Understanding neuromodulators

Currently, 5 different FDA-approved neuromodulators are available: Botox, Dysport, Xeomin, Jeuveau, and Daxxify, each containing the same active ingredient. Neuromodulators are a type of injectable that contain a protein called botulinum toxin type A, which temporarily disrupts communication between nerve signals and treated muscles. Because repeated muscle contractions primarily cause expression lines and wrinkles, relaxing targeted muscles effectively softens or even eliminates the appearance of expression-based lines and wrinkles. Botox can even be used as a “pre-rejuvenation” treatment to prevent lines and wrinkles from forming in the first place!

Side effects and precautions

Since they share the same active ingredient, all 5 formulas have similar side effects. Potential side effects are usually mild, and may include:

• Pain at the injection site
• Redness and swelling
• Headache
• Blurry vision
• Temporary bruising
• Drooping eyelids (ptosis)

Rare but severe side effects can include difficulty swallowing, speaking, or breathing. Choosing an experienced injector with precise injection techniques will minimize the risk of adverse side effects.

What’s the most important deciding factor when considering neuromodulators?

The answer may surprise you: Your choice of injector matters the most! Here’s why:

• Safety:
  • Expert injectors adhere to strict sterilization protocols to ensure a safe treatment environment.
  • Expert injectors know the correct dosages and injection sites to achieve optimal results while minimizing the risk of side effects.
  • Expert injectors have the knowledge and expertise to manage and correct any issues in the unlikely event you experience complications or underwhelming results.
• Personalized treatment. Injectables are not one-size-fits-all treatments. An expert injector will carefully assess your unique facial structure and skin type to create a tailored treatment plan that addresses your specific concerns and aesthetic goals.
• Natural-looking results. Injectables may seem relatively simple and quick, but there is significant nuance in achieving natural-looking results. Skilled injectors have the experience and artistic eye to deliver subtle, natural-looking enhancements that complement your features without the tale-tell signs of looking overdone.
• Proper product selection. Product trends tend to ebb and flow with regularity; experienced injectors thoroughly understand each neuromodulator and will recommend the most appropriate product for your specific needs and desired outcomes.
• Continuity of care. Building a relationship with your injector allows them to get to know your needs and preferences so you enjoy improved results with each appointment.

Botox: The Original

Botox, the most well-known of the injectables, has been on the market since 2002 when it first gained FDA approval. Currently, Botox is FDA-approved to treat glabellar lines (frown lines between the eyebrows), forehead lines, and crow’s feet; however, Botox and its competitors have been used effectively “off-label” in other areas for years. Botox injections also treat migraines, muscle spasms, and excessive sweating.

Main ingredients in Botox:

• Botulinum toxin type A (active)
• Human albumin – plasma (inactive)
• Sodium chloride – salt (inactive)

Why is Botox the most popular choice for patients and injectors?

Botox has been studied extensively, and its consistent results and strong safety profile have rightfully gained the trust of knowledgeable injectors who want to achieve safe, natural-looking anti-aging results for their patients.

Patients typically prefer Botox because they are more familiar with the iconic brand and feel comfortable using a brand that has the most research supporting its safety and efficacy. Botox also has the advantage of being highly predictable, so you’ll know precisely when to schedule touch-up appointments to avoid diminished results.

Our Asheville med spa patients appreciate knowing their Botox results will be consistent and don’t have to worry about scheduling an emergency appointment right before a special event because their results from another brand didn’t last as long as they’d hoped.

Dysport: A Solid Contender

Dysport hit the market in 2009 and is FDA-approved to treat glabellar lines and certain medical conditions.

Main ingredients in Dysport:

• Botulinum toxin type A (active)
• Haemagglutinin complex – a group of proteins that help the product absorb (active)

What makes Dysport different from Botox?

There are a few other differences between Dysport and Botox:

• Smaller protein size. Dysport has smaller molecules than Botox.
• Dosage. Dysport comes in 300 or 500-unit vials, meaning the dosage is larger per injection site.

Some injectors find that Dysport spreads more quickly and that its effects may be visible in just 2-3 days for certain patients. Still, Dysport’s longevity is very similar to that of Botox (up to 4 months or longer).

Xeomin: A Noteworthy Option

Xeomin is one of the newer neuromodulators. It was approved by the FDA in 2011 to treat glabellar lines and has other medical uses, such as alleviating muscle spasms.

Main ingredients in Xeomin:

• IncobotulinumtoxinA – purified botulinum toxin type A (active)
• Human albumin – plasma (inactive)
• Sucrose – sugar (inactive)

What makes Xeomin different from Botox and Dysport?

Xeomin has some differences in formulation compared to its competitors:

• No accessory proteins. Xeomin does not contain any accessory proteins (also known as complexing proteins), making it a “naked” form of botulinum toxin.
• Storage and transportation. Xeomin can be stored at room temperature, making it easier to transport and store; Botox and Dysport require refrigeration.

The absence of accessory proteins may lower the risk of antibody development against the treatment (antibody development can decrease a product’s effectiveness over time) for some patients. Xeomin’s results are comparable to other brands and generally appear within 3-5 days and last up to 3-4 months.

Jeuveau: A Recent Newcomer

Jeuveau (a.k.a. “newtox”) is a fairly new competitor in the world of neurotoxin injectables. It was launched in 2019 and is FDA-approved to temporarily improve the appearance of moderate to severe glabellar lines (frown lines).

Main ingredients in Jeuveau:

• PrabotulinumtoxinA-xvfs – purified botulinum toxin type A (active)
• Human albumin – plasma (inactive)
• Sodium chloride – salt (inactive)

What makes Jeuveau different from Botox, Dysport, and Xeomin?

Jeuveau has a unique quality that differentiates it from Botox, Dysport, and Xeomin:

• Manufacturing process. Jeuveau is produced using a manufacturing process that uses “Hi-Pure technology” to produce a highly purified form of botulinum toxin type A.

The effects of Jeuveau usually become apparent within 2-3 days post-injection and typically last for 3-4 months.

Daxxify: Uncharted Territory

Daxxify is the latest addition to the neurotoxin injectable family, as it became available in late 2022. It has received FDA approval for temporarily reducing the appearance of moderate to severe glabellar lines.

Main ingredients in Daxxify:

• Botulinum toxin type A (active)
• Peptide excipient (inactive)
• Sodium succinate – salt (inactive)

What makes Daxxify different from the rest?

While Daxxify contains similar ingredients to other injectable neurotoxins, there are a few distinguishing characteristics:

• Longevity. Clinical trials showed that Daxxify’s effects may last longer (around 6 months) for some patients.
• Cost. While the cost of the other four neuromodulators is roughly the same, Daxxify is more expensive as it’s units are 1/2 the size as the others.
• Formula. Daxxify uses a peptide as a stabilizing agent, which means it doesn’t use human or animal byproducts.

As the newest option on the market, Daxxify’s efficacy will continue to be studied, and real-world usage will likely reveal more about its duration for the majority of patients. While its unique characteristics are promising, remember that there’s no guarantee you’ll experience longer-lasting effects at the higher price point.