APR 2014

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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greater duration of effect when compared to Botox. Most studies in the U.S. fi nd a similar duration of effect. Dysport claims to also include an increased diffusion ratio and a "softer" effect than Botox. This would make it a better choice for larger areas, such as the upper forehead, but increased diffusion would be a disadvantage in areas like the glabella, where a more targeted effect is desired. "In an ideal world," says Dr. Munavalli, "I would use Dysport for the forehead and crow's feet because of its wider range of diffusion into the bigger frontalis and orbicularis muscles. Botox would be my choice for more specifi c areas that require greater fi nesse like the glabella and lower face." Xeomin marketing materials offer two distinctions: It doesn't require refrigeration, which makes it more por- table, and there is less risk of allergies than with Botox. The latter claim is based on the fact that while Botox contains hemagglutinin and non-hemagglutinin proteins as well as toxin, Xeomin is free of these complexing proteins. Scientists speculate that these proteins could increase the possibility of allergic reactions, but the claim is largely nullifi ed, because after extensive use over more than 12 years, the incidence of allergic reaction after Botox injections is insignifi cant. "In my experience, Xeomin tends to burn less with injection, and fewer patients complain of 'heaviness' after treatment," says Dr. Munavalli. What Studies Say A plethora of studies showing the safety and effi cacy of Botox Cosmetic have been published over the years, and Dysport and Xeomin are also well represented in clinical journals. Unfortunately, there are few published studies comparing these products head to head. The only published study comparing all three formula- tions appeared in the February 2012 issue of the Journal of Drugs and Dermatology by Oliveira de Morais, et al. This small study of 12 male patients with moderate or severe hyperdynamic forehead lines randomly assigned subjects to receive either Botox Cosmetic, Dysport, Xe- omin or Prosigne (a botulinum toxin type A product used in China). Evaluations were performed monthly for 150 days. Researchers concluded there were no statistically signifi cant differences in the four preparations in terms of effectiveness over the three-month study period. Botox Cosmetic and Dysport have been compared in various ways since 2008 when Arnold W. Klein, et al, published "Comparisons among Botulinum Toxins: An Evidence-Based Review" in the June 2008 issue of Plastic and Reconstructive Surgery before Dysport was approved for use in the U.S. The review of studies up to that point concluded that both Botox Cosmetic and Dysport are effective and safe in treating the upper face but suggested that additional studies on Dysport were needed to "establish optimal procedures and treat- ment recommendations." In September 2010, Cory Maas, MD, presented a study comparing Botox Cosmetic and Dysport for the treatment of crow's feet at the American Academy of Facial Plastic and Reconstructive Surgery annual meet- ing (later published in the November/December 2011 Archives of Facial Plastic Surgery). The randomized, double-blind, split-face study of 90 subjects led the researchers to conclude that Dysport offers a quantifi able and demonstrable advantage in wrinkle effacement and hyperfunctional frown lines. Both Allergan and Medicis Aesthetics were approached and offered the opportunity to provide research grants for the study. Medicis did; Allergan declined. Mark G. Rubin, MD, presented his clinical perspec- tive on the differences between Botox Cosmetic and Dysport in the January 2013 issue of Practical Dermatol- ogy, concluding that the preparations were so similar that the choice is likely to come down to patient preference and the physician's own comfort zone in injecting one or the other. The most recent comparison of Botox Cosmetic and Dysport appears in the December 2013 issue of Dermatology and Therapy, an international open-access, peer-reviewed rapid publication journal. Ramtin Kassir and two colleagues conducted a triple-blind, prospective, split-face study comparing the two preparations for the treatment of facial rhytids in 85 subjects. It was funded entirely by Dr. Kassir's practice, Mona Lisa Cosmetic THE POWER OF THREE Although it has been used off-label for crow's feet for years, the FDA approval of Botox Cosmetic for this indication is driving new patients to aesthetic practices. © THINKSTOCK 38 APRIL 2014 | Med Esthetics 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 8 Power of Three/Ad Index MED414.indd 38 3 / 1 8 / 1 4 1 2 : 4 1 P M 3/18/14 12:41 PM

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