When I say I’ve been getting Botox my entire adult life, I’m not exaggerating one bit—I started at the ripe, young age of 19 to help prevent wrinkles from forming, and I’ve honestly never looked back. Over the last decade, I’ve gone from a few micro-injections between my brows once or twice a year to standing appointments every three months to treat my entire forehead and eye area. As a result, I’ve become somewhat of an expert on exactly how to maintain a smooth, wrinkle-free complexion without looking frozen or unnatural, and I’ve tried every single type of neurotoxin on the market (a definite perk of the beauty editor job) in order to do so.
Long gone are the days of brand-name Botox being the only injectable available to those looking to stave off fine lines and wrinkles. Sure, Botox is the OG and synonymous with neurotoxins as a whole (it’s like the Q-Tip of the cotton swab category or the Kleenex of tissues). In recent years, several other big players have joined the neurotoxin space, and while it’s great to have options, it can be hard to determine which is the best for you—especially when each brand makes big, bold claims about the superiority of their product. Luckily, I’m here to break through the noise, sharing my experiences with Botox, Xeomin, Jeuveau, Dysport, and Daxxify, and tapping expert injectors to detail the pros and cons of each one.
What are neurotoxins?
Neurotoxins, also known as neuromodulators, are injectable, purified types of botulinum toxin type A. When in injected in a specific way, they can soften the appearance of fine lines and wrinkles. “They work at the neuromuscular junction to relax muscle movement and, as a result, reduce the appearance of expression lines,” explains Marisa Garshick, MD, a board-certified dermatologist. “Neurotoxins are injected directly into the targeted muscle, often requiring a few different injection sites per area treated,” she says. Sometimes, often depending on how much is injected, they will fully paralyze muscle movement in the area treated, and other times, they will simply soften it. Neurotoxins do wear off over time (usually between three and six months), though, so muscle function will return as they dissipate.
There are currently six FDA-approved neurotoxins, and there were only three in 2018, so the market is really growing, says board-certified dermatologist Shari Marchbein, MD. Right now we have Botox, Dysport, Xeomin, Jeuveau, and Daxxify (a sixth, Letybo, was approved last fall and will likely be available for patients this year). And while they are all botulinum toxin type A, there are a few minor differences between them. “DAXXIFY is surrounded by a peptide, for example, and Xeomin doesn’t have a protein, but they are really all about the same and some work better in certain patients than others. For the most part, botulinum toxin type A is botulinum toxin type A,” explains Dr. Marchbein.
What are the types of neurotoxins?
Botox
First approved by the FDA in 1989 for the treatment of two rare eye disorders, it was soon discovered that Botox could temporarily paralyze the muscles that cause frown lines between the eyebrows, and in 2002, the drug received FDA approval for this cosmetic use. Botox also has the most FDA-approved indications (areas it can be used and conditions it can treat) and the longest-standing safety profile. “I would consider it one of the most well-known botulinum toxins,” says Tiffany Libby, MD, a board-certified dermatologist. “Patients often come in asking for it by name, some even unaware that there are other botulinum toxin injectables available.”
Botox can be used to smooth fine lines and wrinkles in and around the forehead, crow’s feet, eyebrows, nose, chin, jawline, neck, lips, and more. Most people start to notice the effects of Botox within a few days, with full results visible around two weeks after treatment. The neurotoxin typically lasts three to six months, though some lucky patients only see the injectable wear off around six months.
This is the toxin I’ve personally used the most, thanks in part to its wide availability, and I’ve found it to be reliable and consistent, even when injected by different doctors. My body happens to metabolize all injectables pretty quickly (I’m very active, which some studies have shown can lead to toxin wearing off faster), but Botox always lasts exactly three months in my forehead and glabellar areas and four-ish months in my crow’s feet.
