If you want smooth, wrinkle-free skin, neuromodulators like Botox® can be used to soften existing lines and effectively prevent new ones. But with so many options—including the popular formulas Botox Cosmetic®, Dysport®, and the new longer-lasting Daxxify™ (coming soon to our practice)—you may wonder which is best for you. Below, Board-Certified Plastic Surgeon Dr. Emily Kirby explains eight small differences.
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- The formulation and ingredients
- Local spread of product once injected
- Unit measurements
- How quickly results develop
- How long results last
- FDA approvals
- Antibody development
- Personal preference
1. The formulation and ingredients
All cosmetic Botox-type neuromodulator injectables contain a purified strain of botulinum toxin, botulinumtoxinA, which relaxes muscles for several months after injection. These injectables smooth the skin by preventing facial wrinkles and fine lines from forming with your muscle movements.
There are slight differences in how each brand name is formulated; to indicate this, the prefix that comes before “botulinumtoxinA” differs for each neurotoxin:
- Botox is onabotulinumtoxinA
- Dysport is abobotulinumtoxinA
- Daxxify is daxibotulinumtoxinA
- Jeuveau is prabotulinumtoxinA
- Xeomin is incobotulinumtoxinA
This reflects small differences in each toxin’s formulation and secondary ingredients, but all perform in a similar way.
At Kalos Medical Spa, we offer Botox and Dysport, and we will soon begin offering Daxxify. Each of these products arrives at our office in powdered form, which we precisely and carefully reconstitute with saline (saltwater solution) before your treatment. Botox and Dysport need to be refrigerated, while Daxxify can be stored at room temperature. The manufacturing processes vary to some degree, and the different ingredients and accompanying molecules used to stabilize the active ingredients are unique to each product: Botox and Dysport contain accessory proteins, while Daxi contains a peptide—another feature that sets it apart from existing formulas. The importance of these stabilizing ingredients is that the proteins in Botox and Dysport can cause you to develop antibodies against the proteins, essentially making your body fight the product. Daxi’s peptide should avoid the risk of antibodies.
Note that the protein used in Dysport is derived from milk, so we do not recommend Dysport if you have a milk allergy.
2. Local spread of product once injected
There are also differences that affect how each product works once injected. Compared with Botox, Dysport is less concentrated and has smaller molecules, so Dysport spreads slightly more from the injection site. This can be helpful in some anatomical areas, but worrisome in others.
3. Unit measurements needed for treatment
Medical injectors are trained in the differences in “units” of each product, as these differ widely. A single unit of Botox roughly equals about 2.5 units of Dysport; this means that 20 units of Botox used to reduce the glabellar lines between the eyebrows equals about 50 units of Dysport in the same area (the treatment cost of Dysport and Botox ends up being about the same). Daxxify requires 40 units to treat the glabella.
4. How quickly results develop
With any Botox-type injectable, full results typically are visible around 2 weeks, but the time it takes to begin seeing results may vary based on the formula used. Here is the average time it takes to see detectable results, per neurotoxin:
- Botox: 4-7 days
- Dysport: 2-3 days
- Daxxify: within 2 days on average, according to the manufacturer, Revance
5. How long results last
Botox smoothes fine lines and wrinkles for 3-4 months on average. Based on our clinical experience at Kalos Medical Spa, Dysport may last somewhat longer than Botox; some patients have seen results last 5-6 months, although most patients are still ready for a touch-up after 3-4 months when results are fading.
You likely won’t notice a difference in how Botox or Dysport work—but Daxxify may last several months longer for some patients.
The clinical trials conducted with Daxi, on the other hand, show results that lasted up to 6 months for just over 50% of patients, and as long as 9 months for some of those patients.
6. FDA approvals
FDA approval means that the specific formula underwent rigorous clinical trials that showed its safety and efficacy when used in the area where it is specifically labeled for use. Here are the FDA approvals that each formula holds for cosmetic use:
- Botox Cosmetic: FDA-approved to treat frown lines (glabella), forehead creases, and and crow’s feet (canthal lines)
- Dysport: FDA-approved to treat frown lines (glabella)
- Daxxify: FDA-approved to treat frown lines (glabella)
Because these products are not FDA-approved for injection in all of the areas where neuromodulators are commonly used, they are frequently used “off-label,” which is considered safe in the hands of an experienced medical injector. Off-label use is common in the upper lip (the lip flip), the neck (vertical platysmal bands), and the jaw (for TMJ pain).
7. Antibody development
If you and your injector notice that you are not seeing full results from your neuromodulator treatment, you may be experiencing “Botox resistance.” This phenomenon is thought to occur in rare cases—about 1.5% according to clinical trials—when a patient develops an immune response to the non-active ingredients in Botox (i.e. the accompanying proteins or peptides mentioned above).
The solution to neurotoxin resistance is to switch formulas, since each contains a unique compound. Our medical spa offers multiple formulas and we are happy to help you choose a new injectable if you believe you have developed Botox resistance. However, this is a rare phenomenon and there is no need to switch formulas if you are happy with your results.
8. Personal preference
If you talk with an injector, they may tell you that they swear by Dysport for frown lines, or that their long-time patients simply prefer the results they get with Botox. It is also normal for patients to prefer one product over another, just as you may prefer Motrin to Advil.
Many patients feel that Botox is the most reliable option because it has been used safely for so many years. Botox was first approved for treating muscle spasms in 1989; Botox Cosmetic was first approved in 2002 and has maintained a successful, safe track record ever since.
Similarly, Dysport was introduced in 2009, and now has proven to be an indispensable product in the injectable arsenal at medical spas.
Daxi has yet to arrive in medical spas and plastic surgeons’ offices (look for it in 2023), but we are confident that the new formula will also earn a fanbase over time, especially for those looking to reduce the frequency of their appointments.
Looking for expert injectables advice? Visit our Fort Worth med spa. Under the direction of Board-Certified Plastic Surgeon Dr. Emily Kirby, the Kalos Medical Spa team is here to empower you to look and feel your best. We offer a full range of advanced non-surgical treatments and procedures, and all injectables are performed by highly-qualified physician assistants and registered nurses who are extensively trained and experienced in the use of various neurotoxin formulas. We invite you to schedule a consultation by calling or texting 817-292-4200 or completing our online form.