Let’s talk TOX! Botox, Dysport, Xeomin, and Jeuveau are all derived from Botulinum Toxin. This is a protein that prevents the release of a neurotransmitter that is responsible for muscle contraction. When this neurotransmitter is released, the muscles do not contract and therefore relax resulting in improvement of fine lines and wrinkles. So now that we know how all of these neuromodulators work, what is the difference?! Each of these has a slightly different formulation that effects the onset, duration, effect, and spread.
BOTOX (onabotulinumtoxinA) has a greater molecular size. Some studies show that greater molecular size results in less diffusion. Botox binds to a greater amount of accessory proteins than any of the other neuromodulators. Longevity of Botox is 3-4 months and the onset is 7-10 days.
Dysport (abobotulinumtoxinA) has a smaller molecular size. Typically, three units of Dysport is equal to one unit of Botox. Smaller molecular size results in an increase spread making Dysport a preferred choice for certain areas like crow’s feet. Dysport has a faster onset than the other neuromodulators with an onset of 2-5 days. The longevity of Dysport is 4-6 months.
Xeomin (incobotulinumtoxinA) has no accessory proteins making it the “pure” neurotoxin on the market. This may mean that there is less risk of developing antibodies or tolerance against Xeomin than other available neurotoxins. The effects of Xeomin occur within 3-7 days and results last 3-4 months making it very comparable to Botox.
Jeuveau (prabotulinumtoxinA-xvfs)- This is the NEW toxin on the market. Jeuveau is very comparable to Botox in its molecular size, onset, duration and amount of accessory proteins. We will see how the new kid on the block does on the market. I personally am excited to try this TOX and see how my patients like it!
The neuromodulator used needs to be determined by both you and your injector based on your individual goals and needs. I decide which type of neur0modulator I will used with my patients and price them all the same so there is no incentive for one versus the other besides personal preference and results.