Neuromodulators (Neurotoxins) BOTOX, XEOMIN, and JEUVEAU


Botulinum toxin type A is what we tend to call BOTOX because it has the longest track record. BOTOX was the first neuromodulator injectable ever, and still has the biggest market share. It worked so well that more neuromodulators followed and now BOTOX isn’t the only option; there are currently 5 – FDA approved injectable neuromodulators.

BOTOX was approved in 2002, Dysport 2009, Xeomin 2011, Jeuveau 2019, and most recently Daxxify.

They are all designed to address the same types of wrinkles, caused by muscle movement that often become most pronounced when we express emotions. They all contain the same active ingredient, botulinum toxin type A and work the same way by blocking neurological signals to the muscles, reducing the appearance of wrinkles at the point of injection.

In the interest of figuring out what you should know before having injections it’s good to know what to avoid:

  • Price shopping. It’s really not the best place to start. You may have read articles with comparisons, like one unit of Botox is equal to three units of Dysport, making Botox the more cost-effective option. These analogies are faulty by nature: They assume providers are using identical dilutions, which is rarly the case, Varying the concentration, can be totally fine. Some physician practices prefer something more or less diluted, and even a single injector might vary concentrations for different areas of treatment depending on the patient’s anatomy. Since units are not standardized across the field, a less-then-reputable place could theoretically (and often does) offer lower prices using a markedly lower dilution and consumer would never know the difference.
  • Know your injector. No matter which neuromodulator you choose, first thing’s first, vetting your injector, either a doctor, nurse, NP or PA is crucial. It is the single most important thing a patient can do, not only for their safety, but also to ensure the fairest deal and the best possible outcome. You want an injector that has a real mastery of the muscles of the facial expression and in-depth knowledge of how the different products perform. It never hurts to look at the injector to make sure he or she hasn’t over-treated themselves. If the staff and doctor can express themselves in a natural-appearing way then you are likely in good hands. With all the spas and unqualified injectors out there, it bears repeating: Always make sure your injector is credential.

Now that you know to avoid comparisons by price tags and injections at spas. Let’s discuss the main distinction between brands. Their formulations, how large an area a single injection can cover, how quickly you can expect to see results, and how long each lasts.

5 neuromodulators on the market today and how they compare.

  1. BOTOX is the neuromodulator with the most history and larges market share. It is also the only neuromodulator approved for all three o f the major treatment areas: between the brows, the forehead, and crow’s-feet. With fairly little downtime and a little redness around the injection sire for 15 minutes to a day. The results start to kick in as early as day three or four, though the full effects can take up to two weeks to appear and last anywhere from two to four months. To keep result going, touch-ups are recommended every three to four months. Cosmetic use aside, Botox can threat medical conditions including excessive sweating, chronic eyelid twitching, chronic migraines, urinary incontinence, neck spasms, and other types for muscle spasms.
  2. Dysport claim to fame is its spread ability, making it ideal for larger areas like the forehead. It also sets in slightly faster than competitors and anecdotal evidence suggest it may last longer too. Making it popular choice among seasoned neurotoxin users. Dysport really shines when injected in the forehead where it spread well and covers this large flat muscle in complete way that allows for some movement. On the flip side, that same spread ability is less favorable when targeting more precise muscles like those around the brow.
  3. Jeuveau is one of the only two neuromodulators approved for aesthetics use only other then Daxxify. Jeuveau has only been on the market since 2019, meaning research and performance history is fairly limited. There’s anecdotal evidence that Jeuveau has a quicker onset than other neuromodulators and in clinical trial appeared to last longer for about a third of participants. 5 months, rather then the standard 3 months. But evidence that it lasts longer or kicks in faster is fairly limited and inconclusive.
  4. XEOMIN our favorite and what we offer at SPMA! Meet the naked neurotoxin, Xeomin. While that doesn’t mean much for the average consumer, its formula is considered more “natural” by some due to its lack of stabilizing proteins. Xeomin was approved for cosmetic use to treat frown lines between the brows in 2011. Xeomin doesn’t contain the same kinds of proteins as the others. The lack of additional proteins means, theoretically, that patients are less likely to develop antibodies to Xeomin compared to it’s competitors.
  5. Daxxify the NEW kid on the block. Daxxify has been making major headlines as the new, longest lasting option on the market. The results seem to last longer than other neuromodulator. In trial, about 80% of participants saw improvements in facial lines 4 months after treatment and about half saw improvements after 6 months. Some even continued to report results after 9 months; these staying power results can be a double-edge sword. Results that last so long can be problematic for those unsatisfied and needing to wait longer for effects to wear off than they would with other injectables. Plus side, it could translate to a single annual appointment, or biannually for upkeep. Daxxify may not be the choice toxin for a first-time user, but may be better for someone who knows that they like the effects of a neurotoxin and feel comfortable with their injector.
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