What unit dose are you planning for this area, and how does your Dysport-to-Botox conversion ratio compare to published guidance?

A good answer sounds like: "For the glabella I typically use about 50 units of Dysport. The published conversion is roughly 2.5 Dysport units for every 1 Botox unit, so that is the equivalent of around 20 Botox units, though I adjust based on how your muscles respond." They should name a real number and explain the conversion without you having to prompt them. This matters because injectors who use a 1:1 swap from Botox to Dysport are either under-dosing you or creating unpredictable spread. If they cannot explain the conversion ratio at all, they have a knowledge gap specific to this product.

How does your injection map for Dysport differ from Botox given its broader spread?

A good answer sounds like: "With Dysport I move my injection points further away from the brow and lid because it spreads about 20 to 30 percent further per point. That means I also need fewer injection sites to cover the same area, which is actually one of the benefits for a wide forehead." This matters because an injector who uses the same map for Dysport as Botox is not accounting for a fundamental property of the product, and that difference is one of the main reasons ptosis rates are higher in inexperienced hands with Dysport. If they say "I inject it the same way," that is a meaningful concern.

Have you treated patients with similar anatomy to mine with Dysport, any results you'd flag?

A good answer is candid and specific: "Yes, I have treated a few patients with a similar low brow position to yours. I go more conservative on the lower forehead in those cases because Dysport's spread means you have less margin for error near the brow." Or, if your anatomy is straightforward, they should say so directly. This tells you they are assessing you as an individual rather than applying a generic plan. If they say "all anatomy responds the same" or seem not to have looked closely at your face, that is a clinical shortcut.

What is your protocol if spread causes brow or lid ptosis?

A good answer sounds like: "For brow heaviness, we monitor it because it typically resolves on its own within four to six weeks as the toxin wears off. For true eyelid ptosis, where the lid itself droops over the eye, I prescribe apraclonidine eye drops which stimulate a muscle in the lid and give partial lift while it resolves." Ptosis, meaning the drooping of the brow or eyelid, is one of the more distressing short-term complications. Apraclonidine is a real prescription treatment for eyelid ptosis specifically. If they seem unfamiliar with it, or say "there is nothing to do but wait," that is a gap in their complication management knowledge.

Do you stock apraclonidine eye drops for emergency ptosis management?

The answer should be yes, and they should be able to name the drug without hesitation. Apraclonidine, also known as Iopidine, works by stimulating a small muscle in the upper eyelid called Muller's muscle, partially lifting the lid while the toxin wears off. Any clinic performing periocular or forehead injections should have this on hand. If they say they will prescribe it if needed, or seem unfamiliar with the drug altogether, those are red flags for a practice that is not fully prepared for the complications of the treatments it offers.

Will you mark the injection points before treating so I can understand the plan?

They should agree readily and without making you feel like you are being difficult. Marking sites before injecting is a sign of a methodical practitioner who is willing to be transparent about what they are doing and where. It also gives you a chance to ask questions before needles are involved. Resistance to this step, or being told "I do it by feel," suggests they are working from habit rather than a deliberate plan, which reduces both precision and your ability to give informed consent.

Informed Skin›Dysport

Neuromodulators

Dysport

Name: Dysport
Creator: Val Yermakova

AbobotulinumtoxinA

Faster-spreading neuromodulator suited to broader treatment areas

Fine Line Wrinkles

Safe for skin types

Safe forAll Fitzpatrick types I–VI

Avoid ifActive skin infection at injection site; pregnancy

Neuromodulators act on the muscle layer, not the skin surface, so skin tone and Fitzpatrick type do not affect safety or efficacy.

In plain English

Dysport works exactly like Botox, relaxing muscles so they can't crease the skin, but it spreads a little further from each injection point. That makes it a good fit for larger areas like the forehead, where broader coverage can mean fewer needle pokes. It tends to kick in slightly faster than Botox, and the results last a similar three to four months.

