Most experienced injectors carry both. Botox is the default for most patients, most areas, most of the time. Dysport has specific clinical advantages in large surface areas and for patients who have built tolerance to Botox. Understanding both makes you a more complete injector — and gives you something genuinely useful to offer patients whose Botox results have plateaued.
What You're Actually Comparing
Before the clinical differences, a pharmacological clarification that matters for how you think about this comparison:
Botox (onabotulinumtoxinA, Allergan) — The dominant market product. Botox unit is the proprietary Allergan unit. All Botox dosing in training, literature, and clinical practice refers to Allergan units.
Dysport (abobotulinumtoxinA, Galderma) — The Speywood unit is distinct from the Allergan unit. Dysport units are not interchangeable with Botox units — the conversion is approximately 2.5 Dysport units per 1 Botox unit for most areas, though some clinicians use 2.5:1 to 3:1 depending on the area and clinical observation.
The critical point: A patient who received "20 units" at a previous practice — you need to know if that was 20 Allergan units (Botox) or 20 Speywood units (Dysport) before you can counsel them on dosing at your practice. This is a common source of patient confusion and a common source of injector under- or overdosing at subsequent visits.
some use 3:1 for conservative dosing
The Clinical Differences That Actually Matter
Onset
Dysport consistently shows faster onset than Botox. Botox onset is typically 3–7 days for initial effect, with full effect at 10–14 days. Dysport onset is often 1–3 days for initial effect, with full effect at 7–10 days. For patients who are result-anxious or have an event coming up, Dysport's faster onset is a clinically meaningful differentiator. It's also relevant when managing patient expectations post-treatment — a Dysport patient who sees you at day 4 with “it's not working” is reassurable; a Botox patient at day 4 is also reassurable but the reassurance timeline is longer.
Diffusion Radius
This is the most clinically consequential difference between the two products, and the one that most influences area-by-area product selection. Dysport has a larger diffusion radius than Botox after injection — the product spreads more from the injection point in tissue.
Where larger diffusion is an advantage:
- Forehead lines — the frontalis is a large muscle and wider diffusion produces a more even, natural horizontal line reduction with fewer injection points
- Hyperhidrosis (axillary, palmar) — larger diffusion means better coverage per injection point in a treatment area defined by gland distribution rather than specific muscle location
- Platysmal bands — the broad platysma benefits from diffusion in the neck/décolleté area
Where smaller diffusion (Botox) is preferred:
- Lower face and perioral area — precise placement is critical for lip flip and mentalis, and unwanted spread to the orbicularis oris or depressors can create functional issues
- Crow's feet near the lower orbital rim — where diffusion toward the zygomaticus can flatten the smile
- Brow lift technique injections — where millimeter-level precision changes the aesthetic outcome
- New injectors — the precision demands of learning technique are better served by Botox's more predictable, contained diffusion profile
Duration
Duration differences between Dysport and Botox are clinically modest and patient-variable. The literature and clinical experience both support approximately equal duration for the two products when dosed equivalently — 3–4 months for most upper-face treatment areas in most patients. Dysport's marginally faster onset doesn't translate to meaningfully shorter duration in clinical practice. Patients who report that Dysport “lasts longer” than their previous Botox treatments may have been under-dosed with Botox previously.
Protein Load and Antibody Formation
Botox contains complexing proteins alongside the active toxin; Xeomin is the protein-free (naked) neuromodulator. Dysport also contains accessory proteins. The theoretical concern is that repeated exposure to complexing proteins could stimulate antibody formation that reduces clinical efficacy over time. In practice, true toxin resistance (antibody-mediated neutralization) is rare at the doses used in aesthetic practice, but it's the explanation when a patient reports that Botox “stopped working” after years of treatment. Switching to Xeomin (no complexing proteins) or Dysport (different protein complex structure) is the standard clinical approach for these patients.