Xeomin
Xeomin is another popular neurotoxin option. Approved by the FDA in 2010, it’s similarly used to temporarily smooth frown lines between eyebrows, around crow’s feet, and on the forehead, but it does have a few minor differences from Botox. “Xeomin is considered a ‘naked’ form of botulinum toxin A, and is free from any accessory proteins,” Dr. Libby explains. “This purity may help reduce the likelihood of the body developing resistance to the treatment. Xeomin also does not need to be refrigerated prior to use due to its lack of any additive proteins, which simplifies storage and handling requirements for providers.”
Xeomin is also known to take effect slightly faster than Botox and other neurotoxins, with results usually visible three to five days after injection. It’s also purported to last longer, up to six months for most patients. I’ve tried Xeomin a few times myself, and while I don’t necessarily remember it lasting much longer than Botox, it definitely took effect much more quickly.
Jeuveau
Jeuveau is one of the newest neurotoxins to hit the market, gaining FDA approval in 2019. The “new kid on the block” or “Newtox” is very similar to Botox in its structure and works in more or less the same way but is essentially a newer iteration of the same active ingredient, botulinum toxin type A. And while it may very well just be a result of targeted marketing and a slightly more affordable price, many do think Jeuveau is the best option for younger patients and those who are new to neurotoxins.
Jeuveau also kicks in a little faster than some other toxins, with full results usually visible three to four days after treatment—which I can personally attest to. Some patients opt for Jeuveau over Botox and other neurotoxins because it often comes at a slightly lower cost, which allows them to get the same smoothing results for less.
Dysport
Dysport was the first of Botox’s competitors in the U.S., receiving FDA approval in 2009. The injectable has a very similar structure to the OG neurotoxin but performs a little differently. “Dysport is thought to have greater diffusion area, which refers to how much it spreads from the injection location compared to the other types,” Dr. Garshick says. “This can be desirable in some locations and risky in others.”
Dysport takes only a few days to take effect, but results typically only last three to four months. In my experience, it does kick in faster and has a more natural look in large areas, like the forehead, but like Botox, it wore off for me right around the three-month mark.
Daxxify
Daxxify is the newest player in the neurotoxin space, with its FDA approval arriving in late 2022. The major difference with this injectable lies in its formulation. “The others use human serum albumin (HSA), which is of course human derived,” says Jody Comstock, MD, a board-certified dermatologist. “Daxxify is differentiated because it uses peptides in place of the HSA.” Many injectors believe this is the difference that allows Daxxify to deliver softer, gentler, and more natural-looking results, a characteristic that has been confirmed in clinical trials. “With Daxxify, we noticed incredible skin, tone, and texture improvement and decreased size of pores—my colleague calls it the ‘beautiful toxin,’” Dr. Comstock adds.
What really sets Daxxify apart from other neurotoxins, however, is how long it lasts. Results usually start to take effect within three days and develop fully by the two-week mark, but they can last six to nine months, the longest duration of any toxin on the market. In my experience, Daxxify actually kicks in the fastest of any injectable I’ve tried and does have a much smoother look than the others, but I can’t say it lasted quite so long for me. Both times I’ve tried Daxxify, I noticed it starting to wear off right around four-and-a-half months.
Are 20 units of Xeomin the same as 20 units of Botox?
Dosing is not the same across all neurotoxins—which can be quite annoying for patients, especially those who don’t see the same injector every time. “Each product is measured in its own specific unit system, where the potency of a unit is determined by how the manufacturer calibrates it using biological assays,” Dr. Libby explains. “For example, while 1 unit of Botox is approximately equivalent to 1 unit of Xeomin, Dysport has a different unit potency, so roughly, 2.5 to 3 units of Dysport are considered equivalent to 1 unit of Botox.” The good news is that your injector will be able to do a little math and convert the dosing from one neurotoxin to another, and they can adjust it based on your desired effect.
What type of Botox is longest lasting?
Technically speaking, Daxxify has been shown in clinical trials to last the longest. “It has an average duration of six months, and some patients note benefits up to nine months, compared to the other brands, which are thought to last three to four months on average,” says Dr. Garshick. Ultimately, though, the duration of any neurotoxin will depend on your individual biology and how quickly your body metabolizes it.
What type of Botox is the most natural looking?