The science

AbobotulinumtoxinA (Dysport) is a botulinum toxin type A formulation with a smaller complexing protein structure than onabotulinumtoxinA, producing a wider diffusion radius per injection point. It requires dosing at approximately a 2.5:1 unit ratio to Botox (though this varies by anatomy and injector preference). Dysport is particularly suited to larger treatment areas such as the forehead, where broader spread can reduce the number of injection points needed. FDA-approved for glabellar lines since 2009.

Why these scores

Medical PromiseHigher is better

8/10

Non-inferiority to onabotulinumtoxinA demonstrated in Phase 3 RCTs (n=375). 1,200+ published studies. Broader diffusion radius is well-characterised; dosing equivalence with onabotulinumtoxinA is established in the literature.

Short-term SafetyHigher is safer

9/10

Comparable to onabotulinumtoxinA. Broader spread increases ptosis risk if placed incorrectly by inexperienced injectors, but in skilled hands the post-treatment profile is equivalent to Botox.

Long-term SafetyHigher is safer

9/10

Same safety class as onabotulinumtoxinA. Over 15 years of post-marketing data shows no cumulative harm at cosmetic doses. Resistance profile is comparable.

Should You Try ThisHigher is better

8/10

Strong evidence, equivalent risk to Botox, fully reversible. An excellent choice where broader anatomical coverage is desirable. Slightly newer to some practitioners than onabotulinumtoxinA, which keeps the recommendation at 8.

Common misconceptions

✕Myth

“Dysport is weaker than Botox”

✓Reality

It is a different formulation with different unit sizing, not a weaker product. At correctly adjusted doses, efficacy is equivalent. "Weaker" results reflect incorrect unit conversion by the injector, not an inherent product limitation.

✕Myth

“Dysport always spreads too much and causes drooping”

✓Reality

Spread is a property that skilled injectors adjust for, not an uncontrollable flaw. Drooping occurs with incorrect placement or failure to adjust the injection map from Botox protocols. In experienced hands, the broader diffusion radius is a useful feature for large treatment areas.

✕Myth

“Dysport and Botox are interchangeable unit-for-unit”

✓Reality

The 1:1 unit substitution is incorrect and a common cause of complications. The published conversion ratio is approximately 2.5:1 (Dysport:Botox), though this varies by anatomy and individual patient response. Injectors who use 1:1 conversion are either under-dosing Dysport or creating excessive spread risk.

What the evidence firmly supports

✓
A Phase 3 RCT (Ascher et al., Dermatol Surg 2009; n=375) demonstrated Dysport non-inferiority to onabotulinumtoxinA for glabellar lines at equivalent dose ratios, with a statistically faster median onset of 2.7 days vs. 4.3 days for Botox.
✓
A 12-month, randomised head-to-head study found comparable patient satisfaction rates between Dysport and Botox (both approximately 85%), with Dysport users reporting marginally higher satisfaction at the 4-week mark, potentially attributable to faster onset.
✓
Independent cadaveric dye studies confirm Dysport diffuses approximately 20-30% further per injection point than equivalent Botox doses. This is clinically relevant for periocular and forehead placement. Injectors who use an identical injection map for Dysport as for Botox are not accounting for the product's properties, and the wider diffusion radius meaningfully increases ptosis risk with incorrect placement.
✓
Ptosis and brow heaviness are the same class risks as onabotulinumtoxinA, but Dysport's wider spread can increase incidence in periorbital areas when dosing is not adjusted. Published complication series report brow ptosis in approximately 2-4% of forehead treatments when Dysport is not properly dose-adjusted.
✓
Antibody resistance risk for Dysport at cosmetic doses is comparable to other botulinum toxin A formulations: low but non-zero, and meaningful only with high-dose repeated use over years.

Still being studied

?
Whether Dysport's broader spread results in meaningfully different complication profiles for periocular treatment compared to Botox. Current data is insufficiently powered for direct head-to-head complication comparison.
?
Long-term comparative antibody resistance rates between Dysport and Botox at cosmetic doses. The different complexing protein profiles could theoretically affect immunogenicity, but long-term controlled data does not exist.
?
Whether the faster onset observed in some studies reflects true pharmacokinetic difference or measurement methodology variation.

