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by Kerri Otto, PA-C MPAS

The Many Faces of “BOTOX”

Injectables / September 26, 2022
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written by: Kerri Otto, PA-C MPAS

Vesper Aesthetics, Chicago, IL


Injectable wrinkle relaxers such as BOTOX, Dysport, Jeuveau, Xeomin, and the newly approved Daxxify are a group of medications that comprise the “toxins” of aesthetic treatments.  These injectables have traditionally been used to treat wrinkles on the face caused by the muscles of facial expression. 


Botox was the first neurotoxin approved by the FDA 20 years ago and initially was approved for the wrinkles and fine lines of the glabella, aka, the 11’s or frown lines.   The toxin group of medications has since expanded, as well as the areas we use them in the skin. 


Let’s first explore the difference between each of the neuromodulator options available, as this is a common and confusing subject.


BOTOX Cosmetic-onobotulinumtoxinA: This was the first toxin approved in the U.S. in 2002 and is the most recognized by name. It is FDA approved for use in the glabella, forehead, and crow’s feet areas of the face and lasts approximately 3 months in the average patient. Botox takes about 7-14 days to see the full effect.    


Dysport-abobotulinumtoxinA: The U.S. approval of Dsyport was in 2009. This wrinkle relaxer takes effect sooner than botox (5-7 days) and gained approval for treatment of the frown lines for up to 4 months.  In my opinion, Dysport does have a slightly stronger effect, while at the same time, allowing for natural results without a frozen appearance.  


Xeomin-incobotulinumtoxinA: Approved in 2010 for the treatment of the frown lines.  This is the only pure neurotoxin without any associated accessory proteins; this has been believed by some to be a toxin in which resistance is not possible due to the purity of the toxin.    In my experience, Xeomin does seem to have slightly less strength in comparison to both BOTOX and DYSPORT in terms of longevity of effect. 

At Vesper in Chicago, Xeomin is the most commonly requested neurotoxin.

Jeuveau-prabotulinumtoxinA: Jeuveau is very closely related to BOTOX and was approved in 2019 for softening of the glabellar lines. It does have a quicker onset (2-3 days) and lasts about 3 months.   The big advantage of this injectable is the price point.  Jeuveau is typically $1-$2 less per unit when compared to BOTOX.


Daxxify-daxibotulinumtoxinA: Daxxify was approved on September 8th, 2022 and is the newest neurtotoxin on the block.  This is the first peptide-formulated wrinkle relaxer and is much different chemically than the others currently available.    During the initial studies, the duration of the effect was up to 6-9 months and effects can sometimes be seen in 1-2 days.   This injectable is expected to be available for patient use in early 2023.  


Although BOTOX Cosmetic is the only wrinkle relaxer approved to treat all 3 areas of the upper face (frown line, forehead and crow’s feet),it is common practice in both medical and aethetic medicine to use medications in off-label areas.  At Vesper in Chicago, IL, we currently use BOTOX, Dysport, Daxxify, and Xeomin to treat the frown lines, forehead, crow’s feet as well as for use in the mid/ lower face (masseters, chin, corners of the mouth, nose, lip flip,jawline and neck). We feel the most natural results are obtained when treating the entire face as a whole~a “sprinkling” of neurotoxin to both the upper & lower face as well as the neck elicits soft, natural results.  Gone are the traditional methods of injecting only one area.   Our facial muscles work together as an entire group and relaxing an isolated area can cause compensation & over stimulation of adjacent muscles.  This in turn can result in deeper lines and wrinkles in some areas, with a smooth effect in only the isolated area which was treated.  


How much do you need and which neurotoxin is the best for you?  The anwer to this resides in your individual muscular strength, facial shape, structure and budget.   During an initial neurotoxin appointment with me, photos are taken and we carefully evaluate your muscles both at rest and in animation.   We then discuss your aesthetic goals along with me giving you a professional opinion in regards to the amount and form of wrinkle relaxing medications that we feel can most effectively help you reach those goals!   We see all of our new patients back for a follow up appointment 2-3 weeks after the initial treatment.  Westrive for perfection and want to make sure every patient is happy with their results.