It’s easy to get overwhelmed by all the neurotoxin options out there. Botox used to be the most common wrinkle relaxer, but now dermatologists offer several Botox alternatives that are effective for smoothing signs of aging. Which one works fastest? Which one lasts the longest? Does one or the other deliver more natural-looking results? These are all common questions we hear at Forefront, and we’re here to tell you that the answer is complicated.
The best “tox” choice for you will depend on several factors, such as the areas you’re aiming to treat, your aesthetic goals, your metabolism speed and even your muscle strength. Rather than choosing the most well-known brand name, an experienced dermatologist will use their best judgment to choose the product that will deliver the best results for your individual case.
Do all neurotoxin injections work the same?
Neuromodulators like Botox are manufactured using botulinum toxin, a protein produced by the bacterium Clostridium botulinum. They work by blocking nerve signals to muscles or glands, which is sometimes beneficial for medical purposes, such as to relieve chronic migraines or overactive bladders.
When used for cosmetic purposes, neurotoxins block nerve signals that cause facial muscles to contract, allowing the skin to relax and lines to soften. The result is a reduction in the appearance of wrinkles caused by repetitive facial expressions, such as crow’s feet near the eyes, lines across the forehead, and glabellar lines (or frown lines, sometimes referred to as “11’s”).
Botox Cosmetic, Dysport, Juveau, and Xeomin are all FDA-approved for cosmetic injections, but there are slight differences that make one better than the other in some situations. All of these brands of neurotoxin contain Clostridium botulinum, but some are made differently or contain additional ingredients. This makes certain brands work faster, last longer, spread to other areas, or remain in targeted areas more effectively.
The exact amount of time any wrinkle relaxer will last varies depending on a patient’s metabolism and muscle activity. In those with a faster metabolism, all botulinum toxins are likely to break down at a quicker rate, making results fade faster. Likewise, those who are naturally very expressive or animated might notice that neurotoxins don’t last as long, since their facial muscles are fighting back against the treatment. Dermatologists consider all of these factors when determining the best neurotoxin product.
The differences between Botox and Botox alternatives
Botox Cosmetic has been a trusted brand since 2002, when it was FDA-approved for reducing signs of aging. It’s formulated with onabotulinumtoxinA and, when injected, it stays localized, allowing for excellent precision in targeted areas.
Here’s how Botox differs from other tox injections.
Botox vs. Dysport
Dysport was approved for cosmetic use in 2009. It’s formulated with abobotulinumtoxinA, a different protein than Botox uses, which is composed of smaller molecules. This allows for quicker diffusion in the injection area, so it spreads farther, which can be advantageous for treating larger areas such as the forehead. The diffusion can also lead to a more natural, softer look, helping treated areas appear less “frozen.”
A higher number of Dysport units are usually required to achieve the same result as a smaller number of Botox units (typically, about a 3:1 ratio). This doesn’t mean Dysport is more expensive; it just means the injector will need to use more of the product. For instance:
- Frown lines: ~20 Botox units vs. ~50-60 Dysport units
- Forehead lines: ~10-15 Botox units vs. ~25-45 Dysport units
- Crow’s feet: ~12-15 Botox units per side vs. ~30-40 Dysport units per side
Dysport is generally priced lower than Botox, so the treatment price usually evens out. Another big difference is that many Dysport patients begin to see improvement within two to three days vs. five to six days with Botox. That said, both treatments typically last about three to four months.
Jeuveau vs. Botox
Jeuveau was FDA approved in 2019, using the active ingredient prabotulinumtoxinA. Jeuveau uses a proprietary purification method called Hi-Pure™, resulting in a purified form of botulinum toxin type A that may start working up to two days faster than Botox. Jeuveau is primarily used for treating lines between the eyebrows (11’s). While Botox generally lasts 3-4 months, Jeuveau results have lasted up to five months, although 4 months is more typical.
Xeomin vs. Botox
Xeomin is known as a “naked” neurotoxin because it contains only botulinum toxin A—without any additional proteins. It was approved by the FDA for glabella lines in 2009, then approved for use on the forehead and crow’s feet in 2024.
While Botox’s accessory proteins can trigger immune responses over time, potentially making it less effective (or resistant) with repeat use, Xeomin has no added proteins, so there’s a lower risk of developing resistance (this is why it’s also referred to as SmartTox). Xeomin’s pure formulation may also spread slightly more than Botox, so it works well for larger areas like the forehead.
A quick comparison of neurotoxin injections
| Onset of results | Duration | Unique attribute | |
| Botox | 5-6 days | 3-4 months | Gold standard. Stays localized to the injection site to target delicate, small muscles precisely. |
| Dysport | 2-3 days | 4 months | Smaller protein particles spread farther and provide natural looking results. |
| Jeuveau | 2-3 days | Up to 5 months, but typically 4 months. | Proprietary purification method makes it work faster and last slightly longer. |
| Xeomyn | 2-3 days | 3-4 months | Less chance of becoming resistant. |
Which neurotoxin is best for me?
In most cases, the differences in neurotoxins only slightly affect the onset and duration of results. An experienced dermatologist will carefully evaluate your aesthetic goals to determine which product will work best for you.
For example, Botox may be best for targeted treatment, such as an asymmetrical eyebrow or crow’s feet at the edge of the eyes. Dysport might be the best choice if you’re aiming for softer, more natural results, especially in a larger treatment area like the forehead. Jeuveau, with its fast onset, might be recommended if you have a special event like a wedding in a few days, and want to be wrinkle-free in time for pictures.
And if you’ve used Botox for several years and have noticed that it isn’t lasting as long or that you need more units to get the same result, it may be worth trying Xeomen. Studies show that over time, about half of patients tend to build up a resistance to Botox. Xeomin is likely to offer the same results as Botox, but your body will respond better since it’s a different formula.
Keep in mind, however, that if several years have gone by since beginning neurotoxin treatment and you’re noticing an increase in saggy skin and wrinkles, it’s possible that the aging process has continued behind the neuromodulator scene. Your skin continues to lose more collagen and elastin, and facial volume is likely to decrease. Adding dermal fillers to your tox treatment may provide more satisfying, overall youthful results.
Talk to a Forefront dermatologist for guidance on your next injection
With many years of experience in the neurotoxin industry, our providers are highly knowledgeable when it comes to choosing the best product for wrinkle reduction. If you’re struggling to find a trusted injector or are just curious about the best Botox alternative, we’re here to help. Find a Forefront provider near you now.
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