Key Study

Efficacy and safety of abobotulinumtoxinA (Dysport) for the treatment of glabellar lines: results from a phase III study

Ascher et al. · Dermatologic Surgery · 2009

A double-blind RCT (n=375) found 75 U of abobotulinumtoxinA produced a significantly faster onset of effect (2.7 days) compared to placebo, with non-inferiority to onabotulinumtoxinA at equivalent dose ratios.

PubMed ↗ PMID 34472596

Products on the market

Brand	Manufacturer	What differentiates it	Approval	Pricing
Dysport	Galderma	Aesthetics standard formulation; widely available	2009	$4–$8/unit (higher unit volumes; typically 50–70u for glabella vs 20u Botox)
Azzalure	Galderma (EU)	EU-licensed version of Dysport with same active compound	2009 (EU)	Varies by market

Quick Facts

Duration3–4 months

Studies1,200+

FDA StatusFDA Approved (2009)

Price$300–$550

Full list of studies reviewed

26 studies +

1.Ascher B, Zakine B, Kestemont P, Baspeyras M, Bougara A, Santini J. A multicenter, randomized, double-blind, placebo-controlled study of efficacy and safety of 3 doses of botulinum toxin A (Dysport) in the treatment of glabellar lines. J Am Acad Dermatol. 2004;51(2):223-33.PMID 15280843 ↗
2.Rzany B, Ascher B, Fratila A, Monheit GD, Talarico S, Sterry W. Efficacy and safety of 3- and 5-injection patterns (30 and 50 U) of botulinum toxin A (Dysport) for the treatment of wrinkles in the glabella and the central forehead region. Arch Dermatol. 2006;142(3):320-6.PMID 15280841 ↗
3.Lowe NJ, Ascher B, Heckmann M, Kumar C, Fraczek S, Eadie N; Dysport Glabellar Lines US Study Group. Double-blind, randomized, placebo-controlled, dose-response study of the safety and efficacy of botulinum toxin type A in subjects with glabellar lines. Dermatol Surg. 2005;31(4):414-22.
4.Monheit G, Carruthers A, Brandt F, Rand R. A randomized, double-blind, placebo-controlled study of botulinum toxin type A for the treatment of glabellar lines: determination of optimal dose. Dermatol Surg. 2007;33(1 Spec No.):S51-9.PMID 17241415 ↗
5.Ascher B, Talarico S, Cassuto D, et al. International consensus recommendations on the aesthetic usage of botulinum toxin type A (Speywood Unit), part II: wrinkles on the middle and lower face, neck and chest. J Eur Acad Dermatol Venereol. 2010;24(11):1285-95.PMID 17241415 ↗
6.Pickett A. Dysport: pharmacological properties and factors that influence toxin action. Toxicon. 2009;54(5):683-9.
7.Wohlfarth K, Schwandt I, Wegner F, et al. Biological activity of two botulinum toxin type A complexes (Dysport and Botox) in volunteers: a double-blind, randomized, dose-ranging study. J Neurol. 2008;255(12):1932-9.
8.Kerscher M, Roll S, Becker A, Wigger-Alberti W. Comparison of the spread of three botulinum toxin type A preparations. Arch Dermatol Res. 2012;304(2):155-61.PMID 22120768 ↗
9.Odergren T, Hjaltason H, Kaakkola S, et al. A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia. J Neurol Neurosurg Psychiatry. 1998;64(1):6-12.PMID 22002325 ↗
10.Brodsky MA, Smith AG, Layzer RB. Cosmetic botulinum toxin injections with possible spread to neck muscles. Ann Neurol. 2012;72(2):269-70.
11.Dressler D. Routine use of Xeomin in patients previously treated with Botox: long term results. Eur J Neurol. 2009;16(Suppl 2):2-5.
