I have a problem with this Botox / Dysport scenario for two reasons.

First reason:

As dermatologists, we are experts in the treatment and diseases of skin, hair and nails. That is what we are trained for and board certified in. We are NOT experts in TMJ. That is a problem that is usually treated by either Ear, Nose & Throat (ENT) doctors, the dental/orthodontic community or other specialists. TMJ can affect headaches, teeth grinding, clenching, bite issues etc. I don’t believe dermatologists should even be treating TMJ. TMJ also involves other muscles of the face besides the masseter that may need to be addressed also.

Now having said that, we DO treat the masseter muscle (the big jaw muscle at the angle of the jaw) with Botox or Dysport. We do this for cometic reasons, sometimes to slim the appearance of the jaw. That is a different issue and this is an off-label FDA use. Sometimes when we treat the masseter for cosmetic reasons, people will notice that their TMJ improves a little but that’s really just a nice side effect. It’s a little like treating the frown muscles (the corrugators) for cosmetic reasons and having someone notice that their headaches improve. It’s a nice side effect, but dermatologists shouldn’t be treating headaches in general, in my opinion.

Second reason:

The other problem here is not making sure that you understand (should be in the consent you signed), that your dermatologist might use either Botox OR Dysport during your treatment. This IS fairly standard in dermatologist offices. To use them interchangeably depending on what your doctor is trying to accomplish. For example, on the same person, we might use Dysport in the forehead (if the forehead is large) where it’s slight extra diffusion is an advantage. Botox on the wrinkles around the eyes, and the lower face, where we might want a less diffusion (the ability of the product to migrate).

Bottom Line:

• If you have TMJ that’s your main concern, please go to a doctor who specializes in that problem.

• Botox and Dysport are mostly interchangeable – like a Gala apple versus a Fuji apple – and if you really want one or the other, just let your dermatologist know that. Most dermatologists have both in their offices. Read more here.

Hope this helps,  Dr. I