Daxxify vs. Other Neurotoxins: How the New Wrinkle-Relaxer Stacks Up

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There’s been much ado about Daxxify, the new FDA-approved neurotoxin for the temporary improvement of the appearance of wrinkles, lines and folds on the face. Similar to Botox Cosmetic in its mechanism of action, the injectable relaxes the muscles that lead to facial lines and has been touted as lasting longer, meaning less visits to your injector. But, is everyone a good candidate for a longer-lasting toxin? And how long does it really last when compared to Botox Cosmetic, Xeomin, Dysport and Jeuveau? Here, we investigate the hot new injectable to find out how it stacks up against the rest. 

How does Daxxify work?

Daxxify works by temporarily blocking the nerve signals that cause muscles to contract, thereby relaxing the muscles and reducing the appearance of wrinkles, lines and folds on the face. West Palm Beach, FL dermatologist Kenneth R. Beer, MD, who was involved in the clinical trial, says Daxxify is used to treat areas such as the forehead, frown lines, and crow’s feet and is expected to last six months to nine months. 

Daxxify vs. Other Toxins

The main difference between Daxxify and other toxins on the market, which include Botox Cosmetic, Xeomin, Dysport and Jeuveau, is how long it lasts. “During the clinical trials, we’ve seen that Daxxify lasted longer,” says Dr. Beer. “The majority of my patients saw improvement for six months. Some lasted longer, but six months was the average.” 

“We have been using Daxxify in our practice now for four months and our patients still have efficacy at four months,” says Rochester, NY dermatologist Lesley Loss, MD. “In my experience with Botox Cosmetic or Dysport, the treatment has completely worn off by four months. So instead of needing toxin three to four times a year, you may only need Daxxify twice a year.”

Additionally, Dr. Beer noted a “more even spread” when compared to other neurotoxins which results in a smoother-looking outcome. The smaller molecular size is said to contribute to its ability to spread more evenly.

Another major differentiator is how quickly it starts working. “It appears to take effect much faster,” explains Fort Lauderdale, FL dermatologist Dr. Matthew Elias. “We’re seeing the onset in one to two days versus up to two weeks for Botox Cosmetic.”

It’s important to note the dose differentiation between Daxxify and the other neurotoxins available. The recommended FDA-approved dosage of Botox Cosmetic for glabella frown lines is 20 units and for Daxxify it’s 40 units.

The parent company of Daxxify, Revance, says the amount of core active neurotoxin in a 40 unit dose of Daxxify is 0.18 ng which is equal to the amount of core active neurotoxin in a 20 unite dose of Botox. “Therefore the units are product specific and noninterchangeable,” said a spokesperson for the brand.

Is Daxxify more expensive?

“The cost is about one and a half times the cost of the other toxins but if the longevity works out, patients will save about 25 percent in a year’s time,” says Blacksburg, VA dermatologist Dr. Aleksandra Brown, who also says we should wait a beat before making the investment. “That said, Daxxify has not been readily available to many injectors, and those who have had it since it launched haven’t had the six months to know the actual duration, especially in the off-label areas.”

What are the risks of using Daxxify?

Like other neurotoxins, Daxxify can cause potential side effects such as redness, swelling, bruising, and pain at the injection site. More serious, but rare, side effects include muscle weakness, difficulty swallowing or breathing, or drooping eyelids.

Among its list of “cons” to consider, the longer-lasting result can also lead to longer-lasting side effects. If a patient experiences any side effects from the neurotoxin, such as drooping eyelids or difficulty speaking, these effects may last longer with Daxxify compared to other toxins.

A representative for Revance says adverse events with Daxxify are consistent with other products.

More Data Is Needed

New York dermatologist Peter Chien, MD says he wants to know more about how the injectable works and chalks much of the beneficial claims up to marketing. “It’s actually one’s body, not the toxin, that regenerates and remodels in order for the muscle to move again. The company has not explained the discrepancy in claims about purported longevity with what we know about the mechanism of action.” 

Las Vegas dermatologist H.L. Greenberg, MD says limited access means not a lot of injectors have tried it, so it’s hard to comment on its enduring effects.

“As Daxxify has not yet been widely used, it’s difficult to determine its exact duration in the general population,” adds Washington, D.C. dermatologist Farhaad Riyaz, MD. Because it is a newer neurotoxin, there is limited long-term data on its safety and efficacy.

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