Researchers at the Maas Clinic in San Francisco treated crow’s feet on 90 patients with Botox on one side of the face and Dysport on the other. Patients were seen two, four and six days after injections. Patients and doctors rated Dysport as more effective at reducing crow’s feet, when patients were smiling.

Researchers concluded that Dysport had a trend toward greater improvements at day two compared to Botox and “statistically significant greater improvement at days four and six.”

Though Dysport resulted in greater improvement, both showed statistically significant changes two days after injection.

ABC News spoke with doctors about the results of the study. Physicians agreed that both Botox and Dysport have positive results, and that the skill and experience of the doctor administering the injection is more important than which botulinum toxin is used.

Botox Maker Questions Study

Allergan, maker of Botox, responded to the study by saying that is was funded by Dysport’s maker Medicis. A spokesperson for Allergan, Kellie Lao, pointed out that the study, published in the Archives of Facial Plastic Surgery, only reported data out to 30 days after the injections, so “the long-term comparative efficacy is unknown.”

Medicis spokesperson Kara Stancell wrote Cosmetic Surgery Times, “These findings resulted from an independent, physician-initiated study that was funded by a grant from Medicis, but not designed or conducted by Medicis. The study investigators are well-regarded, and the study speaks for itself.”

Dr. Corey Maas, lead author of the study, said, “It’s good for us to know that we have good, quality options out there for patients. When we have choices and there is good competition, it helps both the doctor and the patient.”

Skin Speaks Spa M.D. in the Twin Cities offers both Botox and Dysport. Dr. Carney will help you determine which botulinum toxin is right for you.

The gel contains botulinum toxin, which is Botox’s active ingredient, and results last about four months — similar to the results from Botox injections.

The study said that the gel “noticeably softened crow’s feet,” but there are still many unknowns about the new drug, including how much it would cost, when it might be available and how well it will work compared to injected Botox. More studies are needed before possible FDA approval.

If a Botox gel does prove to be safe and effective, it would likely be embraced by consumers. Botulinum toxins, such as Botox and Dysport, are the most popular non-surgical cosmetic procedures in the country, and the gel could offer a pain-free alternative to the injectables. The gel is applied to the wrinkled area around the eyes; after a half an hour it is then wiped off, according to study researchers.

In one study, close to 90 percent of patients who got the botulinum toxin gel showed a “clinically meaningful” reduction in wrinkles, compared to 28 percent of those who got a placebo gel. In another study with 180 patients who had crow’s feet, about 40 percent responded favorably, the researchers reported.

Topical Botox Would Require Your Dermatologist

The botulinum toxin gel is a drug, not a skin cream. That means that if it were eventually to receive FDA approval, patients could only undergo the procedure at their physician’s office.

The researchers did point out that it may be difficult for a gel to get the level of precision that injections provide; however, the gel’s advantage is that patients can avoid the needle.

While there is no definitive evidence that using Botox to prevent wrinkles is effective, that hasn’t stopped 29-year-old Tiffany Rose Goodyear from getting Botox. She started when she was just 24 to smooth forehead wrinkles that she says she got by frequently raising her eyebrows.

“If I start at a younger age, when I’m older I’ll continue to have that youthful appearance that our society so values,” Goodyear said.

According to statistics from the American Society for Plastic Surgeons, in 2010 almost 78,500 people in their 20s received Botox in the United States, an 11 percent increase from 2009.

Plastic surgeon Arthur Perry thinks the concept of trying to prevent future wrinkles is “nutty.”

“You don’t want to use a drug unless you need the drug, and Botox is a drug,” he said.

Perry feels that even if Botox was proven to prevent future wrinkles, it should not be used for that purpose. “It makes no sense whatsoever to do that,” he said.

Brian Glatt, a plastic surgeon, finds that regular use of Botox seems to make the muscle-relaxing effect last longer so patients don’t need to come in as often for treatments. This may occur because the muscle undergoes atrophy, or wasting, after prolonged periods of not being used, Glatt said, which could mean that wrinkles wouldn’t form as easily on a young person who has had treatments for years.

Also, if Botox is used regularly, the wrinkles that return when it wears off may not be as severe, said Glatt.

Plastic surgeon Steven Pearlman goes by what you could call the “rest test.” He said to wait until lines show up before getting Botox. The wrinkles must be there when your face is at rest, not contorted through smiling or grimacing, he said. “Unless someone has lines at rest, they’re not a candidate for Botox.”

