Botox A vs Botox B?

What is Botox® B?

Lately, we have seen this question circulating among our patients and we wanted to answer it.

Botox® is a brand name for Botulinum toxin, of which there are three varieties available in the US – including Botox®, Dysport®, and Xeomin. All do exactly the same thing – relax the muscles into which they are injected. Botox®, Xeomin and Dysport® are all Botulinum toxin type A.

If you want to get complicated, there are actually SEVEN categories of Botulinum toxins. However, only TWO types, A and B, are approved for human application. And only ONE kind is the only one always used for cosmetic treatment, Type-A.

Botox® and Dysport® (both type A) arrive at the doctor’s office ready to be reconstituted by adding saline, a signature of the Type-A variety of Botulinum. Both Botox® and Dysport® must remain refrigerated – and how they are reconstituted affects dosing. You can read more about that here.

The only commercially available formulation of Type-B is called Myobloc, and it is only available outside the US. Myobloc is primarily used in Europe. It comes in a powder form and is mixed at the doctor’s office. It is generally not used in cosmetic applications. Rather it is prescribed for Cervical Dystonia (CD). Also called spasmodic torticollis, CD is a painful condition in which neck muscles contract involuntarily, causing the head to twist or turn to one side. CD can also cause the head to uncontrollably tilt forward or backward. Myobloc is injected into muscles of the head and neck to treat this extreme condition.

That said, we have heard that in Europe, some doctors are using Myoboc (that is Type-B Botulinum) off-label for patients who request it because they feel they have developed resistance to Botox® and Dysport®.  As we’ve mentioned in the past, if you feel you are developing resistance to Botox®, we suggest switching to Dysport®, at least for a while. While there is currently little research to support the theory of Botox® resistance, we certainly have clients who feel they have become resistant to Botox® and are finding better results with Dysport®.  At Sonata, we don’t currently use Myobloc, nor does or should anyone else in the US. If you feel you may be developing resistance to Botox® or Dysport®, please share your thoughts with Dr. Janowski and together we will find a solution. We are here to serve you, helping you look and feel your very best, day after day, year after year.

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