Not All Botox Is Equal: A Guide to the New Generation of Neuromodulators

You’ve heard of Botox®, the household name for wrinkle-smoothing injectables. But what many don’t realise is that “Botox” is just one brand in a growing category known as neuromodulators.

These treatments are revolutionary for softening lines and preventing the deepening of expression wrinkles. They work by temporarily relaxing targeted facial muscles, creating a smoother, more refreshed appearance. But with newer players like Daxxify® promising longer-lasting results, it’s crucial to ask: are all neuromodulators truly created equal?

Let’s explore the differences so you can make an informed choice.

The Classic Neuromodulators: Botox®, Dysport®, & Xeomin®

For decades, Allergan’s Botox® (Onabotulinumtoxin A) has been the gold standard, backed by extensive research and a long track record of reliable results. Typically, its effects last around 3 to 4 months.

Alongside it are other highly respected, FDA-approved brands:

  • Dysport® or Azzalure®: Abobotulinumtoxin A is often noted for a slightly faster onset (2-3 days) and a wider spread, which can be ideal for treating larger areas like the forehead but can increase the risk of undesired spread to nearby muscles in inexperienced hands. 

  • Xeomin® or Bocouture®: Known as the “naked injectable” because it contains only the core neurotoxin (Inconeurobotulinumtoxin A) without accessory proteins. This may reduce the chance of patients developing botox resistance, which can occur if antibodies to such accessory proteins are created over time, as they are thought to trigger an immune response in some people. In clinical practice, however, botox resistance related to cosmetic treatments is actually very rare and is perhaps more relevant to those receiving medical treatments for dystonia requiring much higher doses of botox. 

  • Jeuveau® or Nuceiva®: Prabotulinumtoxin A is a newer option that is structurally similar to Botox® and is approved only for aesthetic use.

While all are forms of botulinum toxin type A, these subtle differences in formulation, onset, and diffusion influence which injectable we choose. The decision depends on the treatment area, your unique facial anatomy, and your desired outcome.

The New Contender: Daxxify® Explained

Enter Daxxify® (DaxxibotulinumtoxinA-lanm), a newer addition to the neuromodulator family that has generated significant buzz.

One of its key selling points is longevity. Daxxify® is the first neuromodulator formulated with a novel peptide technology, which helps stabilize the active ingredient. It’s marketed as a longer-lasting alternative, with studies suggesting results may be maintained for up to six months in some patients. From a logistical standpoint, it can also be stored at room temperature, making it convenient for clinics.

Is Longer-Lasting Always Better? The Daxxify® Debate

The idea of only two treatments a year is appealing, but real-world results have been more nuanced. Many experienced practitioners report that while some patients achieve the full six months of efficacy, others see results closer to the traditional 3-4 month timeline. Outcomes can vary significantly based on your individual metabolism, and lifestyle

This raises an important clinical question: is longer always better?

While convenient, extended longevity has a hidden catch. If a patient experiences an undesirable side effect—such as eyebrow heaviness, asymmetry, or “Spocking”—that effect will also last longer. Six months can feel like a very long time to wait for a complication to resolve. For patients new to neuromodulators, the shorter duration of Botox® or Xeomin® can be a safer, more flexible starting point.

The Verdict: It’s Not the Product, It’s the Plan

So, are all neuromodulators equal? Not quite.

Each brand has unique strengths, limitations, and ideal use cases. Much like skincare, one size does not fit all. The most important variable isn’t the brand name on the vial, but the clinical expertise behind the injection.

The best results come from a practitioner who understands facial anatomy, respects the science of each product, and develops a personalised treatment plan tailored specifically to you.

Your Personalised Aesthetic Strategy at Dr Miriam A

At Dr Miriam A, we approach aesthetic treatments with the same layered care we give to skin health. We believe in understanding the individual and tailoring each step to align with your body’s natural rhythm.

If you’re considering wrinkle-relaxing injections, we invite you for an in-depth, face-to-face consultation. We will take the time to discuss your goals, evaluate your facial dynamics, and explore all your options. Because the best results don’t just come from the product—they come from the strategy.

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