Botox® and Botulinum Toxin Brands
By Dr Tim Pearce, MBChB BSc (Hons) MRCGP
What are the different brands of botulinum toxin, and how are they different?
In aesthetic practice we use botulinum toxin type A. Currently in the UK there are 3 manufacturers of botulinum toxin, Merz, Galderma and Allergan. All the products are well tested and understood products, but there are some important differences to know.
Before even looking at the products, remember that the units are not equivalent.
Botulinum toxins are all very small proteins, but their power resides not in weight but in their ability to continuously work away and cleave the receptor complex on the pre-synaptic membrane many times over.
For this reason, units are a measure of biological activity rather than weight or volume.
Allergan use a cellular assay to measure Botox units. Speywood units are rather gruesomely quantified as the amount of botulinum toxin that kills 50% of a genetically homogeneous population of mice.
Each company produces different aesthetic and non-aesthetic licenced products, often with the same molecule but in different sized vials.
Galderma make a product aimed at the aesthetic market called Azzalure which contains 125 speywood units and Dysport, which comes in vials of 500 speywood units. The molecule is called abobotulinumtoxinA. Azzalure is not a brand that was launched in the USA, where you will only come across dysport.
Merz produce boucoture and Zeomin, also aimed at aesthetic and general medical uses respectively and it’s molecule is called incobotulinumtoxinA.
Allergan did at one stage produce vistabel and Botox, but now produce three different sized vials labelled ‘Botox’, with 50, 100 and 200 Allergan units. This molecule is called onabotulinumtoxinA.
Manufacturers and their representatives hotly contest many of the differences that are claimed by their competitors, and there are studies to support each view.
It is generally widely accepted that there are a few clinically important differences.
It is generally observed that Merz’s product and Allergan’s product diffused similarly but significantly less than Galderma’s offering. Clinically this has lead to many clinicians preferring particularly the more established brand leader for more precise treatments such as in the lower face (often at a more concentrated dilution to further increase precision).
However Galderma’s product is often chosen over the others for treatment of hyperhydrosis, since in theory a greater spread is advantages where little accuracy is required.
Speed of onset:
Azzalure/Dysport is also significantly quicker in terms of onset. This is occasionally contested by representatives, but rarely by anyone who uses both products routinely- Clients will quite often report that they experience a rather more sudden and earlier onset with Azzalure/Dysport than with either Boucoture/Zeomin or Botox.
The unique ability of the incobotulinuma molecule from Merz to remain biologically active even when stored for long periods at room temperature is largely due to it’s purified form, and the complete removal of the usual stabilising protein complex.
It has been suggested that the lack of stabilising proteins could decrease resistance to the molecule, but it’s worth remembering that these proteins separate early after injection, and it is antibodies to the active botulinum toxin unit that are required to produce true resistance.
Over all, all the products are safe to use in trained hands. The differences for many standard treatments are small and often more of academic or subtle interest rather than a stark difference in results for your client.
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What others say about this post? (2 Comments)
Thank you. Good article.
I bought Azzalure. It’s cheaper than Botox, but the result was better than I expected.
Thank you for the feedback. Azzalure does tend to be cheaper than BOTOX to purchase, although for the benefit of those who haven’t tried it, do bear in mind that dosage is different – a unit of Azzalure is not the same as a unit of BOTOX.
Since this blog article was written, Dr Tim Pearce has produced a video on Azzalure with some excellent advice for practitioners.