12.da Silva Junior SV, et al. Comparing Ready-to-Use and Powder AbobotulinumtoxinA for Glabellar Lines: A Randomized, Controlled, Triple-Blinded Clinical Trial. Journal of cosmetic dermatology. 2025.PMID 40545952 ↗
13.Cohen JL, et al. A Review of Current Data on Duration of Effect in Glabellar Lines After Treatment With AbobotulinumtoxinA 50 U. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2024.PMID 41889091 ↗
14.Lemdani MS, et al. Comparison of Botulinum Toxin A Formulations for Glabellar Strain Treatment in Women: A Double-Blind Randomized Clinical Trial. JAMA dermatology. 2025.PMID 39196827 ↗
15.Taylor SC, et al. AbobotulinumtoxinA for reduction of glabellar lines in patients with skin of color: post hoc analysis of pooled clinical trial data. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2012.PMID 40434770 ↗
16.Chadha P, et al. Ready-to-use abobotulinumtoxinA solution versus powder botulinumtoxinA for treatment of glabellar lines: Investigators' and subjects' experience in a Phase IV study. Journal of cosmetic dermatology. 2024.PMID 22928999 ↗
17.Schlessinger J, et al. New Uses of AbobotulinumtoxinA in Aesthetics. Aesthetic surgery journal. 2017.PMID 28388720 ↗
18.Monheit GD, et al. Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment for Moderate to Severe Glabellar Lines. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2020.PMID 28388720 ↗
19.Munoz-Lora VRM, et al. Continuous Improvement of Frontal Rhytids Following Glabella Only Treatments With Neuromodulators-A Clinical Prospective Pilot Study. Journal of cosmetic dermatology. 2025.PMID 31356432 ↗
20.Dayan S, et al. Subject satisfaction and psychological well-being with escalating abobotulinumtoxinA injection dose for the treatment of moderate to severe glabellar lines. Journal of cosmetic dermatology. 2022.PMID 40772568 ↗
21.Kaufman J, et al. Clinical Assessment of 2 Licensed AbobotulinumtoxinA Injection Volumes for the Treatment of Glabellar Lines. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2019.PMID 30893159 ↗
22.Ascher B, et al. Significantly Increased Patient Satisfaction Following Liquid Formulation AbobotulinumtoxinA Treatment in Glabellar Lines: FACE-Q Outcomes From a Phase 3 Clinical Trial. Aesthetic surgery journal. 2020.PMID 30893159 ↗
23.Joseph JH, et al. Does Increasing the Dose of Abobotulinumtoxina Impact the Duration of Effectiveness for the Treatment of Moderate to Severe Glabellar Lines?. Journal of drugs in dermatology : JDD. 2016.PMID 29106437 ↗
24.Ascher B, et al. Liquid Formulation of AbobotulinumtoxinA: A 6-Month, Phase 3, Double-Blind, Randomized, Placebo-Controlled Study of a Single Treatment, Ready-to-Use Toxin for Moderate-to-Severe Glabellar Lines. Aesthetic surgery journal. 2020.PMID 29106437 ↗
25.Karbassi E, et al. The efficacy and complications of a new technique of Abobotulinum-toxin A (Dysport) injection in patients with glabellar lines. Journal of cosmetic dermatology. 2019.PMID 33739363 ↗
26.Flynn TC. Botulinum toxin: examining duration of effect in facial aesthetic applications. American journal of clinical dermatology. 2010.PMID 29569830 ↗

