Botox vs Dysport: The Brand Matters Less Than You Think.

People arrive at the clinic asking for a brand. They should be asking for a dose and a map. Here is what actually separates Botox, Dysport and the newer products, and what does not.

What they all have in common

Botox, Dysport, Nuceiva, Letybo and Xeomin are five brand names for the same active ingredient: botulinum toxin type A. Every one of them works in exactly the same way. The product is placed into a small facial muscle, it blocks the signal between the nerve and that muscle for a few months, and the muscle relaxes. The skin above it stops creasing, and the line it was folding softens.

All five are approved by Health Canada. All five take roughly the same time to set and wear off on roughly the same schedule. In blinded comparison studies, clients and assessors cannot reliably tell the results apart. That is the honest starting point, and it is the part most "Botox vs Dysport" articles bury under a list of tiny differences.

The product is the paint. The injector is the painter. Nobody has ever looked at a portrait and asked which brand of paint was used.

Where Botox and Dysport actually differ

There are real differences. They are just smaller than the marketing suggests.

Onset. Dysport has a reputation for kicking in faster, and in practice it often does, by about a day or two. If you have a wedding on Saturday and it is already Tuesday, that can matter. For everyone else, both products are fully set inside two weeks and the head start is forgotten.

Spread. This is the one that should actually change what your injector picks. Dysport diffuses a little wider from each injection point. On a broad, flat muscle like the forehead that can be an advantage: fewer injection points, a smoother blend. Near precision areas, like the brow, around the eye, or a lip flip, a product that stays exactly where it is placed is safer. A heavy brow after a forehead treatment is almost always a placement and dose problem, but a wider spreading product gives an inexperienced hand less margin for error.

Allergy. Dysport is formulated with lactose and a cow's milk protein. If you have a true milk protein allergy (not lactose intolerance, which is different), Dysport is off the table and Botox, Nuceiva or Letybo is the right choice. This is a screening question we ask at every assessment, and it is a question that should never be skipped.

Nuceiva, Letybo and Xeomin

The newer products are often sold as "the new Botox" or "the same as Botox but cheaper." The truth is closer to this: they are the same drug class with small formulation differences, made by different companies, and competition has made all of them better value than they were five years ago.

• Nuceiva (prabotulinumtoxinA, sold as Jeuveau in the United States) behaves very much like Botox in onset, spread and duration. Many clinics, including ours, use it interchangeably with Botox.
• Letybo (letibotulinumtoxinA) is the newest Health Canada approval. Early experience is similar to Botox, with a clean, predictable set. We like it for frown lines.
• Xeomin (incobotulinumtoxinA) is the "naked" toxin, made without the accessory proteins that surround the active molecule in the others. In theory that lowers the chance of your body forming antibodies over years of treatment. In practice, resistance to any of these products is rare.

The unit trap, and why "cheaper per unit" is a trick

This is the part that costs people money. Units are not a universal measurement. They are specific to each product. One unit of Botox is roughly equal to two and a half to three units of Dysport. So a clinic advertising Dysport at $4 per unit is not cheaper than a clinic charging $10 per unit of Botox. Treating a frown line might take 20 units of Botox or 50 to 60 units of Dysport, and the two bills land in the same place.

The same logic runs in reverse. If a clinic quotes you "Botox" at an unusually low per unit price, ask which product is in the syringe and how many units you are getting. Dilution is the other quiet way a low price becomes a short result.

What changes your result more than the brand

If you remember one thing from this article, make it this list. Every item on it moves your result more than switching between Botox and Dysport ever will.

• Dose matched to your muscle. A strong frown muscle in a man in his forties and a fine one in a woman in her twenties do not get the same number of units. A clinic that doses from a chart instead of an assessment gives everyone an average result. Nobody is average.
• Placement. Millimetres matter. The difference between a lifted brow and a heavy one is where the product sits relative to the muscle fibres, not which box it came out of.
• Depth. Some muscles are superficial, some sit deep. Injecting at the wrong depth wastes product and spreads it where it was not meant to go.
• Assessment while you move. Your injector should watch you frown, raise, squint and smile before touching the syringe. Lines are made by movement, and a map drawn on a still face is a guess.
• Knowing when Botox is the wrong tool. Neuromodulators soften lines a muscle makes. They do nothing for volume loss, skin quality or heaviness that comes from the mid face. Someone who books Botox for a tired looking face often leaves disappointed, because the honest answer was facial balancing or a biostimulator, not more units.

Ask your injector why they chose the product, not just which one they chose. The quality of that answer tells you everything.

What we use at Mirror, and why

At Mirror we work with Botox, Nuceiva and Letybo, and we select between them at your assessment based on the area, your history and how your muscles have responded before. Treatments are priced at $9 to $10 per unit, and most single areas fall between 20 and 60 units depending on muscle strength. You leave your assessment with an exact unit count and an exact price for your face, which is the only kind of quote worth having.

If you have been treated with Dysport elsewhere and liked the result, tell us. Switching between products is routine, and the dose conversion is something your injector handles for you. What you should expect from any brand, in any clinic, is the same thing: your expression intact, your lines softer, and no surprises when the bill arrives.

Full details, treatment areas and timing are on our Botox and neuromodulators page. Toronto clients can book the same assessment at Mirror Yorkville.