Dysport vs Botox: the differences that matter in the chair

Dysport and Botox are both botulinum toxin type A, and the differences that matter in the chair are smaller than many people expect. Both take a few days to start working and about two weeks to reach full effect, and both last about three to four months. The real differences are the units, which aren’t interchangeable, and what each FDA label covers. The rest mostly comes down to your injector’s preference.

What’s the same

Botox is onabotulinumtoxinA, made by Allergan. Dysport is abobotulinumtoxinA, made by Galderma. Both relax the muscle under a line so the skin stops creasing, both are FDA-approved prescription drugs, and both carry the same boxed warning about the toxin spreading beyond the injection site, per the Botox Cosmetic prescribing information and the Dysport prescribing information.

In the treatment room, your appointment looks the same either way: a few quick pinches with a very fine needle, 10 to 20 minutes for one to three areas, and no need for numbing cream.

If you’re new to either, the Botox page for our Arlington Heights office covers what an appointment is like and what to avoid afterward.

The biggest difference: units

A unit is each brand’s own measure of dose, and the brands don’t share a scale. The randomized trial that compared the two in frown lines used 3 Dysport units for every 1 Botox unit, per Rappl and colleagues, 2013. Xeomin was dosed 1 to 1 with Botox in the same study, and Xeomin’s label says its units “cannot be converted into Units of any other botulinum toxin,” per the Xeomin prescribing information.

So 60 units of Dysport and 20 units of Botox may be the same treatment.

That matters in two ways. First, comparing per-unit prices across brands isn’t meaningful, because Dysport’s per-unit number is always lower and its unit count is always higher. It’s more helpful to ask what the treatment costs for your area than what a unit costs. Second, an injector who works mostly with one brand has a feel for dosing it, and that matters more than the name on the vial.

What each label covers

The FDA-approved uses differ between the two.

Botox Cosmetic is approved for moderate to severe frown lines (the 11s), crow’s feet, forehead lines, and, since October 2024, platysma bands in the neck. Dysport is approved for moderate to severe frown lines in adults under 65, and that’s its whole cosmetic label.

Both drugs get used elsewhere. Forehead lines with Dysport, bunny lines, a lip flip, the masseter, a brow lift: all of those are off-label for Dysport, and everything past the four labeled areas is off-label for Botox too. Off-label means the manufacturer didn’t run trials for that area, not that the use is unusual. We’ll tell you which uses are off-label before you decide.

Does Dysport spread more? What the evidence says

Dysport is often described as spreading more, which is said to make it better for a large area like the forehead and worse for small, precise spots. The evidence doesn’t support that.

A 2018 review of the myths and realities of aesthetic botulinum toxin concluded that diffusion “appears predominately, perhaps exclusively, dose dependent,” and that the protein complexes around the toxin “do not influence movement from injection site,” per Dover and colleagues in Dermatologic Surgery. In other words, how far the drug travels depends on how much is injected and how much saline it’s mixed in, not on which brand is in the syringe.

So we don’t choose Dysport because it spreads or Botox because it stays put. We choose a dose and dilution that suit your area, and either drug can do the job.

Onset and how long each lasts

Both take days, not hours, to start working. The American Academy of Dermatology puts onset at “within 3 to 7 days,” per its botulinum toxin FAQs. In Botox’s frown-line trials, 74 percent of patients had responded by day 7 and 80 percent by day 30, per the label.

The Rappl trial found onset at about three days for Xeomin and about five days for both Botox and Dysport in women, with slower onset in men. That’s why the guidance is the same for both brands: a few days to start, full effect at two weeks, and a check at two weeks to see whether a touch-up would help.

Duration is the same story. The AAD says about three to four months, sometimes longer. Botox’s responder rate fell to 48 percent at day 90 and 25 percent at day 120. Dysport’s label says it reduced frown lines “for up to four months.” Neither lasts noticeably longer than the other. Individual results vary.

Both drugs also work less well with age. In Botox’s trials, 39 percent of patients 65 and older responded at day 30, against 83 percent of those under 65, and Dysport’s label says none of its subjects 65 and older met the success endpoint. That isn’t a reason to rule treatment out, but it does mean expecting a softer result.

Dysport and Botox side by side

Feature	Botox	Dysport
Drug	onabotulinumtoxinA	abobotulinumtoxinA
Approved for	Frown lines, crow's feet, forehead lines, neck bands	Frown lines, adults under 65
Onset	A few days, full effect at 2 weeks	A few days, full effect at 2 weeks
Units	1	About 3 per Botox unit in the head-to-head trial
Spread	Depends on dose, not brand	Depends on dose, not brand
Lasts	About 3 to 4 months	Up to 4 months on the label

So which one should you ask for?

Usually, the one your injector uses most. Consistent product and dosing from visit to visit do more for your result than the brand does.

There are two exceptions. If you’ve had a great run with one brand, it makes sense to stay with it. And if you’re over 65, Botox’s label carries the trial data for your age group and Dysport’s approval stops at 64, so we’d generally recommend Botox.

For who injects Dysport at our office and how to time treatment before an event, see Dysport in Arlington Heights. If your question is about dose, how many units of Botox the forehead takes covers it.

What neither one can do

A crease that’s there when your face is relaxed isn’t a muscle problem anymore. Toxin will soften the motion that made it, but it won’t fill it. For that kind of line, we’d recommend dermal fillers or resurfacing instead.

Book your Botox or Dysport consult

Your questions, answered

Is Dysport cheaper than Botox?

Per unit, Dysport’s number is lower, but you need about three Dysport units for every Botox unit, so the per-unit price isn’t a useful comparison. It’s more helpful to compare the cost of the treatment for your area at the dose the injector plans. The real number depends on your muscles and how many areas you treat, and we’ll go over it at your consult.

Does Dysport last as long as Botox?

Yes, in practice. Both run about three to four months per the American Academy of Dermatology. Dysport’s label says up to four months for frown lines, and Botox’s trial responder rate had dropped to 25 percent by day 120. Individual results vary.

Can I switch from Botox to Dysport?

Yes. They’re the same class of drug, and switching between visits is common. The dose will look different on paper because the units differ. It’s best to let your last treatment wear off first. The Botox label says dosing more often than every three months hasn’t been clinically evaluated.

Which one is better for the forehead?

Botox is the only one of the two approved by the FDA for forehead lines. Dysport is approved for frown lines only, so forehead treatment with Dysport is off-label. Both get used on the forehead in practice, and the idea that Dysport spreads better across a wide area isn’t supported by the evidence. What matters most on the forehead is a conservative dose, because over-treating it drops the brow, so we start carefully.