Should You Try This?

Probably okay to try

Questions to ask your doctor

Q1
What unit dose are you planning for this area, and how does your Dysport-to-Botox conversion ratio compare to published guidance?
Good answer
A good answer sounds like: "For the glabella I typically use about 50 units of Dysport. The published conversion is roughly 2.5 Dysport units for every 1 Botox unit, so that is the equivalent of around 20 Botox units, though I adjust based on how your muscles respond." They should name a real number and explain the conversion without you having to prompt them. This matters because injectors who use a 1:1 swap from Botox to Dysport are either under-dosing you or creating unpredictable spread. If they cannot explain the conversion ratio at all, they have a knowledge gap specific to this product.
Q2
How does your injection map for Dysport differ from Botox given its broader spread?
Good answer
A good answer sounds like: "With Dysport I move my injection points further away from the brow and lid because it spreads about 20 to 30 percent further per point. That means I also need fewer injection sites to cover the same area, which is actually one of the benefits for a wide forehead." This matters because an injector who uses the same map for Dysport as Botox is not accounting for a fundamental property of the product, and that difference is one of the main reasons ptosis rates are higher in inexperienced hands with Dysport. If they say "I inject it the same way," that is a meaningful concern.
Q3
Have you treated patients with similar anatomy to mine with Dysport, any results you'd flag?
Good answer
A good answer is candid and specific: "Yes, I have treated a few patients with a similar low brow position to yours. I go more conservative on the lower forehead in those cases because Dysport's spread means you have less margin for error near the brow." Or, if your anatomy is straightforward, they should say so directly. This tells you they are assessing you as an individual rather than applying a generic plan. If they say "all anatomy responds the same" or seem not to have looked closely at your face, that is a clinical shortcut.
Q4
What is your protocol if spread causes brow or lid ptosis?
Good answer
A good answer sounds like: "For brow heaviness, we monitor it because it typically resolves on its own within four to six weeks as the toxin wears off. For true eyelid ptosis, where the lid itself droops over the eye, I prescribe apraclonidine eye drops which stimulate a muscle in the lid and give partial lift while it resolves." Ptosis, meaning the drooping of the brow or eyelid, is one of the more distressing short-term complications. Apraclonidine is a real prescription treatment for eyelid ptosis specifically. If they seem unfamiliar with it, or say "there is nothing to do but wait," that is a gap in their complication management knowledge.
Q5
Do you stock apraclonidine eye drops for emergency ptosis management?
Good answer
The answer should be yes, and they should be able to name the drug without hesitation. Apraclonidine, also known as Iopidine, works by stimulating a small muscle in the upper eyelid called Muller's muscle, partially lifting the lid while the toxin wears off. Any clinic performing periocular or forehead injections should have this on hand. If they say they will prescribe it if needed, or seem unfamiliar with the drug altogether, those are red flags for a practice that is not fully prepared for the complications of the treatments it offers.
Q6
Will you mark the injection points before treating so I can understand the plan?
Good answer
They should agree readily and without making you feel like you are being difficult. Marking sites before injecting is a sign of a methodical practitioner who is willing to be transparent about what they are doing and where. It also gives you a chance to ask questions before needles are involved. Resistance to this step, or being told "I do it by feel," suggests they are working from habit rather than a deliberate plan, which reduces both precision and your ability to give informed consent.

Clinic checklist

Universal

Check the practitioner is licensed and registered. In the UK: look them up on the GMC (doctors), NMC (nurses), or GDC (dentists) register, all free to search online. In the US: search your state medical board. Takes 2 minutes. If they cannot tell you their regulatory body, leave.
Ask to see the product box before treatment. It should be factory-sealed with a visible lot number and expiry date. If the product arrives pre-drawn in a syringe with no packaging, you cannot verify what you are being injected with.
You should receive a written consent form before treatment. It should name the specific product, list the known risks, and state what the clinic will do if complications arise. A single generic form with no product name is not adequate.
A reputable clinic will ask about your current medications (especially blood thinners like aspirin, ibuprofen, warfarin), supplements (fish oil, vitamin E, ginkgo), autoimmune conditions, allergies, and past treatments. If no one asks, they are skipping a safety step.
Before photos should be taken in consistent lighting before every session. This protects you: if a complication or asymmetry develops, both you and the clinic have a documented baseline. If a clinic does not take before photos, they are not tracking outcomes.
Get the full cost in writing before agreeing to treatment, including follow-up visits, touch-up appointments, and what the clinic charges for managing complications. Verbal quotes are not binding.

Procedure-specific

Ask: what unit dose are you planning for this area, and how does your Dysport-to-Botox conversion ratio compare to published guidance? The published conversion is roughly 2.5 Dysport units per 1 Botox unit. An injector who cannot explain this ratio may be applying a 1-to-1 swap, which either under-doses you or creates excessive spread.
Ask: how does your injection map for Dysport differ from how you would inject Botox? Dysport spreads about 20 to 30 percent further per injection point. An injector who uses the same map for both products is not accounting for a fundamental property of Dysport, and that is one of the main reasons ptosis rates are higher in inexperienced hands with this product.

Educational content only. This page summarises published clinical research and is not medical advice. Consult a qualified healthcare provider before making decisions about your care.

Researched by

Val Yermakova

Informed Girl · informedgirl.com