If Botox isn’t the answer, how can you prevent wrinkles? Two of the best ways are to wear sunscreen and avoid smoking, according to the experts.

For more tips, view our 5-step skin care guide.

The society just published results of a study that tested the effectiveness of 4% hydroquinone combined with tretinoin when used in conjunction with botulinum toxin type a.

Reported benefits include a significant improvement in:

• fine lines
• wrinkles
• hyperpigmentation

The 120 day study was a multi-center, randomized, investigator-masked, parallel-group study with 61 Botox patients. Patients were randomly prescribed either a hydroquinone system (cleanser, toner, 4% hydroquinone, exfoliant, and sunscreen) combined with 0.05% tretinoin cream, or a “standard skin care regimen” with cleanser, moisturizer, and sunscreen.

Investigators and patients alike were tasked with evaluation of the results. They found “significantly milder fine lines/wrinkles and hyperpigmentation at days 30, 90, and 120″ in the hydroquinone/tretinoin group. They also found “superior overall ratings” in patient surveys.

The ASAPS press release reports:

“Patients using the hydroquinone system plus tretinoin believed that their study treatment had further enhanced the improvements attained with botulinum toxin type A compared to those using the standard skin care regimen (86% vs. 8%).”

“The new hydroquinone system is not only effective, it is also easy for patients to use, increasing the likelihood that they will be able to get maximum benefits,” reported Dr. Joel Schlessinger, the study’s co-author.

You can read about the results in the July issue of Aesthetic Surgery Journal.

“It’s a toxin-free alternative to treating unwanted lines and wrinkles, similar to what is being done with Botox and Dysport,” said study co-author Francis Palmer, director of facial plastic surgery at the University of Southern California School of Medicine in Los Angeles. From early clinical trials, this procedure appears to have the same clinical efficacy and safety comparable to the existing techniques, he added.

To perform the procedure, doctors use small needles that deliver cold to nerves running through the forehead, and the cold freezes the nerve, interrupting the nerve signal and relaxing the muscle that causes forehead lines. The technique does not permanently damage the nerve, Palmer said.

Researchers said they are still refining the technique but that the results last about the same amount of time as Botox, which works for about three to four months. However, unlike Botox, which takes a few days to kick in, the effects of the cryotechnology are seen immediately, according to the researchers.

The current study had 31 people, all of whom had fewer wrinkles after two to eight injections, and the level of discomfort was comparable to that from Botox or fillers, Palmer said.

If this new technique is eventually approved by the FDA, it would offer consumers an alternative to a neurotoxin injection for getting rid of forehead wrinkles. Statistics from both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery for 2010 showed that Botulinum Toxin Type A, which includes Botox and Dysport, was the number one non-surgical cosmetic procedure.

The company plans to seek FDA approval, but it may seek approval in Europe first.

Images via Botox's before and after tool

Botox and Dysport have more than proven their popularity as injectable wrinkle fillers, and the companies that make them continue to look for new uses.

CBS Interactive Business Network reports that Medicis, maker of Dysport, is working with a company called Revance to create a “wipe-on, wipe-off” version of botulinum toxin to treat facial wrinkles and excessive sweating.

Meanwhile Allergan, maker of Botox, is researching the drug for use as a painkiller and as a treatment for juvenile cerebral palsy and enlarged prostate.

Allergan also continues to focus on Botox’s success as a wrinkle filler with a new website that allows users to upload their own photos and then create photos of what they might look like after Botox.

Botox was also recently approved as a preventive treatment for chronic migraine in October 2010.

The CBS report says sales of Allergan’s Botox began recovering last year after declining during the recession, and recent statistics from the American Society of Plastic Surgeons showed that cosmetic non-surgical procedures increased 5 percent in 2010 from 2009.

Dysport, which was released by Medicis in 2009, has also seen sales success. The company’s non-acne skin products were up 31 percent in 2010, and most of that increase is most likely due to Dysport.

Skin Speaks Spa M.D. is one of the Midwest’s leading provider of Botox® Cosmetic treatments.

Conducted by plastic surgeon Dr. Steven H. Dayan, the study had 100 patients who were treated with either Botox or a saline placebo for facial wrinkles between the eyebrows, on the forehead and around the eyes.

Participants took a quality of life survey before the injections and two weeks and three months after the injections.

