Ophthalmology was the first specialty to see the potential medical application of botulinum neurotoxin. Dr. Alan B. Scott was the first to inject botulinum into a patient to treat strabismus in 1977. Soon, the medication was used to treat a number of muscular conditions. The first cosmetic use of botulinum toxin was reported in 1989 to treat facial asymmetry. The FDA approved Botox Cosmetic in 2002 and Dysport in 2009.
Botulinum can used to remove dynamic wrinkles, which are wrinkles that appear with facial movement. These include “crows feet” that appear at the corner of eyes when smiling, “frown lines” that can create an angry look, “bunny lines” across the nose, and winkles across the forehead. Other popular treatments are to address a “gummy smile” where the upper gums appear when smiling. Injections can be done for marionette lines or chin creases. Botulinum can also be used to stop sweating when injected into the armpits. Botulinum is most beneficial in maintaining a youthful appearance if injected when these dynamic wrinkles first appear before they become a permanent crease in your skin.
Results from injection with botulinum can be seen as early as 3 days but the full benefits of botulinum are not seen until 2 weeks after injection. The benefit typically lasts around 3 months but may range between 2-6 months depending on the person, amount of injection, and site of injection.
Botulinum is generally very safe and very few people experience side effects with the smaller doses used for cosmetic injection. The most common side effects of cosmetic botulinum injection are injection site pain, injection site skin reaction, bruising, and headaches. As with any medication, people can have an allergic reaction.
Botox and Dysport work similarly and have subtle differences. Dysport is a smaller protein so there are some reports that it may have faster onset. Dysport has been reported as “spreading more” during injection compared to Botox. This can be good in large areas (forehead, armpits) needing injection because it can mean less injection sites. However, it may mean it could spread to unwanted areas causing side effects like droopy eyebrows or eyelids. They both last for the same duration. The units for Dysport and Botox are not equivalent but the proper number of units of either medication can be injected to produce the desired effect. The most important thing is to go to an experienced injector if you are considering treatment with Botox or Dysport.
Author: Elizabeth Chiang, M.D. , PhD
