Neurotoxin injections are the go-to option for so many different aesthetic and therapeutic approaches. They can fix or significantly help with wrinkles, various muscular disorders, etc.

Among the available options, Botox and Dysport are the most widely used and clinically proven neurotoxins. Yes, as you probably know, they both originate from botulinum toxin type A, but differ in potency, diffusion, onset speed, and longevity.

For those considering neurotoxin treatments (whether for cosmetic enhancements or medical conditions) recognizing the nuances between Botox and Dysport is crucial.

We are here to help with an in-depth comparison of Botox vs. Dysport, breaking down their key differences in formulation, effectiveness, and practical application. By the end, we are sure you will have a clearer understanding of which neurotoxin best suits your patients.

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Understanding Neurotoxins

Let’s just quickly recall the basics, before we get into the details.

Botulinum toxin type A (obtained from the bacterium Clostridium botulinum) is a powerful neurotoxin that temporarily blocks nerve signals to muscles by inhibiting the release of acetylcholine at neuromuscular junctions. This controlled muscle paralysis prevents excessive contractions, making it effective for both medical and aesthetic applications.

In aesthetic medicine, this mechanism is used to smooth dynamic wrinkles caused by repetitive facial movements. With extensive clinical research supporting its safety and efficacy, botulinum toxin type A remains one of the most important substances in both therapeutic and cosmetic fields.

Botox

Botox, developed by Allergan, is one of the most well-known and widely used neurotoxins. It has become synonymous with this type of treatment.

Initially receiving FDA approval in 1989 for therapeutic applications, Botox gained additional approval in 2002 for its use in cosmetic treatments. Its remarkable versatility has made it a staple in treating a variety of conditions. Below are some of the most common indications for Botox:

• • Reducing Glabellar Lines and Marionette Lines: One of Botox’s most popular uses is for the reduction of glabellar and marionette lines.
  • Managing Cervical Dystonia: Botox is also FDA-approved for the treatment of cervical dystonia, a painful condition in which the muscles in the neck contract uncontrollably, causing the head to twist or tilt in abnormal positions.
  • Treating Blepharospasm: Blepharospasm is a condition whose main symptom is blinking or eyelid spasms, which can range from mild to debilitating.
  • Chronic Migraine: Chronic migraine is defined by the occurrence of headaches on 15 or more days per month, often accompanied by nausea, vomiting, and sensitivity to light. Botox is FDA-approved for the treatment of chronic migraines, and studies have shown that it can reduce both the frequency and intensity of these debilitating headaches.

• Jaw tension and TMJ

• Tennis Elbow, low back pain, and other orthopedic problems

Dysport

Dysport, developed by Ipsen, was FDA-approved in 2009, much later than Botox. It has since become a widely used botulinum toxin type A injection and practically the main competitor of Botox.

Like Botox, Dysport works by inhibiting the release of acetylcholine at neuromuscular junctions.

Dysport is commonly used for the following indications:

• Smoothing Moderate to Severe Frown Lines: Dysport is used for the treatment of moderate to severe glabellar lines, vertical wrinkles that appear between the eyebrows due to repeated frowning or facial expressions.
• Treating Cervical Dystonia: Cervical dystonia is a neurological condition that causes involuntary muscle contractions in the neck, leading to abnormal head movements and postures. Dysport provides significant relief.
• Managing Upper Limb Spasticity: Dysport is widely used for the treatment of upper limb spasticity, which causes stiffness and involuntary contractions often resulting from stroke, cerebral palsy, multiple sclerosis, or traumatic brain injuries.

When choosing between Botox and Dysport for either therapeutic or aesthetic applications, it is crucial to understand their key differences. They are similar, but even 1 or 2% difference in medicine is a lot.

Molecular Structure and Composition – Botox vs. Dysport

Botox is composed of uniform 900 kDa complexes, which provide a consistent and localized effect. In contrast, Dysport contains a heterogeneous mixture of 500–900 kDa complexes, leading to differences in how it diffuses and interacts with tissues.

Botox’s larger, more stable complex results in a confined, predictable effect. Dysport, with its smaller and more varied protein complexes, has a tendency to spread over a wider area.

