A Guide to Neurotoxins: What’s the Difference?

The average patient may not know that when it comes to neurotoxin injections, they have a few options. (Currently, there are four FDA-approved neurotoxins that top doctors employ for anti-aging, cosmetic and even health benefits.) Even the most beauty-conscious patients may not understand all the nuances of each injectable and what sets them apart from each other. While each of the four neurotoxins has slight differences, experts say they’re very similar and all effective.

“In general, most of the neurotoxins are essentially interchangeable, but there are subtle differences,” says Omaha, NE dermatologist Joel Schlessinger, MD. New York dermatologist Jody A. Levine, MD notes that the active ingredient in each is botulinum toxin type A—but their compositions vary slightly, with some containing protein blends, which causes potency and diffusion to differ.

Nanuet, NY dermatologist Heidi Waldorf, MD acknowledges, “We all have our preferences, but an experienced injector who understands the science can get the same results with any of the FDA approved neurotoxins.” New York dermatologist Erin Gilbert, MD says her approach to selecting which neurotoxin is right for each individual patient is to think through her experience. “What has my clinical experience been with this product? What is the unit to unit comparison after dilution? What does my patient want? A more aggressive treatment for more etched in lines or a more subtle effect? How quickly do they hope to see results?” Dr. Gilbert asks herself. “Then I proceed based on my own clinical experience to discuss with them what I think the right choice is and why, and I get to work.”

When getting an injection, it’s best to defer to your provider’s professional opinion on which neurotoxin you should get—but you should be knowledgeable about what is going in your body and where one neurotoxin diverges from the others.

Botox Cosmetic

Botox Cosmetic has the most FDA indications and has been around the longest. Dr. Schlessinger says he uses Botox Cosmetic in his practice daily “for concerns ranging from forehead wrinkles to jawline slimming. It is absolutely amazing to see the advances in treatments that have been discovered.” He notes that since it’s been around for so long, Botox Cosmetic has “the most research of any cosmetic product or procedure that we perform.”

Xeomin

There’s not much that’s “natural” about neurotoxins, but Xeomin is known as the purest of the bunch. “Many of my patients choose Xeomin because they like that it is double filtered and without unnecessary complexing proteins,” says Dr. Waldrof. She adds that Xeomin helps “minimize the risk of developing resistance.” Additionally, Dr. Gilbert notes that one thing that makes Xeomin stand out is that “it doesn’t need to be refrigerated to maintain integrity, which can be a plus for certain practices.”

Dr. Schlessinger says while doing trials, they found that older patients loved it “as it allows for a less heavy look.” He notes that Xeomin works in a similar manner as Jeuveau, and he specifically likes using it for “lids that are starting to feel or look heavy as it has a light touch.”

Dysport

What makes Dysport stand out from the others is its onset time and soft finish. Dr. Schlessinger began working with Dysport in 2003 when his facility was involved in the first clinical trials on forehead wrinkles, and he noticed a trend back then. “In one of the trials I was involved in, we found it took effect quicker than expected, with some patients seeing results as quickly as one to two days,” says Dr. Schlessinger.

“Dysport’s onset is the fastest, making it best for last-minute treatments,” says Dr. Levine. “It also diffuses more, so it’s good for large areas,” adds Dr. Levine. Dr. Schlessinger explains that it has a “larger field of effect, which means that it covers areas like the upper forehead very nicely, so if someone comes in and says they tried another neurotoxin and it didn’t get the complete forehead relaxed, I would normally suggest Dysport.”

Dr. Waldorf likes using Dysport on patients “with high foreheads and long necks to produce a softly spread effect.” Additionally, Dr. Schlessinger feels Dysport is a great option for younger patients “as it provides a more complete relaxation of wrinkles.” 

Jeuveau

“Jeuveau is the newest prescription neurotoxin available, and we sometimes refer to it as NewTox,” says Dr. Schlessinger. He notes that many of his patients that want to try something that affords some movement gravitate towards Jeuveau.

“It has a fresh and ‘undone’ look and is great for all ages. In particular, those who may have had a ‘heavy’ feeling with other neurotoxins seem to do well with Jeuveau in my practice,” says Dr. Schlessinger. He adds that it’s great for tackling neck and chest lines. In Dr. Gilbert’s experience, patients that receive Jeuveau often see onset as quickly as Dysport, though each patient’s experience is different.

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