Botox vs. Dysport vs. Xeomin vs. Jeuveau Compared: A Cosmetic Surgeon’s Guide to Neuromodulators

When it comes to non-surgical treatments for wrinkles, neuromodulators are the go-to solution for millions of people. With so many options on the market—Jeuveau, Xeomin, Daxxify, Botox,and Dysport—it can feel overwhelming to figure out which one is right for you. With over 18 years of experience, Dr. Hooman Khorasani, a quadruple board-certified surgeon in Manhattan’s Flatiron District, is here to break it all down.

How do neuromodulators work?

Neuromodulators work by temporarily blocking signals from nerves to muscles, preventing the treated muscles from contracting. This relaxes the targeted muscles, smoothing out the appearance of wrinkles and fine lines, providing amore youthful and refreshed look.

However, not all neuromodulators are created equal. Each brand has its own formula, dosing, and duration, which impacts how it works and who it’s best suited for.

It’s essential to choose the right one based on factors such as:

1. Duration of Results: Different brands have varying durations. If long-lasting results are a priority for a patient, choosing the right neuromodulator that works with their body’s metabolism is crucial.
2. Reduction in Movement: Some neuromodulators are more potent than others and may reduce muscle movement too much, leading to a "frozen" or unnatural look. It’s important to choose one that provides the right balance—enough relaxation to smooth out wrinkles but not so much that it limits your natural facial expression.
3. Immune Response (Antibody Phenomenon): Over time, your body can start to get used to a specific neuromodulator, making it less effective. This means the treatment might not last as long, you might need more to see the same results, or it might not work as well at all. To avoid this, it’s important to choose a neuromodulator that’s less likely to cause your body to build up a resistance. This way, the treatment stays effective for a longer time. Sometimes, switching between different types of neuromodulators and taking breaks from using them can help as well. Also choosing a product with less protein content will reduce the chance of your body developing antibodies to this product resulting in a more consistent response to the product over time.
4. Over-injection and Muscle Atrophy: When a muscle is continuously relaxed or immobilized through excessive use of neuromodulators, it can shrink and weaken over time. It is essential to carefully manage dosing and frequency to avoid overuse as well as to use a neuromodulator that is less likely to trigger an immune response, which can cause your body to require more of the product to achieve the same effect. An example of this is aggressive treatment of the forehead muscle (frontalis) in patients who do not have any “botox holiday” which can result in excessive thinning of this muscle resulting in:
   1. Concave forehead
   2. Drooping of the brow
   3. Exposure of forehead veins

The Expert Breakdown

‍Jeuveau: Often called “Newtox,” Jeuveau is a newer neuromodulator and is appealing for its lower price point and quick results. The longe feedback seems to be variable. Some patients feel it lasts longer than other products, while others feel it does not last as long. Therefore, this product is great for patients that have sub optimal results from other products, and are looking to try something new.

Xeomin: Xeomin is a "naked" botulinum neuromodulator, meaning it doesn’t have any additive proteins, which can reduce the risk of developing immunity. It’s great for people who’ve built resistance to other neuromodulators. Xeomin may take longer to show results compared to other neurotoxins, and its effects may not last as long. Additionally, it may be more cost effective than its other competitors. Some providers prefer this product for the forehead (frontalis) muscle, as its effects are lighter than other products, and therefore, reduce the chance of muscle atrophy.

Daxxify: The newest neuromodulator on the market, Daxxify offers longer-lasting results—up to six months or more, per manufacturer. However, in clinical practice, its effect is less, though still longer than its competitors. Given the longevity of this product, if complication occurs, they are not as forgiving. This product has a high potency and when used in delicate areas such as the forehead or around the eyes, can lead to a less natural, frozen appearance. This product is also significantly more expensive than its competitors. The best utility for this product seems to be for male patients with strong 11s (glabella complex) muscle.

Botox: Botox is a classic, reliable choice that has been effectively reducing wrinkles for decades. However, with long-term use, some patients may develop antibodies that reduce its effectiveness over time. This is likely due to its high protein content.  It's a tried-and-true favorite but be mindful of overuse—your body might eventually say, “I’m over it.” Botox is a safer option for areas where migration is a concern, such as around the eyes (peri-ocular area).

Dysport: Dysport spreads more evenly, kicks in faster, and has a lower chance of immunity development, delivering natural-looking, youthful results. It also offers a more subtle effect, with less risk of over-freezing the muscles, which means your facial expressions can still shine through. Plus, it often requires fewer units, making it a cost-effective choice for the patient. While it may be less well-known than Botox, Dysport is the secret powerhouse in Dr. Khorasani’s clinic.

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Request a Consultation

Dr. Hooman Khorasani and his highly-specialized team look forward to working with you to transform your medical or aesthetic goals into reality. To request a consultation, message us securely, or contact Dr. Khorasani’s Manhattan office by phone at 212-230-3378. Also check out our Wrinkle & Line Reduction Page for more information!