The Ultimate Guide of Neurotoxins: What Are They and What’s The Difference?

The Ultimate Guide of Neurotoxins: What Are They and What’s The Difference? featured image
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The average patient may not know that when it comes to neurotoxin injections, they have a few options. (Currently, there are five FDA-approved neurotoxins that top doctors employ for anti-aging, cosmetic and even health benefits.) Even the most beauty-conscious patients may not understand all the nuances of each injectable and what sets them apart from each other. While each of the neurotoxins have slight differences, experts say they’re very similar and all effective.

“Patients often forget that there are multiple FDA-approved uses for neurotoxins, from migraine treatments to muscle spasticity and the safety profile has been established for use in much higher doses than needed for cosmetic effects,” says board-certified New York dermatologist Julie Russak, MD. “I often joke with my patients (being fully serious) that I feel safer with Botox injections than with taking Tylenol.”

“In general, most of the neurotoxins are essentially interchangeable, but there are subtle differences,” says board-certified Omaha, NE dermatologist Joel Schlessinger, MD. Board-certified New York dermatologist Jody A. Levine, MD notes that their compositions vary slightly, with some containing protein blends, which causes potency and diffusion to differ.

Board-certified Nanuet, NY dermatologist Heidi Waldorf, MD acknowledges, “We all have our preferences, but an experienced injector who understands the science can get the same results with any of the FDA-approved neurotoxins.” Board-certified New York dermatologist Erin Gilbert, MD says her approach to selecting which neurotoxin is right for each individual patient is to think through her experience. “What has my clinical experience been with this product? What is the unit to unit comparison after dilution? What does my patient want? A more aggressive treatment for more etched in lines or a more subtle effect? How quickly do they hope to see results?” Dr. Gilbert asks herself. “Then I proceed based on my own clinical experience to discuss with them what I think the right choice is and why, and I get to work.”

When getting an injection, it’s best to defer to your provider’s professional opinion on which neurotoxin you should get—but you should be knowledgeable about what is going in your body and where one neurotoxin diverges from the others. “Each neurotoxin has slightly different personality,” says board-certified New York dermatologist Marina Peredo, MD.

Botox Cosmetic

Botox Cosmetic has the most FDA indications and has been around the longest. Dr. Schlessinger says he uses Botox Cosmetic in his practice daily “for concerns ranging from forehead wrinkles to jawline slimming. It is absolutely amazing to see the advances in treatments that have been discovered.” He notes that since it’s been around for so long, Botox Cosmetic has “the most research of any cosmetic product or procedure that we perform.”

Depending on the units, especially around the range of 30 to 50 units, Botox Cosmetic can range from $500 to $1,000, depending on the doctor. Board-certified Davie, FL dermatologist Marianna Blyumin-Karasik, MD notes that “results after one month slowly wear off,” and people repeat injections every three to four months consistently. It’s an “intro procedure” that can be customized to help you “feel and look refreshed, but still look like yourself.”

“Botox has now become a household term and a verb to describe injection procedures to reduce the appearance of dynamic wrinkles,” says board-certified New York dermatologist Elaine Kung, MD. “However, many aesthetic providers use different brands of neurotoxins in their offices other than Botox.”


There’s not much that’s “natural” about neurotoxins, but Xeomin is known as the purest of the bunch. “Many of my patients choose Xeomin because they like that it is double filtered and without unnecessary complexing proteins,” says Dr. Waldrof. She adds that Xeomin helps “minimize the risk of developing resistance.” Additionally, Dr. Gilbert notes that one thing that makes Xeomin stand out is that “it doesn’t need to be refrigerated to maintain integrity, which can be a plus for certain practices.”

Dr. Schlessinger says while doing trials, they found that older patients loved it “as it allows for a less heavy look.” He notes that Xeomin works in a similar manner as Jeuveau, and he specifically likes using it for “lids that are starting to feel or look heavy as it has a light touch.” Dr. Peredo says she also loves using it on younger patients. Dr. Blyumin-Karasik notes that this treatment helps to “diminish harsh aging wrinkles, which often create the appearance of negative expression, anger, tension or displeasure.” Depending on your location and provider, this form of treatment costs about $450 for 50 units.


What makes Dysport stand out from the others is its onset time and soft finish. Dr. Schlessinger began working with Dysport in 2003 when his facility was involved in the first clinical trials on forehead wrinkles, and he noticed a trend back then. “In one of the trials I was involved in, we found it took effect quicker than expected, with some patients seeing results as quickly as one to two days,” says Dr. Schlessinger.

“Dysport’s onset is the fastest, making it best for last-minute treatments,” says Dr. Levine. “It also diffuses more, so it’s good for large areas,” adds Dr. Levine. Dr. Schlessinger explains that it has a “larger field of effect, which means that it covers areas like the upper forehead very nicely, so if someone comes in and says they tried another neurotoxin and it didn’t get the complete forehead relaxed, I would normally suggest Dysport.”

Dr. Waldorf likes using Dysport on patients “with high foreheads and long necks to produce a softly spread effect.” Additionally, Dr. Schlessinger feels Dysport is a great option for younger patients “as it provides a more complete relaxation of wrinkles.” Dr. Peredo specifically loves Dysport for addressing crow’s feet. Depending on the session, Dysport can be cheaper than Botox as the cost is around $400.


Dr. Schlessinger says that many of his patients that want to try something that affords some movement gravitate towards Jeuveau. “It has a fresh and ‘undone’ look and is great for all ages. In particular, those who may have had a ‘heavy’ feeling with other neurotoxins seem to do well with Jeuveau in my practice,” says Dr. Schlessinger. He adds that it’s great for tackling neck and chest lines. In Dr. Gilbert’s experience, patients that receive Jeuveau often see onset as quickly as Dysport, though each patient’s experience is different. Dr. Peredo says it’s a great option for younger patients.

Atlanta, GA board-certified dermatologist Dr. Mary Alice Mina shares that Jeuveau helps “to feel and look refreshed, but still look like yourself.” She also notes that this treatment helps “contour and shape” the muscles and “even out a crooked smile.” The cost is the same range along with Botox Cosmetic, beginning around $400.


As the newest FDA-approved neurotoxin on the block, Daxxify has stirred up much excitement in dermatologists and patients alike. The allure of Daxxify is that it tends to last longer than the other options. “Typically Daxxify lasts five to six months, while other neurotoxins last anywhere from three to four months,” says Dr. Peredo. She especially loves using Daxxify “for brow lift and improvement of the skin texture.

“It was observed that almost 10 percent of study patients had a good response in glabellar lines at 36 weeks (nine months),” says Dr. Kung. “I think aesthetic providers can only be confident in saying that Daxxify may last longer than Botox but we can’t specifically say how much longer.” It’s important to note that, “The number of units we normally use for Botox, Dysport, Xeomin or Jeuveau is not interchangeable with Daxxify units,” says Dr. Kung.

As with the others the pricing will differ amongst aesthetic providers. “Revance, the makers of Daxxify, leave pricing at the discretion of the providers. Some providers may decide to charge more because patients may be seeing them less often since Daxxify’s results may last longer,” says Dr. Kung. “Other providers may decide to keep the fees similar to the price of neurotoxins they used in the past.”

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