Diffusion and Spread

The diffusion properties of neurotoxin injections significantly influence their clinical utility. As we said, Dysport’s smaller molecular size and protein composition allow for broader diffusion. Because Dysport spreads more easily, fewer injection points may be required. However, this broader diffusion also necessitates careful administration to prevent unintended muscle relaxation in adjacent areas.

Botox’s larger molecular weight and more uniform complex structure result in a more localized effect.

Onset and Duration of Effects

Several studies suggest that Dysport may have a faster onset of action and a longer duration of effect compared to Botox, although individual results vary.

A randomized, double-blind clinical study found that Dysport exhibited a quicker onset in some patients, with visible results appearing within 24–48 hours post-injection, whereas Botox generally takes 3–5 days to show initial effects.

Regarding duration, a study published in JAMA Dermatology noted that Dysport, when administered at a unit dose conversion ratio of 3:1 (Dysport to Botox), provided a longer-lasting reduction in forehead wrinkles and electromyographic (EMG) activity compared to Botox.

Dosage and Potency

The conversion ratio between Botox and Dysport is a topic of ongoing debate due to differences in their molecular compositions and diffusion properties. While some studies suggest a 3:1 ratio (Dysport to Botox), others propose a 2.5:1 or even 4:1 ratio depending on the treatment area and patient response.

Cost Considerations

Economic factors also influence the choice between Botox and Dysport. Pricing varies by region, institution, and manufacturer agreements, but on average Dysport is 17% less expensive per patient per injection for upper limb spasticity compared to Botox.

Botox vs. Dysport – Injection Best Practices

Familiarity with these injection techniques directly impacts patient satisfaction.

• Use ultra-fine needles (e.g., 30G) to reduce discomfort: Using fine-gauge needles, such as 30G, minimizes pain and tissue trauma. On top of that, smaller needles reduce bruising and swelling at the injection site.
• Inject at a perpendicular angle (90°) for deep muscles and at 45° for superficial muscles: The injection angle affects the depth at which the neurotoxin is delivered. A 90° angle ensures that the toxin reaches deeper muscles. Conversely, a 45° angle is better suited for superficial muscles.
• Aspirate before injection to avoid intravascular administration: While rare, accidental intravascular injection of neurotoxins can lead to unintended diffusion. Aspirating before injecting (pulling back on the syringe plunger) helps verify that the needle is not inside a blood vessel.
• Massage and spread injections (if necessary) based on product properties and treatment goals: Depending on the product used and the desired effect, gentle massaging or strategic spacing of injection sites can help achieve better distribution.

Safety and Side Effects

Botulinum toxin injections are safe, but we must not overlook potential complications and high-risk areas.

Common Adverse Effects

• Localized pain, bruising, or swelling at the injection site.
• Transient headaches or flu-like symptoms post-injection: Some patients report mild headaches or flu-like symptoms, possibly due to an inflammatory response or muscle tension changes.
• Temporary asymmetry due to uneven diffusion or muscle compensation.

Rare but Serious Complications

• Ptosis (eyelid drooping): Can occur if toxin diffuses into the levator palpebrae muscle. Usually resolves in 2–4 weeks.
• Dysphagia (difficulty swallowing): More common in therapeutic applications for cervical dystonia.
• Paradoxical muscle activation: Improper dosing or placement may cause unwanted movement patterns.
• Systemic effects: Extremely rare but possible in patients with predisposing neuromuscular conditions.

Prevention

• Use conservative doses initially to gauge response: Starting with a lower dose and adjusting as needed.
• Avoid injecting too close to critical muscles (e.g., frontalis near the brow to prevent eyelid ptosis): Proper anatomical knowledge and precise placement prevents complications like drooping eyelids or asymmetric smiles.
• Educate patients on post-injection care to prevent unintended diffusion: Patients should avoid rubbing, massaging, or lying down for several hours post-treatment.

New Neurotoxins in 2025 and Beyond

The botulinum toxin market never sleeps. So, we always have new products with expanded treatment options.

• Letybo: Recently FDA-approved for the treatment of glabellar lines, Letybo is a botulinum toxin type A product developed by Hugel. It has been widely used in Asia and is now gaining traction in Western markets for its safety profile and effectiveness in reducing dynamic wrinkles.
• Daxxify: A next-generation botulinum toxin, Daxxify incorporates a proprietary peptide-enhanced formulation with a significantly longer duration of action than Botox and Dysport.
• Revance RHA Collection: While not a traditional neurotoxin, the Revance RHA Collection blends neuromodulation with hyaluronic acid-based dermal fillers. This combination is very interesting and opens many potential options for facial rejuvenation.

