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HD Connection: Comparing Neurotoxins

There are four neuromodulators or neurotoxins that are FDA approved for treating dynamic lines, or lines that appear when you activate the muscles in your face. These are Botox, Jeuveau, Dysport, and Xeomin. Although the mechanism in each is the same, there are slight key differences to know before getting treated.

Botox (onabotulinumtoxinA) is the original neurotoxin. Most people just refer to all neurotoxins as “Botox.” Allergan, the same company that makes Jeuvederm and now owns CoolSculpting, makes Botox. Because of the name brand and popularity, it tends to be more

expensive than the other brands. Due to higher levels of preservatives & complexing proteins, over time people can create antibodies to these additives and ends up degrading the toxin faster than previous treatments. It takes effect in about 10-14 day. In general, I find my patient population 40 years old and up seem to like Botox brand as it makes you slightly less mobile.

Jeuveau (prabotulinumtoxinA) is a newer brand that is nearly identical to Botox but is approved only for cosmetic use. It seems to show similar results at a lower cost point. Jeuveau is made by Evolus. It also takes effect in about 10-14 days.

Dysport (abobotulinumtoxinA) is Galderma’s neurotoxin brand. Galderma also manufactures Restylane products. Dysport is a smaller toxin than the other brands, so the dosing is slightly different. For every 1 unit of Botox/Xeomin/Jeuveau you need ~2.5 units of Dysport. The units are priced differently due to needing more units per treatment. Because of the small molecule size, the rate of diffusion in increased and it is ideal for treating larger areas. Dysport tends to kick in a bit faster than Botox, with results noticeable around 5-7 days but full effect is always gauged at 14 days. I find that my younger patient population prefers Dysport as patients find they are slightly more expressive while still not having dynamic lines.

Xeomin (incobotulinumtoxin

A) is manufactured by Merz. Xeomin was designed to avoid tolerance to treatment due to antibody formation. Xeomin does not contain preservatives or complex proteins. This is the only neurotoxin that does not require refrigeration prior to reconstitution. Like Dysport, it starts to take effect in 5-7 days but full efficacy should be assessed at 14 days.

Each of these brands is estimated to last 90 days, but it depends on how each individual metabolizes the neurotoxin. Some people may get 60 days while others may get 120 days. It may take some experimenting to see what brand is best for you. I have had patients who metabolize Xeomin and Botox very quickly and see limited effects, but when treated with Dysport have great results. I have also seen patients who claim prior treatments with Dysport have been ineffective and they prefer to stick with Botox. It is important to consider efficacy, duration, and cost prior to choosing a brand.

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