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Pick Your Poison: Everything You Need to Know About Getting Botox vs. Its Alternatives

Buzzy new neuromodulators like Daxxify are gaining popularity — but how do they compare to the formulas that have been on the market for years?

For beauty nerds, the announcement of a new neuromodulator is always cause for excitement. Such was the case in September 2022, when the FDA finally approved Revance’s Daxxify, a botulinum toxin (daxibotulinumtoxinA-lanm) specifically for use on the glabellar lines, aka the “11s” that can appear between the eyebrows. While it’s easily the buzziest new kid on the block in terms of injectables — and is currently one of the more exclusive options, with only a handful of providers gaining access in its initial post-launch months — Daxxify is joining a roster of four other popular neuromodulators currently available in the United States, including Botox, Dysport, Xeomin and Jeuveau.

Although the five brands vary in terms of specific formulation and biologic activity, the differences from a consumer standpoint are relatively minute. If you’re looking to “freeze” your muscles, minimize fine lines and generally address some signs of aging, each of the neurotoxins can achieve a relatively comparable result. So distinguishing between them and choosing the right one for your face can be a bit daunting and tricky. And does it even matter?

Actually, yes, but there’s a whole lot more nuance to it than simply picking your poison. “The results [of different neuromodulators] are dependent on the product, but also on the person injecting the product,” says Dr. David Shafer, a double board-certified plastic surgeon and founder of Shafer Clinic in New York City. “One example I like to tell patients is [that] you can give the same ingredients to an amateur chef and to a Michelin star chef and have completely different results. Same goes for neurotoxins.”

He explains that there are many crucial factors to consider before a needle ever punctures the skin, like properly reconstituting the neurotoxin (each formula is diluted prior to injecting a patient) and determining the correct dosage. But even if you’ve found a skilled, board-certified provider that you trust, there are several factors to think about before deciding whether or not Daxxify, or one of the other four options, is best for you.

Photo: Imaxtree

How do the formulations differ?

First things first: formulation. While it may seem negligible to the casual aesthetics patient, it’s helpful to remember that you are injecting neurotoxin into your body — what’s inside those little vials matters. Botox, Xeomin, Jeuveau and Dysport all utilize forms of botulinum toxin type A; Xeomin specifically is marketed as a “purified” form of the toxin. For the most part, choosing among these brands boils down to personal (and practitioner) preference. 

Daxxify utilizes this same botulinum toxin, but coats it in a peptide that sticks to the neurons your injector is targeting in the skin. “[This means] you get less washed away when you inject it,” says Dr. Melissa Doft, a double board-certified plastic surgeon and Clinical Assistant Professor of Surgery at Weill Cornell Medical College. “[Daxxify] gets incorporated faster into the target receptors, so we’re seeing an earlier onset [in some patients].”

Dr. Doft notes that some of her Daxxify patients have seen reduced muscle movement after two to three days, which could sound appealing to the impatient ones in the crowd who would rather not wait for their injections to kick in. Xeomin, Dysport and Jeuveau also claim to start working within this three-day time frame, while Botox typically resides in the four-to-five-day window. However, Dr. Corey L. Hartman, a board-certified dermatologist and founder of Skin Wellness Dermatology in Birmingham, Alabama, reveals that many of his patients who decided to try Daxxify still didn’t notice the effects until about four days in. Essentially, like many cosmetic treatments, the results of your preferred neurotoxin can vary widely from person to person.

You may also choose to consider the areas of the face that a neurotoxin is officially FDA-approved to treat: Daxxify, Xeomin, Jeuveau and Dysport are currently only meant for the glabellar lines, while Botox is approved for this area as well as crow’s feet and vertical forehead lines (in addition to other non-cosmetic uses). Still, that doesn’t mean that your provider will refuse to inject the other four brands into other sections of your forehead, and even your masseter muscles, around the chin, or other areas of irregular muscle activity. Dr. Doft explains that this is what’s known as “off-label” use, and that it’s generally considered safe among cosmetic professionals.

How long do the results last?

Once your neurotoxin of choice starts working, the next obvious concern is how long it will last before your muscles start moving again. Three-to-four months is the average length of time most patients will experience muscle immobility from Botox, Dysport, Jeuveau and Xeomin — but this is where Daxxify sets itself apart. The brand’s clinical studies showed that 50% of patients had no or minor frown lines six months after treatment. Between 5% and 17% still had noticeable improvement nine months later — a significantly longer stretch than the other neuromodulators. 

However, because Daxxify has only been available to injectors since January 2023, providers haven’t been able to determine for themselves whether or not their patients experience longer-lasting results. Longevity also varies between patients, with some people seeing results wear off faster than others, even if they’re treated with the same neurotoxin.

But that doesn’t mean switching to another brand is automatically the answer to neuromodulator longevity. “If someone wants a stronger or longer-lasting result, I would first look at the dosing used,” says Dr. Shafer. “Many patients are under-dosed and do not receive the FDA-approved dose for their area.” He adds that if someone has maxed out their injectable dose and they’re still looking for better results, he’ll often discuss whether their expectations are realistic — or even achievable. Remember: Cosmetic treatments can address only so much, even if you want smoothness that could rival a TikTok filter.

How does the cost compare?

While we wait to see whether Daxxify can stack up to its claims of longer-lasting benefits, it’s important to note the differences in price. After speaking with providers in different areas of the country, all revealed that they are pricing Daxxify significantly higher than other neurotoxins — by about 50%, according to Dr. Doft. And that doesn’t mean you’re getting any more product. 

Dr. Hartman explains that the way Daxxify is dosed differs from its competitors, with 40 units of Daxxify equal to roughly 20 units of Botox. “The actual kiloton of the product that’s active is the same,” says Dr. Hartman. The cost of each vial, however, is much more expensive for providers to purchase, a cost that is then passed onto their patients. So why the drastic difference in price in the first place?

The experts agree that the most obvious benefit of Daxxify — how long it lasts — is also what makes it more expensive. If you’re able to achieve your desired effect with injections every six months as opposed to every three or four, you’re not swiping your credit card as often. Daxxify’s parent company Revance knows this, which might explain the price hike. Unfortunately for prospective patients, those savings aren’t as significant as you might wish for if that twice-a-year bill is equal to your three-times-a-year bill.

Still, if time is of the essence and frequent trips to your provider are a hassle, or you haven’t seen the results you’d hoped for after trying other neuromodulators, it might be worthwhile to talk with your injector and give Daxxify a try. But if you’re happy with your current injectable routine, don’t be too easily swayed to mess with a good thing just because something new hits the market. 

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