Final Thoughts

Both Botox and Dysport are highly effective neurotoxin injections.

Botox remains the gold standard due to its precise formulation and extensive clinical history. Yet, Dysport offers a faster onset and broader diffusion, making it a strong alternative in certain cases. The choice between the two depends on treatment area, patient response, budget, and desired result, not on whether one is better than the other per se.

Frequently Asked Questions (FAQs)

Can Botox or Dysport be used for preventive wrinkle treatment in younger patients?

Yes, both Botox and Dysport are commonly used as preventive treatments for patients in their 20s and early 30s. By relaxing targeted facial muscles before deep wrinkles form, these neurotoxins can delay the onset of visible aging. Preventative use often involves lower doses to maintain natural facial movement while preventing fine lines from becoming permanent.

How do Botox and Dysport interact with dermal fillers?

Botox and Dysport work synergistically with dermal fillers but serve different purposes. Neurotoxins relax dynamic wrinkles by limiting muscle contractions, and fillers restore volume and smooth static lines. When used together, they can create a more balanced look, but it’s up to the doctor to apply proper technique and placement.

Is there a difference in how Botox and Dysport affect different skin types or ethnic backgrounds?

Both Botox and Dysport are effective across all skin types and ethnic backgrounds, but muscle structure and skin thickness can influence results. Some patients may require different dosages or injection techniques based on facial anatomy. An experienced injector will adjust treatments for diverse patient needs.

Can Botox and Dysport be used interchangeably in the same patient over time?

Switching between Botox and Dysport is possible, but adjustments in dosing and technique are necessary. Since Dysport has a higher diffusion rate and requires more units than Botox, practitioners must account for these differences. Some patients may find that one product works better for them, so trials with both can help determine the best fit.

How does individual muscle strength affect the choice between Botox and Dysport?

Stronger facial muscles may require higher doses or a neurotoxin with greater diffusion to achieve optimal relaxation. Dysport, with its wider spread, may be preferable for larger muscle areas like the forehead, and Botox provides more precise targeting for smaller, stronger muscles like the crow’s feet.

What are the differences in FDA approvals for Botox and Dysport in various medical and aesthetic applications?

Both Botox and Dysport are FDA-approved for treating wrinkles, but Botox has broader medical applications, including migraines, excessive sweating, and muscle spasticity. Dysport is primarily approved for aesthetic use and cervical dystonia, but is often used off-label for other conditions.

References

Karsai S, Adrian R, Hammes S, Thimm J, Raulin C. A Randomized Double-Blind Study of the Effect of Botox and Dysport/Reloxin on Forehead Wrinkles and Electromyographic Activity. Arch Dermatol. 2007;143(11):1447–1462. doi:10.1001/archderm.143.11.1447-b

Simonetta Moreau M, Cauhepe C, Magues JP, Senard JM. A double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis. Br J Dermatol. 2003 Nov;149(5):1041-5. doi: 10.1111/j.1365-2133.2003.05620.x. PMID: 14632812.

Ranoux D, Gury C, Fondarai J, Mas JL, Zuber M. Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):459-62. doi: 10.1136/jnnp.72.4.459. PMID: 11909903; PMCID: PMC1737843.

Botox and Dysport: Is there a dose conversion ratio in dermatology and aesthetic medicine?, Karsai, Syrus et al., Journal of the American Academy of Dermatology, Volume 62, Issue 2, 346 – 347

Escher CM, Paracka L, Dressler D, Kollewe K. Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Ther Adv Neurol Disord. 2017 Feb;10(2):127-135. doi: 10.1177/1756285616677005. Epub 2016 Nov 16. PMID: 28382110; PMCID: PMC5367647.

Nestor M, Cohen JL, Landau M, Hilton S, Nikolis A, Haq S, Viel M, Andriopoulos B, Prygova I, Foster K, Redaelli A, Picaut P. Onset and Duration of AbobotulinumtoxinA for Aesthetic Use in the Upper face: A Systematic Literature Review. J Clin Aesthet Dermatol. 2020 Dec;13(12):E56-E83. Epub 2020 Dec 1. PMID: 33488922; PMCID: PMC7819591.