Your Complete Guide to Neurotoxins (and How To Pick the Right One for You)

In the last few years, an interesting thing has happened in the world of cosmetic injectables. A practice once cloaked in stigma has become a widely accepted form of skincare—with many people integrating injections into their grooming routines with the same normalcy as waxing or getting facials. In 2022, research found the global facial injectables market was valued at $7.81 billion—and is expected to double within five years.

Though Botox is the most well-known neurotoxin, it isn't the only one. In recent years, alternatives like Dysport, Xeomin, Jeuveau, and Daxxify have hit the scene, offering similar wrinkle-reducing results with subtle differences. Whether you choose to try one of these treatments is entirely up to you, but given the breadth of options on the market, it's important to know what you're working with before you go under the needle. Keep reading for what you need to know. 

What is a neurotoxin, and how do they work?

Neurotoxins are injectable solutions that temporarily block the transmission of nerve signals to the muscles in a treated area. Wrinkles occur due to the muscle contractions that come with regular facial movements—neurotoxins essentially work by giving those muscles a little nap. "By blocking these nerve impulses, muscles of the face and neck relax, and wrinkles formed by muscle movements like frowning, squinting, raising eyebrows, pursing lips, and clenching jaws are smoothened," says Corbett. 

Botox

Botox was the first neurotoxin to hit the scene and is still the most well-known and commonly used—so much so that the brand name "Botox" is often used as an umbrella term for neurotoxins the same way "Kleenex" is used as a synonym for facial tissues. In 2002, the Food and Drug Administration (FDA) approved Botox for the treatment of frown lines. "Botox is made from the same neurotoxin as Dysport and Xeomin to achieve the same desired cosmetic outcome of treating wrinkles by targeting muscle movement," says Dr. Parsa. "It helps smooth out fine lines and wrinkles where it is injected. It temporarily causes muscle relaxation by blocking chemical signals from nerves that cause muscle contraction." 

Who is Botox best for?

According to the American Society of Plastic Surgeons, 'preventative Botox' injections have risen in popularity by 28 percent since 2010 amongst 20 to 29-year-olds, and is something Dr. Parsa recommends too. "Botox is suitable for all skin types and can be a preventative treatment in mid to late 20-30s and a corrective treatment when older," he says. Where possible, try not to start too late, with better results seen for candidates without significant skin laxity or volume loss.

"Botox can be injected on the forehead, around the eyes, in between brows, around the mouth, and neck," says the surgeon. "Additionally, it can be used to treat excessive sweating on the armpits, TMJ around the lower cheeks, and migraines." However, keep in mind that any locations outside of the forehead, frown line, and crow's feet are considered off-label treatment areas. For all areas—on-and-off label—you should do your research and make sure you're seeing an experienced, careful practitioner for best results. 

How long does it take to see results from Botox?

"Botox can take a few days to start kicking in, with noticeable results in 5-20 days," says Dr. Parsa. While downtime is minimal, you may experience some bruising at the injection location. If bruising doesn't improve or subside over a few days, you should talk to your provider. If you're wondering how long your Botox results will last, Dr. Parsa says you can expect up to four months, or a bit longer if it's your first time. "Regular treatments can contribute to weakening muscles over time but varies for each person," he says. Heavy exercisers (like marathon runners) are also more likely to not get to the four month mark as they typically metabolize the neurotoxins faster.

What are the risks of Botox?

Botox is the OG of the neurotoxins and it’s the most studied and most consistently used. But like with any injectable, there are risks. Common side effects include; pain, swelling, or bruising to the injection site, muscle weakness, and dry eyes, which typically go away within 48 hours. Dr. Parsa adds that other side effects may include asymmetry, lowered brows, and headaches. “Make sure a qualified provider administers it to evaluate if you are a candidate for potential contraindications like neuromuscular disease, egg allergies, etc.,” he adds.

Drooping eye, AKA, ptosis is another common side effect that can occur not just with Botox but with the other nuerotoxins too. “Ptosis happens when 'tox inadvertently travels to the muscle that holds your eyelid up and leads to the appearance of a lazy eye,” says Dr. Allen, stressing the importance of working with an experienced practitioner when getting Botox, to avoid these risks.

Dysport

Dysport was approved in 2009 by the FDA to temporarily treat glabellar lines (11 lines) in adults under 65. According to Jones, Dysport may feel "lighter" and spread more than Botox. While this injectable works the same way as Botox, Jones prefers Dysport, especially for those looking to tackle smile lines around the eyes. "Dysport can be very elegant to the crows-feet, softening the movement without eradicating the lines," she says. "This is my favorite product for the crows-feet area."

What is Dysport best for?

Like Botox, Dysport can be injected in popular areas such as frown lines, crow's feet, and the upper lip for cosmetic use, says Corbett. Additionally, the FDA has approved the injectable for areas including the neck, lower, and upper limbs to help treat those suffering from cervical dystonia, upper limb spasticity, and lower limb spasticity.