In truth, your results will depend more on your injector and their technique than on the product used. “I don’t think there is a more natural-looking toxin; I think it is dependent on the injector,” Dr. Marchbein says. “It is about the artist, not the paint.”
That said, some (including this writer) have reported that Daxxify has a noticeably smoother effect, perhaps thanks to its use of peptides. “We are all asymmetrical, but when you inject Daxxify, we notice more of a neutralization of muscle movement,” notes Dr. Comstock. “Even when you just inject the glabellar lines, we find that the eyebrows are more symmetric, and other muscles soften.”
What type of Botox is most popular?
It may not come as a surprise since its name is used as a blanket term for all neurotoxins, but Botox is indeed the most popular option. “Botox is generally the most popular based on name recognition, though most dermatologists feel comfortable using all of the different brands,” explains Dr. Garshick. “Some dermatologists may have a preference for one over another, but that’s not necessarily based on what’s the most popular.” She also notes that patients are increasingly aware of other brands and products, sometimes even coming in with a specific request for a certain brand after hearing about it from a friend or a marketing campaign.
Can you mix and match types of Botox?
While brands generally advise against mixing and matching different neurotoxins, it’s actually common practice for many injectors. “Someone who has previously used one type of Botox can definitely switch to another type of Botox, and in some cases, different types of Botox may be used in a single treatment depending on the areas being targeted,” Dr. Garshick says. “For example, someone may opt for Dysport in the upper part of the face since it has a greater area of diffusion and Botox or Xeomin for the lower part of the face for a more targeted treatment.”
Some doctors have also found that rotating neurotoxins can help make them last longer. “Since the pandemic, I’ve had at least a handful of patients who have become botulinum toxin type A-resistant,” says Dr. Marchbein. “I have started rotating toxins every 6 months or so, as I think it might decrease the potential for resistance.”
The final word:
When determining which neurotoxin is best for you, especially if you’re new to injectables, there are several things to consider. While duration and price are obvious factors for many patients, it’s also very important to think about both the area you want treated and your desired results. While every neurotoxin can help smooth fine lines and wrinkles around the face and neck, either on- or off-label, some are better for certain areas than others. You should also consider your own tendencies, including which muscles you tend to furrow the most, as you may need a stronger injection there to get lasting results. The most crucial factor, however, is your injector. It’s paramount that you visit a doctor who is not only trained in the injectable being used but also who will listen to you because, ultimately, it’s your face and you should get the results you want. If you’re in the right injector’s hands, you really can’t go wrong with any of these neurotoxins.
Meet the experts:
Marisa Garshick, MD, is a board-certified dermatologist serving patients throughout Manhattan, New York and Clifton, NJ at MDCS Dermatology. Dr. Garshick provides a wide variety of cosmetic and medical procedures and services including treatments for acne, eczema, hyperhidrosis, moles, psoriasis, rosacea, signs of aging, skin cancer, skin tags, vitiligo, and wrinkles. Shari Marchbein, MD, is a board-certified dermatologist in New York, NY. Dr. Marchbein’s academic and clinical interests include the treatment of acne, in particular adult female acne, acne scarring, and rosacea. She also specializes in various aesthetic procedures and laser surgery. Tiffany Libby, MD, is a board-certified dermatologist at Brown Dermatology in Providence, Rhode Island. Dr. Libby is the is the Director of Mohs Micrographic and Dermatologic Surgery and an Assistant Professor of Dermatology at the Brown University Warren Alpert School of Medicine. Jody Comstock, MD, is a board-certified dermatologist in Tucson, Arizona. Known nationally and internationally as a pioneer in the field of cosmetic dermatology, Dr. Comstock is contacted often for her thoughts about the latest advances in techniques and products.
Why trust Cosmopolitan?
Gabby Shacknai is a New York City–based journalist with years of experience researching, writing, and editing beauty and wellness stories. Gabby is an authority in all beauty categories but an expert when it comes to skincare and cosmetic treatments. She regularly works with the industry’s top dermatologists and plastic surgeons to assess new brands, treatments, trends, and technologies.
