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Indications for using Botox
Non-cosmetic indications for botulinum toxin include the following: strabismus, hemifacial spasm and blepharospasm, spasmodic torticollis, focal dystonias such as writer’s cramp, post facial nerve palsy synkinesis,migraine, hyperhidrosis, bruxism and esophageal achalasia.
How to choose between Botox, Dysport and NeuroBloc for rejuvenation The choice between BTX-A (Botox and Dysport) and BTX-B (NeuroBloc) will be based on the duration of action required, unless the patient already has antibodies to BTX-A.
NeuroBloc (at a concentration of 200 units per 0.1ml) is the toxin of choice for shorter periods of action. Some patients (and practitioners) are nervous of the outcome of their first treatment and may be happy to have an effect lasting six rather than 12–14 weeks.
Others need to use their facial muscles professionally and are happy to induce muscle atrophy for a limited period e.g.while ‘resting’ between film productions.
This encourages their wrinkles to flatten,while retaining the ability to retrieve full facial expression when desired. It is also possible that even shorter actions will be available with further modifications of the dose. It is worth noting that inadequate storage of Botox or Dysport (e.g. at an incorrect temperature), or excessive dilution, also shortens the duration of their effect.
Botox or Dysport?
Botox Cosmetic is the only botulinum toxin Type A currently licensed for cosmetic use in the USA for the treatment of the vertical glabellar frown. The rights to Dysport in the USA have been acquired by INAMED Corporation (Zyplast, Zyderm) and licensing is expected in the near future. Both are widely used in Europe. Dysport is licensed for cosmetic use in Brazil and Mexico.
In Europe, the choice lies between Botox and Dysport. Research shows both to be equally effective in comparable doses for cervical dystonia and facial rejuvenation. Experience with both types of BTX-A for rejuvenation and blepharospasm indicates that Dysport may be more effective in patients with blepharospasm who have had an incomplete result with Botox.
Both Dysport and Botox have similar durations of action, their effects wearing off after 12 to 14 weeks. Dysport tends to diffuse to more muscle fibers per site of injection than Botox.
These qualities are useful for the beginner who may find it easier to start with Botox around the eyes and Dysport to the frontalis.An experienced practitioner with a busy BTX-A practice may choose between the two on economic grounds only – both are currently available at the same price in Ireland.
From a practical point of view, an inexperienced practitioner,with few patients and an irregular demand for BTX-A,may initially prefer the storage qualities of Dysport though the larger vial of Botox makes preparation and dilution easier.