Is Xeomin better than Botox? Or is Dysport the best?

With the advent of the new botulinum preparation called Xeomin, many people are wondering which one is better - Botox, Dysport or Xeomin?  Here's what we know, scientifically speaking:

1)  A comparison study (here) of Botox versus Xeomin for wrinkles in the glabella (frown lines) found these two products to work virtually the same, according to independent raters.

2)  Botox and Xeomin spread out through the tissues to the same extent, so the patient's response to the placement of a given dose is very similar.  (study #2 here)

3)  The potency (LD50) of Botox and Xeomin is very similar - so the dosing is the same.  No conversion ratios are needed.  (study #3)

4)  Xeomin worked identically as well as Dysport in a comparison test in the crow's feet area, when the usual 3:1 conversion ratio was used.  (study #4)

Conclusions:  So far, the three preparations work in a very similar manner for the treatment of dynamic facial wrinkles.  There's no convincing study - as of today - that shows a clear winner.

In other words, people, what we have here is a three-way version of "Coke vs. Pepsi".  Pick your favorite...they all work.  We have all 3 of them available at our Orlando, Florida office.  Come on in and give your favorite a try!

Obagi skin care really works

Compared to other areas of our field, skin care often lags behind when it comes to good science. That's one reason why an article in this month's issue of ASJ (the Aesthetic Surgery Journal) is exciting: it looks at the effect of the Obagi skin care system in a good quality study. Here the study focused on the combination effect of Obagi in patients receiving Botox for facial wrinkles.

I'll skip to the bottom line for you: the Obagi system, with additional Retin-A, significantly improved fine lines, wrinkles, and hyperpigmentation, leading to higher patient satisfaction ratings in patients who combined the skin care system with Botox treatments. It's a winning combination.

Here's one of the many charts from the article, showing the higher patient satisfaction scores with Obagi and Retin-A, compared to a standard skincare regimen. You don't have to be a statistician to see the difference here!


“The new hydroquinone system is not only effective, it is also easy for patients to use, increasing the likelihood that they will be able to get maximum benefits,” said study co-author Joel Schlessinger, MD, FAAD, FAACS. “Most importantly, using the system in combination with tretinoin significantly improved how patients perceived themselves, which is the ultimate goal of any aesthetic treatment.”

Botox, Dysport and now...Xeomin

Just this week, the FDA has approved another competitor for Botox. This one is called Xeomin, and it's sold by Merz Aesthetics.

Just like Botox and Dysport, it temporarily reduces wrinkle lines, such as the frown lines between the eyebrows. However, Xeomin does not require refrigeration prior to reconstitution and mixing. According to the manufacturer's press release, Xeomin will be available in the spring of 2012.

One of the subtle differences between these 3 products is that Xeomin has a lower "protein load" than either Botox or Dysport. This might be helpful for the rare person that has developed antibodies to either Botox or Dysport.

Also, unlike Dysport, the dosages used are the same as Botox® Cosmetic - so direct comparison of the treatment effect is much easier.

So the big question: will more competition bring the wholesale price of the product down? While that would be nice, I'm skeptical that it will happen. Time will tell.

New evidence of the benefits of Botox

We've always known that Botox is an effective wrinkle fighter. But now, new evidence shows it can actually prevent wrinkles from forming in the first place.

According to research from Dr. Roger Dailey's group at Oregon Health and Science University (OHSU), patients who begin receiving Botox injections between their 30s and 50s were able to prevent wrinkles from forming in the glabella (frown) and forehead regions, as well as eliminating existing wrinkles. To my knowledge, this is the first time I've seen scientific evidence of the long-suspected prophylactic effect of Botox.

In addition, after about two years of regular Botox therapy, Dr. Dailey and associates found that patients could reduce the frequency of Botox® Cosmetic treatments, and still receive most of the same wrinkle-smoothing cosmetic benefits.

Dailey studied 50 women ages 30 to 50, who received regular Botox® injections for two years. "We found that after the patient received Botox® Cosmetic injections every four months for two years, the frequency of the injections can be changed to every six months and still achieve good results," Dailey said. "This demonstrates patients have the ability to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.

Study Shows Women Are More Prone to Facial Wrinkles Than Men

Findings from a study published in the November/December issue of Aesthetic Surgery Journal (ASJ) suggest that gender-specific differences in the perioral skin (skin surrounding the mouth) account for more and deeper skin wrinkling in women than in men.

“The aim of this study is to obtain new insight into the perception that women wrinkle earlier and more severely than men,” said the study’s lead author, Emma C. Paes, M.D., from the Department of Plastic, Reconstructive and Hand Surgery at the University Medical Center in Utrecht, Netherlands. “If we understood the reasons for differences in wrinkling between women and men, then we might be able to develop better strategies for the treatment of perioral wrinkles.”

The study found that all of the following could explain the presence of more and deeper perioral wrinkles in women:

Women’s perioral skin contains fewer sweat glands and sebaceous glands (microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate skin and hair), which could influence the natural filling of the dermis (skin).

Women’s perioral skin contains fewer blood vessels and, therefore, is less vascularized compared to men, which could accelerate the development of wrinkles.

In women, the closer attachment of the muscular fibers surrounding the mouth to the dermis may cause an inward traction, thereby creating deeper wrinkles.

Current treatments for perioral wrinkles include the use of lasers & chemical peels, Botox injections, and injectable or implantable wrinkle fillers. Despite these many options, the effective treatment of wrinkles in the perioral region still remains a challenging problem.

“We think it's important to consider the reasons why a particular treatment may or may not be effective,“ said Dr. Paes. “Sometimes one has to go back to the basics... In the end, having more basic knowledge about a problem can speed up the process of finding the right solution.”

Source: ASAPS