What are the Differences Between Neuromodulators AKA “Botox”?

They are all created from the purified Clostridium botulinum bacterium and each brand has its own unique formulation process. Each version has its own molecular weight and applications; however, they each deliver a similar effect when used in appropriate doses for relaxing wrinkles due to the effects of aging. They inhibit acetylcholine release from the presynaptic terminal in skeletal muscles which results in relaxation of the muscle fibers in the treated area, which ultimately means it stops the muscles from wrinkling the skin.

Botox (OnabotulinumtoxinA) is the oldest and most studied neuromodulator on the market. It was FDA approved in 1989, and it was reformulated by Allergan in 1997 to decrease the immunogenic protein content, so that we can use it for years before our body develops an immunity to its effects. It is purified by repeated precipitation and re-dissolution.  Botox set the bar for what we all expect from neuromodulators.

Dysport (AbobotulinumtoxinA) was FDA approved in 2009. It is made by Galderma and is purified by a column separation method, has greater spread effect and is dosed as 3:1 with other botox brands. Dysport is also dosed differently: 3 units of Dysport gives you a dose of 0.73 ng whereas, 1 unit of Botox gives you 0.73 ng of drug (3:1 ratio).

Xeomin (IncobotulinumtoxinA) is produced in Germany. It was approved by the FDA in 2010. Xeomin is unique in that Merz formulated it by stripping out much of the complexing proteins. It has been suggested that this formulation produces less sensitivity (immunity) over time thereby having more efficacy – though this has yet to be determined. 

Jeuveau (prabotulinumtoxinA-xvfs) became FDA approved in 2019. It is formulated by Evolus in South Korea. It is exclusively approved for use in aesthetics and is comparable to Botox in dosing and efficacy. 

Daxxify (DaxibotulinumtoxinA) is the newest neuromodulator with FDA approval in 2022. It is made in California by Revance. It is formulated using peptides that bind the agent to the target site creating a longer lasting bond in the presynaptic terminal and therefore longer duration of effect – about 6 months, whereas other neurotoxins last 3-4 months. The peptides also exert a faster onset – about 2 days as compared to other brands, which is between 7-14 days. Dosing is slightly different with Daxxify, because it’s formulated differently. If your dose in botox is 20 units for frown lines, your Daxxify dose is 40 units for the same area. 

Your Aesthetic Injector has been trained and understands these differences and the reasons why you will benefit from a specific formulation of neuromodulator. Dosing is so important to get efficacious results. Each of these products feel different while active – some feel heavier, some feel lighter, and some just work better for certain people. Ask your Injector questions, be informed, but remember they are the experts in the safe administration of these medications and they want you to get the best results every time.