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Tatyana Khan, MD

“Neuromodulators,” a general term for injectable medicines like Botox that are used to relax wrinkles, are one of the most in-demand non-invasive facial rejuvenation techniques available to patients today. These substances were created as synthetic versions of a naturally occurring protein. However, scientists have been studying it since the 1800’s because it has the unique characteristic of causing relaxation of treated muscle tissue. With time and research, this substance was isolated and replicated using synthetic methods which allowed us to deliver precise and accurate doses to ensure safe and effective treatment of conditions such as muscle spasms, migraines, salivary gland dysfunction, and of course, over-active muscles of the face responsible for gradual formation of creases in our skin. 

The use of this medication class in facial rejuvenation originated with the FDA approval of Botox in late 2002, and it remains the most popular neuromodulator used as a preventative treatment for the face. Today, Botox accounts for approximately 70% of all doses of neuromodulating agents delivered. 

Dysport was introduced in 2009, and Xeomin followed in 2010. Both were approved for cosmetic and medical treatments. In 2019, Jeuveau/NewTox was approved for cosmetic use only. With millions of doses delivered every year, neuromodulators have a proven safe track record. Up until now, there have been relatively few major differences in the effect of these four neuromodulators.

Recently, the FDA approved a new neuromodulator called Daxxify (daxibotulinumtoxinA-lanm), which acts in a way similar to both Botox and Dysport. However, in clinical trials, its effects on the treated areas were observed to last on average for six months, about 33% longer than medications already on the market. This means fewer visits and time out of your day required to maintain your result. 

Here are answers to common questions we’re getting about Daxxify:

Can I switch the type of neuromodulator I use if I have been using the same one for years?

Because all existing neuromodulators relax the muscle using the same mechanism, if you switch, you can expect the alternate neuromodulator, be it Daxxify, Xeomin, Dysport, or Botox to give you a similarly effective result. It may require a period of dose adjustment of your new treatment to achieve your treatment goals. That is why we always encourage our patients to follow up with us two weeks after their treatment, so we can take care of any touch-ups and dose adjustments as necessary.

I still have some effects from my last injection of a different neuromodulator. When can I come in to try Daxxify?

We recommend that you allow all of the effects of your previous neuromodulator treatment to wear off to allow your provider to determine the correct dose to address your concerns.

I have never used a neuromodulator before. Is there any reason I should not ask for Daxxify when I am ready to try it?

Neuromodulators provide a safe and predictable result in the hands of experienced injectors. Still, patients have different preferences about the look they want to achieve which may take a couple of rounds of treatment. For patients with no experience with neuromodulators, we recommend starting with one of the shorter-acting options available, in particular, Botox and Dysport have a proven track record.

Are there any downsides to Daxxify lasting 6 months?

In most cases, treatment with a neuromodulator gives reliable desired effects. Yet, even in the hands of very experienced injectors, small imperfections or asymmetries in muscle relaxation may occur. As with all neuromodulators, this effect is temporary, but with Daxxify, can be expected to last six months – twice as long as the effect of other agents. Our injectors are very thoughtful and reserved when initiating treatment to avoid these effects no matter which neuromodulator is used. At your follow-up visit at 2 weeks, when the full effect of the treatment is apparent, we can further refine any areas that may be particularly challenging.

Is Daxxify safe?

Yes. In order for each of the neuromodulators to have been approved by the FDA, their manufacturers had to show that they will not cause significant permanent harm when administered by a trained medical professional such as a physician, physician assistant, or nurse practitioner. It is important to remember that like all medical interventions (and life choices in general!), all neuromodulators have a small chance of causing unwanted effects. During your consultation, one of our providers will discuss these and answer any questions you may have.

Can I have an allergic reaction to Daxxify or one of the other neuromodulators?

Allergic reactions to neuromodulators are extremely rare with a handful reported since the earliest agent was approved for treatment in 2002. Daxxify has an additional protective characteristic in that it is formulated without animal-based components or human serum albumin. While these are generally safe and well-studied proteins used to protect the active ingredient in some neuromodulators from degradation in storage, rarely they can cause your body to form neutralizing antibodies (making the agent ineffective at all subsequent attempts at treatment) or potentially cause a local allergic reaction. Talk to your injector if you have a history of severe allergies or have additional questions.

Here’s a summary of neuromodulators currently available. Ask your injector about the best option for you! Schedule your consultation to learn more. 

Daxxify (daxibotulinumtoxinA-lanm)

  • FDA approved in 2022
  • Formulated using Peptide Exchange Technology and is free of both animal-based components and human serum albumin
  • Results 1-2 days following treatment 
  • On average, effects last 6 months, and some effects last 9 months

Botox (onabotulinumtoxinA)

  • FDA-approved for cosmetic and medical use in 2002
  • Effects start approximately 72 hours after treatment
  • Results last 3-4 months
  • First neuromodulator to market and still the most popular treatment for cosmetic use to smooth away lines and wrinkles for facial rejuvenation

Dysport (abobotulinumtoxinA) 

  • FDA-approved for cosmetic and medical use in 2009
  • Results noticeable within 1-2 days
  • Effects last 4-5 months
  • Rare instances of neutralizing antibody formation due to the protective proteins used in the formulation. Once this happens, the muscle no longer relaxes in response to treatment and the patient usually elects to switch to another neuromodulator

NewTox/Jeuveau (prabotulinumtoxinA-xvfs)

  • FDA-approved for cosmetic use only in 2019
  • Some patients report slightly quicker onset at 2 days and results typically last about 4 months
  • Like Botox and Dysport, this neuromodulator is formulated with protective proteins, so it can theoretically cause neutralizing antibodies, but no cases of this have been reported since it was approved in 2019

Xeomin (incobotulinumtoxinA)

  • FDA approved for cosmetic and medical use in 2011
  • Usually effects are apparent at 4-5 days
  • Results last an average of 3 and up to 4 months
  • This formulation contains only the active ingredient and is not known to cause the formation of neutralizing antibodies making it a good option for patients who stopped getting benefits from alternatives Dysport or NewTox

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