From Botox Cosmetic to Xeomin: How Every Wrinkle-Reducing Injectable Differs

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We keep hearing that the FDA is about to approve the next generation of wrinkle reducers, DAXI, which is said to last longer than the other neurotoxins on the market. That got us thinking about the injectable neurotoxins we currently have at our disposal and what makes them unique. “First of all, everything that we have now, we’re headed to a next generation that we’re testing already,” says West Palm Beach, FL dermatologist Kenneth Beer, MD. “The landscape is going to get much broader. There will be toxins that last for two weeks and there will be toxins that last from nine months to a year. There are a lot of revamps in the works.”

While we aren’t quite there yet—Dr. Beer says expect to see these come to market in 2023— of the injectable neurotoxins we do have, there are subtle differences in how they perform, how quickly they start working and how long they last. Here, our top expert injectors share the small nuances that make each neurotoxin distinctive.

Botox Cosmetic: The Household Name

“All neurotoxins work in the same way,” explains Woodbury, NY oculoplastic surgeon David Schlessinger, MD. “They block release of acetylcholine, the chemical that causes muscles to contract, from being released from the motor nerves. The nerves regenerate and movement to the muscles return.”

According to Delray Beach, FL dermatologist Dr. Janet Allenby, Botox Cosmetic is the industry gold standard. “It has the most medical indications, is very precise and has a low risk of ptosis or drooping. Results average around three to four months when used for full correction. It can take anywhere between 24 hours and 7 days for the toxin to kick in and start working.”

Botox Cosmetic, or Onabotulinum Toxin A, is the oldest neurotoxin on the market and its active ingredients are made mostly of proteins that provide protection, and they stick around the botulinum which ensures its longevity. “It’s this big chain of protein and it gets taken up by the nerve and stops the nerve from transmitted,” Dr. Beer explains. “Most of the other toxins have what are called carrier proteins, too. Albumin is the most common one and it’s included to help stabilize the Onabotulinum toxin A and allow it to work effectively in your body.”

Dysport: The Smooth Operator

Dr. Beer says that Dysport has a little bit of a smoother onset. “It’s better when you’re cleaning up a neighborhood than going after an individual wrinkle,” he notes.

According to New York dermatologist Jody A. Levine, MD, Dysport lasts longer than Xeomin and Botox Cosmetic, but spreads more. “I will use Dysport for certain areas, such as on crow’s feet for people who have many, or the forehead and glabella for people whose muscles are super strong and seem to not fully respond fully to Botox Cometic or Xeomin.” 

Xeomin: The “Naked” Toxin

Of all the toxins, Xeomin has fewer proteins, so it’s sometimes referred to as the “cleaner” wrinkle-relaxer. “It’s also called a naked toxin,” Dr. Beer says. “What that means is, it just has the protein that is the active ingredient.”

“Because it has fewer proteins, in theory it is considered cleaner with potentially a lower immune response,” says Dr. Schlessinger.

Jeuveau: The Fast Worker

Dr. Levine finds that with many of her patients, Jeuveau works faster and has quicker onset than the others. “I use it if the patient wants to look good for an event in two days, but I find that it doesn’t last as long as Botox Cosmetic or Xeomin,” she says.

“The difference between the toxins is minimal and Jeuveau and Botox are almost the same exact formulation,” adds Dr. Schlessinger.

DAXI: The Longer-Lasting Tox

The new DAXI injectable, which is not available to consumers yet, is said to last almost twice as long as the current toxins says Dr. Schlessinger. “Although this may be desirable, side effects or unsatisfactory results also may last longer. It is made with a proprietary stabilizer that allows it to stay effective longer. As Daxi is still awaiting FDA approval, widespread use is pending and more information about its effectiveness and potential side effects will be discovered soon.”

“I am super excited for DAXI as it lasts longer than all the others and is a much-needed addition to our neurotoxin armamentarium,” Dr. Levine shares.

Dose Dependent

“All these things are dose dependent,” adds Dr. Beer. “2.5 units of Dysport has the same activity as one unit of Botox. So, it’s not apples and apples, it’s really dependent on the dosage and also the person. People who work out a lot and have a lot of muscle mass, they tend to need higher doses.”


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