Botulinum Toxins

 Botox®, Dysport®, Xeomin®, Jeuveau®

Botulinum Toxins 1

Cosmetic botulinum toxin is a popular part of most anti-aging regimens. 

It’s a quick, 10-minute procedure that requires no downtime or recovery.

It provides temporary improvement of moderate to severe wrinkles and crow’s feet, and overall softens facial lines for a more youthful appearance.  

Results are dramatic and apparent within days and unlike surgery it is fast, simple and minimally invasive.

BOTOX

Botox, onabotulinumtoxinA,  was FDA approved in 1989 for two rare eye muscle disorders – blepharospasm and strabismus in adults. Today, BOTOX® is FDA-approved for 11 therapeutic indications including Glabellar complex (the 11s), Lateral canthal rhytides (crows feet), Frontalis rhytides (horizontal forehead lines)Because it is the oldest and most known of the botulinum toxins it still dominates the Type A botulinum toxin market, at 80% market share. It lasts well for 3 months and falls off in month 4. Month 1 95-99% effective -at month 2 90-95% effective; at month 3: 77-81% and 61-67% at month 4.

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DYSPORT

Dysport, abobotulinumtoxin A,  was FDA approved in 2009. It is made by Medicis Pharmaceuticals. It was approved for glabellar treatment. It has lower molecular weight (150kDa) than Botox (900 kDa) which is why it can diffuse easily and spread faster across larger areas like the forehead.  It is less potent than Botox. Injectors triple up on units to deliver equivalent dosage to Botox, some use 3.5 units Dysport for every 1 unit they would use of Botox or Jeuveau.  It is often used for forehead and glabella 11’s. Care needs to be taken in the lower forehead as it can easily knock out muscles it was not intended to target like the lower frontalis (resulting in low brow and forehead heaviness) and the levator palpebrae superioris (resulting in upper eyelid droop in the affected eye). Dysport has plasma proteins attached, like human albumin,  just like Botox, and is not for people with lactose allergies.

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XEOMIN

Xeomin, incobotulinumtoxin A, was FDA approved in in 2010. It is made by Xeomin Aesthetic. It is made in Germany and sold by Merz. The loyalty rewards program is called Merz Advantage Loyalty Program and the trademarked Xperience+ program. It is better purified in the sense that it does not contain lactose or human albumin or other complexing proteins.  Xeomin is also smaller (150 kilodaltons) vs Botox (900 kDa); Jeuveau is the same molecular weight as Botox (900 kDa). Xeomin lasts well x 3 months, and then falls off in effectiveness in month 4. Month 1 93-96% effective, at month 2 87-90% effective; at month 3: 75-89% effective and 61-67% at month 4.

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JEUVEAU

Jeuveau, prabotulinumtoxin A, was FDA approved in 2019.  In 2014, Jeuveau launched in South Korea, where it is called Nabota.  It is also called “Newtox” as it was the most recent of the 4 approved Type A toxins to get FDA approval for wrinkle reduction. It is technically approved (on label) for glabellar (between the eyebrows vertical wrinkles). Jeuveau tends to last a little longer than Botox and Xeomin at 4-5 months vs 3-4 months. Molecules are almost identical to Botox. Jeuveau is 900 kDa size, same as Botox Cosmetic. Jeuveau is the toxin that most closely resembles Botox. Jeuveau is similar to Botox Cosmetic in that it kicks in day 2-3 and full effect is seen a little later; Botox cosmetic (7 days) for full effect vs Jeuveau (10 days) to achieve full effect.

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