Different Types of Neurotoxin
The injection of toxin is the most common elective aesthetic treatment in plastic surgery. But sometimes there is confusion about what the treatment options are, various pros and cons, and the reasons to seek one neurotoxin over another. “Botox” is sometimes referred to the way “Kleenex” is referred to for tissues: a generic term for what is actually a brand name for one of multiple different neurotoxins used to treat wrinkles. This is probably because Botox is the original and most common agent used to paralyze facial muscles for the purpose of youthful rejuvenation. However, there are actually four different types of neurotoxin treatments, all of which are effective at reducing the appearance of wrinkles and fine lines. However, there are subtle differences between Botox, Dysport, Xeomin and Jeuveau. So here is some information that people often consider when selecting a neurotoxin treatment.
Our muscles rely on neurological signals to contract. Fundamentally, all neurotoxins work about the same when it comes to the treatment of fine lines and wrinkles (otherwise known as “rhytids”). Your brain tells muscles to contract through communication along nerve fibers with motor nerve endings that stop just before the muscle starts. If a muscle remains in a contracted state or repeatedly causes creases in the same location on the skin, then it can lead to the formation of wrinkles or fine lines or even pain (eg, headaches). Neuromodulators relax muscles and prevent their contraction by blocking neurological signals at the end of nerves. This, in turn, prevents the muscles from folding the skin repeatedly, and therefore prevents the formation of wrinkles.
Botox is a toxin made by Allergan that with a specific formula known as onabotulinumtoxin A. It’s injected directly into muscle tissue for the purpose of blocking neurological signals to the respective tissue. Dysport is made by Galderma and is an injection containing a different formulation, called abobotulinumtoxin A, which is also designed to block neurological signals to the targeted muscle tissue. Xeomin is produced by the German pharmaceutical company Merz Pharma GmbH & Co and uses incobotulinumtoxin A. Also known as “Newtox,” Jeuveau is made by Evolus and is an injection that uses botulinum toxin type A.
In terms of onset, Dysport is the fastest in as little as a few hours. Botox takes about 3 days, whereas Xeomin takes approximately 4 days to see the effects, which makes it the slowest onset, and Jeuveau is in between. All four types of injections have been approved by the U.S. Food and Drug Administration (FDA), but their approvals are each somewhat different. Botox was first approved in 2002 to treat moderate to severe facial wrinkles and is used on the forehead (upper transverse lines), glabella (lower vertical lines), and the lateral canthal area or “crow’s feet” lateral to the eyes. Dysport is technically only approved for glabellar wrinkles and cervical dystonia, since 2009. Since 2010, Xeomin has been approved for the treatment of blepharospasm and cervical dystonia. Jeuveau is approved for cosmetic purposes only. Both Botox and Dysport contain additives, which assist in the spread of product, but also require refrigeration, unlike Xeomin, which is stored at room temperature.
One of the benefits of having multiple different types of toxin to choose from is having options. Another is having alternatives in the setting of resistance. Over time, certain agents may become less effective due to the creation of antibodies by a patient’s immune system after repeat treatments. While this is rare, changing agents may be the best option if one’s primary treatment regimen becomes no longer effective.
In terms of the number of units used, Botox and Xeomin use similar amounts of approximately 20 units per treatment area for “full effect.” Dysport is generally twice as many units, though each unit costs less, which often offsets any difference in overall price. Jeuveau requires the most units of all four but usually costs the least per unit.
The summary is that Botox, Dysport, Xeomin and Jeuveau are all injections that paralyze muscles to prevent the formation of fine lines and wrinkles. The difference is the formula of the compound, which produces slightly different properties, but all create the effect of blocking neurological signals, paralyzing facial muscles, and decreasing wrinkles. At Pacific Sound Plastic Surgery we primarily use “name brand” Botox by Allergan but can obtain any of the four different products. If you’re interested in learning more about neurotoxin options or want to come in for treatment, simply reach out for your consultation!
