Botox has long been the only player in town for treating lines of the forehead and various wrinkles. It has been so dominant in the market that there is probably not a single person on the planet who has not heard of Botox. However, just like the innovation of the iPhone has drawn imitators galore, so too has Botox, as evidence in the array of similar upcoming products. As Charles Caleb Colton famously said, “imitation is the sincerest form of flattery.” This is good news to the consumer, as the cost of Botox is expected to go down, mainly as a result of competition. So, how do all the Botox “competitors” on the horizon stack up? Here is the lowdown on each of the upcoming products:
Dysport (aka Reloxin in Europe) was approved in the United States for treatment of lines in 2009 It has disappointed consumer and physicians alike by coming in at a similar price point to Botox.
In Europe, Dysport is substantially less in cost than Botox, creating a market more favorable to the patient.
Botox continues to dominate the American market due to some of Dysport’s several disadvantages, such as: the confusion in amount of product needed for effictiveness (Dysport uses a different metric than Botox) and diffusion (product spreads more rapidly making it harder to control).
In addition, Dysport has little to no name brand recognition.
Few if any physicians will tout Dysport as a superior product than Botox for cosmetic applications. In the use of sweating (hyperhydrosis), Dysport diffusion may be slightly advantageous.
Xeomin is the latest botulinum type A drug to be released in the United States.
It is produced by Merz, a German pharmicutical company.
Currently in phase 3 testing, it works almost identically to the more readily identified Botox made by Allergan.
The dosing is exactly the same, but the main difference is that it is free of complexing proteins which results in forumulation with less risk of sensitization and antibody formation.
This means that overtime, users of this product are theoretically less likely to develop “Botox Resistance”.
“Botox Resistance” is where patients develop less and less effectiveness of Botox over longer period of times.
This is the primary reason why I advocate not using Botox unless there are lines to treat (i.e. Preventative Botox).
Depending on its price point, this product should have a big impact in the United States.
Myobloc is the only available Botox type B (which is another subtype of Botox) and most physicians do not recommend it as a first line therapy.
It is indicated in patients with hypersensitivity to Botox type A formulations.
The main drawbacks are more painful injections and shorter duration of action.
In addition, Myobloc has a much greater area of diffusion making it harder to control in aesthetic applications.
Currently in phase 3 trials in the United States, it is similar to Xeomin (see above) in its advantages.
Having similar products which are equivalents or offer advantages, allows for more competitive pricing.
Chinese BTX-A is proof that everything will be made in China someday.
Chinese BTX-A is somewhat less effective than Botox.
I do see patients who have been treated in Asia who have had minimal results and then have greater result in the States from Botox.
Chinese botox contains bovine gelatin protein which can cause sensitization issues as well.
Aside from the above drawbacks, the name itself sounds and feels like an inferior product.
Unlikely to have an impact on the US market, it may be a formulation received by internet advertisements.
Another variation of Chinese botox, this is probably the variant most likely sold on the internet.
Little regulation exists on the internet due to differences in laws in various countries.
This is where the informed consumer can make a difference in understanding the differences.
Not recommend and not approved in any country in the world.
Used in Korea, supposedly equivalent to Botox.
Below are some questions patients ask about Botox and fillers:
Q – Can I bring in my own vial of Botox?
The answer to this is obviously no. I do not trust any product which is received from the internet as its controls are not regulates and can be an imitation product. In addition, any drug or pharmaceutical has to be regulated and approved by the FDA and bought in a legal manner. If there is ever a reaction to a product injected (thankfully I have had none), there is a company which assumes responsibility for the quality of the product.
Q – Can I inject myself with Botox?
Again, I don’t recommend this for several reasons. First of all, even experienced injectors are working on the nuances of using the product. What little money is saved is likely wasted in creating a result which is unaesthetic.
Q – Should I have Botox injected in another country?
Any product injected outside the United States should be done in a careful manner and with extreme caution. Regulation of products is much less rigorous in other countries and certain reactions can be permanent or even fatal. Saving a few hundred dollars is not worth having an irrevisible reaction. Botox used in the United States for aesthetic purposes is one of the safest materials on the planet.
Q – Why does the US have the longest delay of approval for products?
The FDA regulates all pharmaceuticals that are released in the US. The main advantage of this is that many products have a long history of use in Europe or Canada, making the introduction to the US a safer decision for many patients here.