Botox - Botulinum Toxin Brands
Written by Jessica Tapia, MD
In 1987, husband-and-wife medical team Alastair and Jean Carruthers helped popularize Botox after Jean, an ophthalmologist, discovered that the botulinum toxin relieved patients' eye spasms and smoothed their wrinkles.
Fast forward to more than 30 years later: Botox has become one of the most requested treatments and its popularity continues to grow.
But while Botox is the most famous of these types of injectables, there are others available, such as Xeomin, Dysport and Jeuveau, each with their differences. Knowing these differences can help people determine which is the best option for them.
It is important to perform a professional evaluation to determine the best choice of botox brand for each patient.
Botox, Xeomin, Dysport and Jeuveau are different types of neurotoxins that block the release of neurotransmitters from the nerve-muscle junction.
The result of this is that the muscles cannot contract and instead are temporarily paralyzed. When injected into the face, the visible effect is a smoothing of wrinkles.
Just as Botox was originally developed for spasms, these neurotoxins also have therapeutic doses for applications beyond their cosmetic indications. They are effective in relieving congenital torticollis (a muscular condition in which the baby's neck is twisted) due to muscle spasms and are also useful in the prevention of migraines.
The four brands of neurotoxins differ in their chemical structure, but the end result is effectively the same for each.
Here, you can learn more about the specific characteristics of all neurotoxins considered alternatives to Botox.
Brand: Botox
Point of differentiation: First and #1
Because it was the first of its kind to hit the market, Botox or onabotulinumtoxinA is a household name at this point.
Botox is approved by the FDA and COFEPRIS to treat moderate to deep lines and wrinkles between the eyebrows (the "11") and on the forehead, as well as crow's feet. Botox uses botulinum toxin type A to treat wrinkles and other conditions.
Many cosmetic physicians also commonly use Botox to treat excessive sweating, migraines and jaw bruxism. Botox, which is prepared from a powder to a liquid, is kept in a freezer before mixing, as the purified proteins bound to the toxins must be stored at a specific cold temperature.
These proteins are believed to protect the toxin. There is also a belief that the presence of these proteins may have an effect on the stability of the product or the duration of its effects, but research suggests that they do not make a difference compared to non-protein toxins.
According to some research, antibodies can potentially form against these proteins, so there is a risk that Botox may stop working for the patient.
However, resistance to Botox is not common: according to clinical studies conducted by Botox manufacturer Allergan, only 1.5% of patients developed neutralizing antibodies.
How long does Botox last?
Patients can expect to see results within 10 to 14 days after treatment, which can last from two to five months. He also says there is a small chance that some wrinkles will disappear completely.
A 2014 study showed that Botox increased skin elasticity, which means, in theory, that it can change the structure of the skin and prevent new wrinkles from forming or old ones from reappearing.
How much does Botox cost?
The cost varies among aesthetic doctors but is generally determined per unit, ranging from $100 to $130 MXN.
Dysport vs. Botox
Differentiation point: disperses more quickly
Dysport has a different molecular structure than Botox, which allows it to disperse more quickly once injected. This can be beneficial for treating larger areas with fewer injections.
However, this same feature may make Dysport not the best choice for areas that require extreme precision, such as around the eyes.
Dysport is one of the options available on the market along with other Botox brands.
What is Dysport?
Dysport, known as abobotulinumtoxinA, is approved by the FDA and COFEPRIS to treat cervical dystonia (a painful condition involving involuntary spasms of the neck muscles), spasticity of the extremities and, for cosmetic purposes, expression lines.
It is recommended for people with moderate to intense expression lines.
Dysport has similar characteristics to Botox, it also requires refrigeration due to the presence of proteins.
Although the proteins in Dysport are smaller than those in Botox, there is still a risk of antibody formation and resistance to the botulinum toxin.
One difference between Dysport and Botox is their molecular weight. Dysport proteins have a lower molecular mass, resulting in a greater chance of diffusion. This higher diffusion rate of Dysport allows it to spread faster and cover a larger area, so it might be better for the forehead. In comparison, the lower diffusion rate of Botox makes it better for more minor wrinkles.
How long does Dysport last?
It varies among patients, but evidence suggests that Dysport can act a few days earlier than Botox and last longer. Recent studies by Galderma, the makers of Dysport, have shown that the neurotoxin can last up to five months and that 95% of 120 people reported 'high satisfaction' with just two treatments per year. Patients report that Dysport tends to feel 'less frozen' and a little more 'pliable' than Botox. This is where personal preference is taken into consideration.
How much does Dysport cost?
Because Dysport is more diluted than Botox, it initially appears cheaper, but that also means more is needed. Hence, the price of the treatment ends up being comparable to Botox.
Xeomin vs. Botox
Differentiation point: Protein free
What is Xeomin?
Xeomin, or incobotulinumtoxinA, is approved by the FDA and COFEPRIS to treat patients with chronic sialorrhea (excessive drooling), eye spasms, limb spasticity and expression lines.
One of the major differences between Xeomin and Botox is that Xeomin contains no stabilizing proteins, which means it does not require refrigeration before opening. In theory, patients are less likely to develop antibodies to Xeomin due to the lack of attached proteins.
So, if a patient begins to notice that Botox is no longer working for them, Xeomin may be a good option.
The lack of additional protein is also the reason why Xeomin is considered to be a more "natural" alternative to Botox, Dysport and Jeuveau.
While it is true that the Xeomin molecule is technically purer (as defined by not having the auxiliary ingredient), it still works the same as other neuromodulators.
How long does Xeomin last?
Duration varies, although the average duration of Xeomin among patients is estimated to be approximately three months. Patients believe the results look and feel like Botox. How quickly results can be seen with Xeomin (or any toxins) can vary from patient to patient.
How much does Xeomin cost?
Some providers offer Xeomin injections at a lower price than Botox, while others charge the same amount.
Jeuveau vs. Botox
Differentiation point: Aesthetic use only.
What is Jeuveau?
Jeuveau, or prabotulinumtoxinA-xvfs, is a new toxin that hit the market in 2019. Marketed as "Newtox," it has been approved by the FDA to treat moderate to deep lines between the eyebrows, commonly referred to as "11" lines.
Like Botox and Dysport, Jeuveau has proteins attached to the toxin and must be refrigerated; however, it is the only neurotoxin that was developed solely for aesthetic purposes versus medical treatment of muscle spasms.
It may have a faster onset of action than other neurotoxins. However, as it is still very new to the market, time will tell how it compares to the different toxins.
How long does Jeuveau last?
Clinical studies have shown that Jeuveau lasts an average of four months. Doctors who have been using Jeuveau for months or years have found that It can be more potent than Botox. Many specialists use seven units of Jeuveau to get an effect equivalent to every 10 units of Botox previously used. Patients also share the impression that it appears and disappears very naturally.
How much does Jeuveau cost?
The cost of Jeuveau can be slightly more expensive than Botox.
"When it comes to choosing between the right and affordable botulinum toxin products for you, in the end it's all going to depend on your personal preferences and it's going to be trial and error. The interesting thing about these neurotoxins is that everyone metabolizes the substance differently.
Some people may notice that Dysport or Jeuveau have a faster onset of action, while others may notice the same with Botox, or that one of these neurotoxins lasts much longer than the others.
It is important to go to a board-certified aesthetic physician who is familiar with each of these neurotoxins, to help evaluate the patient and determine the optimal application plan."
