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 make Bocouture, Galderma make Azzalure and Allergan make the worlds best known brand Botox.

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 in the muscle to ‘freeze’ it or minimise its movement to slow or stop the formation of the lines.


Azzalure for Crows Feet

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.

Azzalure contains 125 speywood units. The molecule is called abobotulinumtoxinA.

Boucoture and Zeomin, also aimed at aesthetic and general medical uses and it’s molecule is called incobotulinumtoxinA.

The Botox 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 and therefore they are chosen more on preference of the practitioner rather than any being better than the other.

Spread:

It is generally observed that Azzalure and Bocouture spread slightly more, so clinically this has lead to many clinicians preferring Botox as the more established brand leader for more precise treatments and in my opinion is safer for less experienced aesthetic practitioners.

However, Azzalure is often chosen over the others for treatment of hyperhydrosis, since in theory a greater spread is advantages where little accuracy is required.

Botulinum Toxin can treat excessive sweating

Speed of onset:

Azzalure is significantly quicker in terms of onset. This is occasionally contested by representatives, but rarely by anyone who uses both products. Clients will quite often report that they experience a rather more sudden and earlier onset with Azzalure than with either Bocuoture or Botox.

Storage

The Bocouture incobotulinuma molecule remains biologically active even when stored for long periods at room temperature, which 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 difference in results.

Because I use Restylane and this is a Galderma product I generally use Azzalure unless a patient specificaly asks for another brand.

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