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As many of you may already be aware, there are now two FDA-approved forms of Botulinum toxin A available in the USA to treat frown lines of expression.

BOTOX® Cosmetic was FDA approved in 2002 in the US to treat glabellar frown lines, the wrinkles that occur between the eyebrows with expression. DYSPORT® was recently FDA approved in the US in the first quarter of 2009.

Botox® is onobotulinumtoxinA; Dysport is abobotulinumtoxinA. Both forms of botulinum toxin A are highly refined and purified proteins that can be injected using a very fine needle to relax muscles that cause wrinkle lines of expression. No live bacteria is contained in either product.

The amount of botulinum toxin A that we use in cosmetic medicine is very small compared with the amount that we normally use to treat other medical conditions such as cerebral palsy, cervical dystonia and torticollis (severe muscle spasm of the neck).

Either product can also be used off-label to treat the horizontal wrinkle lines on the forehead, the “crows feet” on the side of the eyes, under the eyes, around the mouth, chin, angle of the jaw, and neck. We also use Botox® to treat excessive sweating of the underarm areas, a condition for which this treatment is also FDA-approved. This is a very simple procedure that can easily be done over a lunch hour.

Botox® Cosmetic is a product of Allergan, a medical pharmaceutical company that manufactures not only Botox®, but prescription ophthalmologic medications such as Lumigan®, and the recently FDA approved eyelash growth stimulator–Latisse®, a prescription only medication that we have available for you.

Dysport® is manufactured by Ipsen Pharma, LTD, and comarketed in the USA by Medicis Aesthetics, the company that brings us Restylane® and Perlane®.

Both forms of botulinum toxin A are very safe and effective when used appropriately by those who understand their respective mechanisms of action. It is equally important to have a working understanding, based on experience, what the subtle differences between these products are. The toxin associated proteins, which are somewhat different between Botox® and Dysport® are thought to have an affect on how the toxin A is absorbed into the nerve endings. This can influence onset of action, duration of action, and injection radius of diffusion. Beyond the science, there is certainly an Art to placing these injections that depends on individual factors such as muscle strength, individual anatomical variances, skin age, type of wrinkle, opposing muscles, size of the area to be injected, and a whole host of other factors.

A careful and thorough evaluation with patient education is what we offer you. We realize that injector reputation is important, because we know you value safety and efficacy. The eye sees only what the mind knows. We will help you “know” what options are available to best suit your needs.

Feel free to post any questions you may have about this or related products.

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