Galderma released new research proving Dysport may be able to last longer than previously expected.
The business of aesthetic injections is booming, with nearly three million injectable procedures performed in 2019 according to Surgery.org, and the majority of them being made of botulinum toxin like Botox, Dysport, and Xeomin. What has also increased is patient curiosity about which product is best for them and their specific wrinkle-related concerns.
Galderma recently announced top-line results from a Phase 2 clinical study of Dysport for injection – used to smooth moderate to severe frown lines between the eyebrows – which demonstrated that higher Dysport doses result in longer-lasting effects, potentially narrowing the path to tox-confidence for consumers.
Image courtesy of Mira Kaga, MD
"Dysport temporarily treats moderate to severe frown lines between the eyebrows by reducing specific muscle activity," explains Mira Kaga, MD, a New Jersey-based board certified internal medicine physician with a focus on aesthetic treatments. "By injecting specific muscles, we can temporarily prevent muscle contractions, thereby reducing wrinkles. In the hands of someone who understands muscular anatomy, you can use Dysport to manipulate muscles in a way that can make someone more aesthetically appealing. This injection also has the added advantage of having a very quick onset time, which is perfect for our Generation Z and millennial patients who tend to want immediate gratification."
Dr. Kaga has long preferred Dysport for last minute procrastinators for this reason, citing the occasional rush of last minute pre-event injections. "As injectors, we have all had that mother of the bride who decides 10 days before the wedding that they want to smoothe out some wrinkles, and traditional Botox may not kick in before pictures," she says, affirming her cautious optimism for Galderma's newest research outlining the added benefits of using additional units of Dysport for a longer-lasting effect. "Using more of any neurotoxin can usually make it last longer, but you usually are sacrificing movement. To look natural, we want to be able to maintain some movement of the muslces we inject. We usually prefer to inject a lesser amount a little more frequently as opposed to placing more product so that it can last longer. That being said, some patients prefer to only come in two to three times a year and want to be injected accordingly."
The multicenter, randomized, dose-ranging, double-blind, placebo-controlled Phase Two study followed 401 subjects ages 18 to 65 with moderate to severe glabellar lines. Study participants were randomized four to one to receive a single dose of Dysport (50U, the dose in the FDA-approved label, 75U, 100U or 125U) or placebo and followed for nine months. After one month, all dose groups treated with Dysport showed a statistically significant improvement when compared with placebo. Favorable results were achieved for all doses in the secondary objectives, including longevity, including a significant grade improvement in treated wrinkles and subject satisfaction throughout the study duration.
Expert injectors around the country are excited for this longer-lasting effect in pandemic times when in-office visits are less frequent, if at all. "Dysport is what I describe as the 'Power Tox' to my patients," shares Erika Barry NP-C and the face behind the popular aesthetics-focused Instagram account, @InjectorBunny. "It holds a tight and firm no-wrinkles look, and with more units it may last as long as six to seven months depending on the individual," she says of the benefits of added dosing, highlighting the traditional dosing of similar toxin injections lasts more like four months, and citing the quick onset time of the Dysport over close competitors like Botox and Xeomin. "Most of my Dysport patients start seeing noticeable improvements in three to five days."
Image courtesy of @injectorbunny on Instagram
She stresses the need for consumer awareness, and that each type of toxin has its own benefits. "Dysport by far lasts the longest and has the strongest hold. I do still love Botox Brand and Xeomin, because some patients don't like that 'frozen' look, and Xeomin is great for beginners with almost no heaviness so you can still maintain some movement. Botox is still the original big toxin brand and is very reliable."
Doris Day, MD, clinical associate professor of dermatology at NYU Langone Health and popular New York-based injector with a reputation for natural-looking faces believes the data has been clear on higher-doses offering longer-lasting results. "With all the products now available, there is clearly a dose-related connection where higher doses will have longer-lasting results, but only to a point. This comes at a cost of increased effect of the drug which may not be desirable, including effects like overly-frozen faces or dropped brows," she says, suggestiong that new products may soon hit the market with longer-lasting results that remain gentle in appearance and efficacy. "This is causing a bit of a stir with the other available products out there, and they're trying to make the case that if you use higher doses of currently-available products you'll see the same longer-lasting effect. I don't know if this is true, and I will have to wait until the new product is available to be sure."
While pre-pandemic patients likely sought injection finesse with a degree of natural-seeming movement, the Zoom-screened beauty seekers of 2020 and beyond may be seeking a less-frequent approach to injections, fearing frequent outings and potentially added costs. "Longevity is a byproduct of amount of product placed and that is the main factor as opposed to brand in evaluating how long a toxin lasts," says Kaga. "I can put 10 units of toxin in a forehead or I can put 20 units. The 10 units would look more natural but may only last two to three months. Placing 20 units would make it difficult to achive natural movement, but it could last twice as long. Having a product that lasts a few months means that our patients are coming back more frequently, which allows us to address other issues as opposed to things accumulating and needing to do more maintence all at once. With longer lasting toxin injections, we are able to cut the number of visits down which may be more convenient for both the patient and the office."
The bottom line, according to Barry, is that longer-lasting toxin is great news in an era where leaving home is a calculated risk. "This is great news," she says of Galderma's new research, confirming what most expert injectors have long suspected. "Most of my patients will be thrilled to come in every six to seven months instead of the usual three to four months."