The findings revealed that Botox injections result in improvements in quality of life and self-esteem. Those treated with Botox showed statistically significant improvements in answers to many quality of life questions, including those pertaining to:

• Mood
• Overall life satisfaction
• Body satisfaction
• Self-worth
• Appearance
• Attractiveness
• Sense of well-being

The study also found increases in overall self-esteem and appearance-, social- and performance-related self-esteem for those treated with Botox. In addition, patients who received Botox for the first time demonstrated a greater improvement in quality of life and self-esteem when compared to participants who had previously received Botox.

“The findings in this study ask us to think much differently about Botox treatments,” says Dr. Dayan. “We have long known the physically enhancing benefits of Botox treatments, but to now have data that indicates Botox also improves one psyche, self-esteem and quality of life is very significant. The question now has to be asked is if getting Botox makes people feel better about themselves, could this translate into them being more productive in their professional lives and happier in their personal lives?”

Learn more about Botox at Skin Speaks Spa M.D.

Dr. Joel Schlessinger, a cosmetic surgeon, presented his findings at the American Society for Dermatologic Surgery 2010 Annual Meeting. His results were of a subset analysis of a phase 3 clinical trial designed to evaluate the effectiveness of Dysport.

An analysis of the Dysport group, which had 1160 participants, found that 19.7 percent of the patients responded to Dysport on day one, and that three days was the median response time to the Dysport treatment. Furthermore, Dr. Schlessinger said that Dysport appears to take effect slightly faster than Botox, by about two days.

Dr. Schlessinger explained, “There are many different neurotoxins out there, and they have different types of effects on the injected individual, depending on the physical and molecular makeup of the neurotoxin.”

Based on his findings, he points out that the quicker onset of Dysport “can be very helpful for a person who … has a social function coming up.”

Dr. Elliot Weiss from the Laser and Skin Surgery Center of New York in New York City, said the “study … validates what clinicians have observed clinically with the use of [Dysport] with regard to its early onset of action in many patients.”

Skin Speaks patients can view the comparable dosage and pricing charts for Botox and Dysport to get a better idea of pricing differences between the two.

Migraines, which are three times more common in women than men, are characterized by intense pulsing or throbbing pain. Patients with chronic migraine experience a headache more than 14 days a month.

Botox is given about every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms and prevent migraines. While researchers are still exploring how Botox works on migraines, one theory is that it blocks pain signals from reaching nerve endings.

Botox had worldwide sales of about $1.3 billion last year, divided equally between medical and cosmetic uses, according to the New York Times. Allergan, the maker of Botox, believes its sales as a medical treatment may eclipse its sales as a cosmetic wrinkle treatment.

In other Botox news, earlier this month it was reported that British scientists developed a way to refine the anti-wrinkle treatment to improve its use for treating chronic migraine, as well as Parkinson’s and cerebral palsy. The researchers’ method produced a refined Botox-like molecule, they said, which would be practical for clinical use but would not have unwanted toxic effects.

“It will now be possible to produce Botox-based medicines in a safer and more economical way,” said Bazbek Davletov, who led the study at Medical Research Council’s Laboratory of Molecular Biology.

Davletov said the new refining technique could allow scientists to produce new forms of Botox with wider practical medicinal uses, for example as a long-term painkiller.

Read the FDA press release on its approval of Botox to treat chronic migraine and the article on refining Botox, “Scientists Find Way to Refine Botox for New Uses.”

Statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS) show that for those in the 51-64 age range:

• The number of facelifts dropped from over 75,000 in 2008 to just under 55,000 in 2009
• The number of Botox procedures increased from 672,840 in 2008 to 734,751 in 2009

“If you are a woman who has to come back to work full-time or a man who isn’t going to be able to retire any time soon, you’ve got to look like you can compete,” says Wendy Lewis, a New York–based plastic surgery and skin care consultant. “And if you are working in a field like media where everyone is really young, you don’t just want to look good for your age, you want to look good, period.”

Overall the number of facelifts in the U.S. dropped 29 percent from 2008 and eyelid surgeries dropped 23 percent during the same time frame, according to ASAPS. Meanwhile, Botox and Dysport injections increased 3.8 percent from 2008 to 2009.

Less invasive procedures have several benefits for those in the job market: they require less recovery time and are generally less expensive compared to cosmetic surgical procedures.

Lewis does point out that minimally-invasive treatments can be overdone. “There is a point at which you are going to have a better result and spend less money if you just have a facelift,” she says. In addition, there are some problems, like sagging jowls, that can only be fixed by surgery.

Skin Speaks Spa MD offers a wide array of cosmetic non-surgical procedures, including Fraxel, Thermage, IPL (intense pulsed light), and Juvederm.