How long does it take to see results from Dysport?

According to Jones, it can take up to 10-14 days for Dysport to fully kick in, but some patients may find it kicks in quicker than Botox. Dysport can last up to five months and, "dose equals duration," so more product can lead to longer results. However, like Botox, increased physical activity, recent illness, or weight loss can potentially alter how long your results last. 

Xeomin

Xeomin was approved in 2010 and is great for smoothing wrinkles while allowing movement. "You can still have expression and look like yourself without appearing frozen," Dr. Allen says. Xeomin is the most 'naked' of the tox products," says Dr. Allen. "While the other market injectables add accessory or complex proteins, which are extra things that the tox doesn't need to work, Xeomin lacks these," she says, meaning you only receive what you need. 

Who is Xeomin best for?

Like Botox, Xeomin is suitable for all skin types and is a great preventative treatment for fine lines and wrinkles in those aged in their mid to late for those mid to late 20-30s, and a great corrective treatment when older.

How long does it take to see results?

Like other injectables, Xeomin typically takes 14 days to settle in. "Also note that it can settle in asymmetrically—you may see it working on one side of your forehead before the other side starts working," adds Dr. Allen. So if your face feels a little lopsided the immediate days after treatment, don't be too alarmed. According to Dr. Allen your muscles will start waking up after two and a half months, with most patients returning for treatment every 90 days. 

What are the risks?

There are no exclusive risks to Xeomin, but Dr. Allen warns about drooping eye, similar to the other neurotoxins. Of course, there's also the risk of swelling, tenderness, and bruising at the injection site.

Jeuveau

The FDA approved Jeuveau in 2019, twenty years after approving Botox. But trouble quickly began to brew with similarities to the original neurotoxin injectable. Being bioidentical, the Botox company took Jeuveau to court for copyright infringements and won, walking away with $35 million plus royalties on all Jeuveau US sales. With that in mind, Jeuveau works similarly to Botox but is only FDA-approved for cosmetic use to ease frown lines between the eyebrows.

Who is Jeuveau best for?

Like Botox, Jeuveau is suitable for all skin types. It is a great preventative treatment for those in their mid-to-late 20s- 30. And, like the others, is also and a a great option for corrective treatment if you desire. 

How long does it take to see results from Jeuveau ?

According to Dr. Levine you may start noticing results around the 24-72 hour mark, but it can take a full two weeks before you get the full effect. "Like Botox, it lasts up to four months," says Dr. Levine. "However, increasing the number of units may increase the product's longevity." 

What are the risks of Jeuveau?

There are no exclusive risks with Jeuveau, but like the other injectables, bruising, swelling, ptosis, allergic reactions, and headaches may occur. 

Daxxify

Daxxify entered the market in 2022 and has been touted as a longer-lasting alternative to Botox. It's received quite a bit of attention, as some patients and studies have shown that results can last up to nine months (which is significantly more than the three to four months you’ll get with other injectable neurotoxins). Daxxify is the result of the protein and peptides working together to deliver a product to the muscle-nervous system connection. Together, they not only efficiently deliver the product but also assist in providing longer-lasting effects compared to their counterparts.

Who is Daxxify best for?

"Daxxify can be valuable for those who are not having any success with duration with their current Botox or Dysport treatments," says Corbett. "Patients who have only been getting results lasting up to two months with Botox and Dysport are now seeing a more normal outcome of three to four months with Daxxify." Currently, Daxxify is FDA-approved for treating frown lines, but there are off-label uses for crow's feet, trapezius, and even underarms which, again, you should only see an experienced practitioner for. 

How long does it take to see results from Daxxify?

According to Dr. Levine, Daxxify works pretty quickly, with some patients noticing the difference within 24 hours. Once the injectable is settled in, you can expect results to last up to six months. While results have shown to be longer, keep in mind the upfront cost is double that of the other neurotoxins, and if you don't like the results, you'll have to live with them for double the time.

What are the risks of Daxxify?

Since Daxxify is the newest neurotoxin on the market, more research has to be done on it. Before its approval, the FDA completed two clinical trials, and from those states, the most common side effects of Daxxify include "headaches, drooping eyelids, and weakness of facial muscles."

Final takeaway

The past two decades have seen a significant shift in the cosmetic injectables industry, going from a once-taboo practice to an integral part of many individuals’ beauty regimens. Even among my circles of friends, allocating funds for anti-aging treatments like Botox has become as routine as budgeting for our annual girl’s trip.

And while this surge in popularity has fostered a wealth of options and a greater understanding of how they work, it remains crucial that we use these procedures with caution and only by the hands of qualified professionals who can help us navigate potential risks and benefits, while ensuring a personalized approach. Because hey, at the end of the day, we’re mostly all striving for the same common goal; healthy and happy skin, and if you want to get there with some help the advancements in cosmetic science, you should have all the facts to make the best choices for you.