Botox Vs. Other Botulinum Toxins



While Botox and botulinum are often used synonymously, they are in fact very different!

Doctor Medica team

While Botox and botulinum are often used synonymously, they are in fact very different! Botox is a drug manufactured by Allergan, whereas botulinum is a toxic compound produced by the bacterium Clostridium botulinum. 

The primary compound of Botox, which is derived from botulinum, is known as onabotulinumtoxinA. Its primary mechanism of action is the relaxation of muscles and the blocking of pain impulses from the brain.

Botox was the first drug to be approved by the Food and Drug Administration (FDA) for treating facial wrinkles. It is used to ‘freeze’ facial wrinkles that are caused by the breakdown of collagen within the skin.

Other firms are exploiting the clinical benefits of botulinum and manufacturing their own products. While the results can be the same, there are significant differences between the classic Botox and other Botulinum toxins.

In addition to Botox, there are several injectables that have been created that utilize onabotulinumtoxinA, such as Dysport, Xeomin, and Azzalure. These products contain the same therapeutic amounts of onabotulinumtoxin A (150kD) but have key differences.

Botox, along with botulinum toxin type A, contains a 900kD protein complex. It is the only product on the market that has high amounts of proteins (clostridial) with five nanograms per 100-unit vial. It is widely used to treat facial wrinkles and is the first to be commercially manufactured.

Let’s examine how other botulinum toxin injectables differ from Botox in their composition, onset of action, and treatment costs:


Azzalure contains approximately 4.5 nanograms of clostridium protein per 500-unit vial. It acts similarly to Botox but requires fewer injections than other commercial botulinum toxins.

Several studies have shown that the difference between Azzalure and Botox is not significant. One of the primary differences is the molecular size. Botox has a larger molecular structure than Azzalure, which makes it more accurate in treating conditions because it does not spread far away from the treatment site.

Even though a greater number of injections are required when using Botox, it is considered more effective than Azzalure.


Similar to Azzalure, Dysport also contains 4.5 nanograms of clostridium protein (1) per 500-unit vial. It is primarily used to treat the progression of glabellar lines with age.

Dysport treatment is ideal for mild, moderate and severe glabellar lines. The Food and Drug Administration (FDA) recommends approximately 50 units for glabellar lines divided into five segments, whereas Botox requires only 40 units equal to 10 injections. This means that Botox is more effective than Dysport for treating these wrinkles.

Ipsen Biopharmaceuticals in Paris, France manufactures both Dysport and Azzalure.


Out of all the botulinum toxins, Xeomin contains the smallest amount of clostridial protein at 0.6 nanograms per 100-unit vial. This product does not trigger significant immune response when compared to similar commercial products and does not contain additives that require refrigeration.

Often referred to as a “naked injectable”, Xeomin has fewer side effects and does not require cold storage when compared to Botox, but its onset takes longer. It takes approximately four days for the drug to show its effects, whereas Botox’s results appear in less than 72 hours.


A new product approved by European regulatory authorities is Bocouture. It is used to treat upper facial lines, glabellar lines, and horizontal frown lines.

Bocouture contains 0.6 nanograms of clostridium protein and is similar to Xeomin because both are manufactured by Merz Pharmaceuticals in Frankfurt, Germany. Like Xeomin, it does not have any active proteins encapsulating the drug.

Bocouture contains significantly less clostridial proteins than Botox.


While a number of commercially manufactured products are similarly designed and formulated, Botox is the first botulinum toxin product to be approved by the Food and Drug Administration (FDA). On the market for several years, it has developed an extensive fanbase and excellent brand value.

While Botox, Dysport, Xeomin, Azzalure and Bocouture are all proven to safely and effectively treat facial wrinkles, the former’s high percentage of proteins means that, on average, fewer injections are needed. This results in a more comfortable – and affordable – experience for the patient. Additionally, the results of Botox appear more quickly than the results of some other botulinum toxin products, making it an even more competitive choice.

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