Side-by-Side Comparison
| Property | Botox (onabotulinumtoxinA) | Dysport (abobotulinumtoxinA) |
|---|---|---|
| Manufacturer | Allergan / AbbVie | Galderma |
| Unit system | Allergan units | Speywood units — NOT interchangeable |
| Conversion ratio | 1 Botox unit | ≈ 2.5 Dysport units |
| Onset (initial effect) | 3–7 days | 1–3 days (faster) |
| Full effect | 10–14 days | 7–10 days |
| Duration | 3–4 months (typical) | 3–4 months (comparable) |
| Diffusion radius | Contained, precise | Wider spread from injection point |
| Best areas | Lower face, perioral, brow lift, crow's feet precision, all standard upper-face areas | Large forehead, hyperhidrosis, platysma, patients needing wider coverage |
| Protein content | Contains complexing proteins | Contains complexing proteins (different structure) |
| Reconstitution | Available as 50U and 100U vials; 300U vial for hyperhidrosis | 300U vials (most common); smaller vials available |
Pricing Considerations for Your Practice
Because Dysport requires more units to achieve the same clinical effect as Botox, patient-facing pricing should be structured by unit count (not by “area”) to avoid confusion. Galderma's Aspire Rewards program and Allergan's Allē program both provide per-unit rebates that affect your effective wholesale cost. The landscape shifts with program promotions, so track your actual per-unit cost with both products through your distributor quarterly.
Two pricing models to consider when adding Dysport:
- Per-unit pricing: Charge per Speywood unit at a lower per-unit rate than Botox (reflecting the conversion ratio). Patients who know their Botox dose can be counseled: “If you use 20 Botox units, you'd use approximately 50 Dysport units — we price those differently.” Transparent, but requires patient education.
- Per-area pricing: Charge the same price per area regardless of product selection, and absorb the unit-count difference in your product cost calculation. Simpler for patients, but requires you to ensure your per-area pricing is correctly calibrated for both product costs.
Most practices that carry both standardize on per-unit pricing with explicit “Allergan units/Speywood units” labeling on their menu to avoid confusion between products.
Patient Selection: When to Suggest Dysport
In practice, the patient selection logic for Dysport is often reactive rather than proactive — meaning a patient presents with a specific situation that makes Dysport the better choice. The most common scenarios:
The Patient Whose Botox “Stopped Working”
A patient who has been receiving Botox for 3–5+ years and reports that results have become progressively shorter or less complete. Rule out under-dosing first (increasing Botox dose is the first intervention). If dosing adjustment doesn't restore full efficacy, this may be mild antibody-mediated resistance. Switching to Dysport (different protein complex) or Xeomin (no proteins) often restores response. This is a meaningful clinical service you can offer patients that their previous provider may not have known how to address.
The Patient Who Wants the Fastest Possible Onset
Pre-event patients — weddings, reunions, professional photo sessions — who are booking within 7–10 days of their event. Dysport's 1–3 day onset vs. Botox's 3–7 day onset can be clinically meaningful in this scenario. Caveat: results at day 3 of Dysport are not full results; managing expectations about the timeline to full effect still applies.
The Patient With a Large Forehead Requiring Even Coverage
For patients with a tall, wide frontalis who have historically had uneven results from Botox requiring multiple touch-ups, Dysport's wider diffusion often produces a more uniform horizontal line reduction across the forehead with fewer injection points. This is particularly useful for patients with a tendency toward brow drop from Botox due to the need to place large doses high in the frontalis.
Hyperhidrosis Patients
For axillary or palmar hyperhidrosis, Dysport's larger diffusion radius means better glandular coverage per injection point and often fewer total injection points needed to achieve complete treatment of the affected area. This can translate to a more comfortable patient experience and potentially lower product cost per treatment area.
Dysport's wider diffusion is an advantage in specific situations and a risk when your injection placement is still being refined. The same placement error that produces a manageable result with Botox can produce wider spread with Dysport in critical areas like the periorbital zone or lower face. Build your baseline technique on Botox, then add Dysport to your toolkit when your placement precision is reliable.
How to Talk to Patients About the Difference
Most patients ask about Dysport vs. Botox in consumer terms: “which is better?” or “which lasts longer?” The most useful answer is honest: both products work well, neither is universally better, and selection depends on their goals, their anatomy, and their treatment history. A script that works in practice:
“Both products are botulinum toxin type A and produce the same effect — relaxing the muscle to smooth lines. The main differences are that Dysport tends to work a bit faster and spreads slightly more from the injection point, which can actually be an advantage in some areas like the forehead. For your [treatment area], I'd recommend [product] because [reason]. If you have a specific reason you'd prefer one or the other, I'm happy to use it.”
This positions you as knowledgeable about both products, makes a recommendation based on their specific anatomy, and invites their input. It also avoids the false framing of Botox being the generic-commodity option and Dysport being the “premium” upgrade — neither is premium, they're different tools for different situations.