cisco's Bay Area Laser Institute. "Having multiple products has raised awareness and that has helped grow the market. We have used Botox for crow's feet for years, but media attention generated by FDA approval of this cosmetic use did bring in more patients for that service. We now see as many patients for crow's feet as for glabellar lines." How do these toxins differ and what advantages, if any, do the newer prod- ucts provide physicians and consumers? We asked a panel of experts, who have used all three products—Xeomin, Botox and Dysport—to share their experiences. Brand Distinction Botox Cosmetic, onabotulinumtoxinA, gained FDA approval in 2002 for the temporary improvement of glabellar lines. In September 2013, it was approved for temporary improvement in the appearance of moderate to severe lateral canthal lines, or crow's feet. Dysport, abobotulinumtoxinA, gained FDA approval in April 2009 for temporary improvement in the appear- ance of glabellar lines, and the newest neurotoxin, Xeo- min, incobotulinumtoxinA, was approved in July 2011, also for temporary improvement in the appearance of glabellar lines. "The three FDA-approved botulinum toxins are more similar than different," says Joel L. Cohen, MD, director of AboutSkin Dermatology and DermSurgery, Engle- wood and Lone Tree, Colorado and associate clinical professor at the University of Colorado. "They share the same mechanism of action; they are all type A botuli- num toxins; and they have the same type of heavy chain receptor. One major difference is in dosing between Dysport and the other two. All three have proven to be safe and effective when used appropriately in many stud- ies worldwide for cosmetic use." While the products have more similarities than dif- ferences, practitioners are identifying some unique characteristics, says Gilly Munavalli, MD, medical director and founder of Dermatology, Laser & Vein Specialists of the Carolinas. "The speed of onset of the products is dif- ferent, with Dysport and Xeomin kicking in much quicker than Botox," says Dr. Munavalli. "This may be important depending on the patient's schedule. Some anecdotal re- ports suggest that the effects of Xeomin may last slightly less long than those of Botox in a 1:1 unit comparison, but in my experience they have shown about the same duration of effect in my patients. By and large, the dura- tion of effect is the same for all three products. "Botox is still the gold standard, best studied and most widely used," he continues. "It is also the most costly, and the prices keep rising every year. The 3% increase in 2014 is less than in past years, probably due to the pres- ence of competitors. Dysport and Xeomin are still trying to gain market share so they tend to be 10% to 20% cheaper to the physician." Comparing prices can be diffi cult because of basic differences in the products. While the potency (biological activity per unit) is the same for Botox and Xeomin, it is quite different for Dysport, and there is no standard dose conversion. The amount used in FDA clinical trials was 2.5:1 when compared with Botox, but it can be used at 3:1 or higher. The dosage differential can also make it diffi cult to compare Dysport with Botox and Xeomin in clinical trials. Some studies of Dysport in Europe have shown "Botox is still the gold standard, best studied and most widely used. It is also the most costly, and the prices keep rising." All three currently approved neurotoxin products are Type A botulinum toxins. Signifi cant differences relate to dosing and reconstitution. © THINKSTOCK P o w e r o f T h r e e / A d I n d e x M E D 4 1 4 . i n d d 3 6 Power of Three/Ad Index MED414.indd 36 3 / 1 8 / 1 4 1 2 : 4 1 P M 3/18/14 12:41 PM