For months, cosmetic surgery insiders predicted that Botox, the most popular cosmetic treatment in the US, would soon have a rival. And yesterday, the FDA approved one. Instead of Reloxin—as it was supposed to be called—it's called Dysport, the name it's known by outside the US, where it has been approved for several years. There are no head to head (or should we say forehead to forehead) studies of the two type-A botulinum toxins, but there are some differences, say doctors who have studied both. Botox takes about five to seven days to see the full relaxation effect and lasts about three to three and a half months, says Michael Kane, a New York plastic surgeon and author of The Botox Book. Dysport, he says, shows results in about two to three days and may last a little longer: "It's hard to tell without head to head studies, but Dysport lasts up to 109 days for most patients in the study-closer to four months." Kane judges the two products "equally effective and equally painful," though pain is minimal and can be eased by topical anesthetic or icing. Dysport also has a slightly larger zone of effect around each injection point—good if it requires less needle pricks, but bad if it drifts far enough to cause droopy eyelids. (About 5 percent of Botox treatments result in eyelid weakness.) Patients should be aware that the dosages are not equal and until doctors become familiar with Dysport, the FDA warns there is a risk of dosage error. (The FDA also is requiring the makers of Botox and Dysport to supply a warning to consumers that in high doses, especially when used medically for spastic limbs, there is a rare risk of breathing and swallowing problems.) The biggest benefit of Dysport for cosmetic use could be its price: 15 to 20 percent lower than Botox.
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