Botox, Dysport, Xeomin, or Jeuveau: What’s the Difference?

Botox, Xeomin, Dysport and Jeuveau, all neurotoxins with small differences. Understanding what those are can help you determine which is the best for you.

In 1987, husband-and-wife medical team Alastair and Jean Carruthers helped bring Botox to the forefront after Jean, an ophthalmologist, discovered that botulinum toxin didn’t just help a patient’s eye spasms but also smoothed out her wrinkles. Fast forward to more than 30 years later: Botox has become one of the most requested cosmetic treatments, and its popularity only continues to grow. But while Botox is the most famous of these types of injectables, there are several other injections available, such as Xeomin, Dysport and Jeuveau, each with its own small differences. Understanding what those are can help people determine which is the best option for them.

“Botox, Xeomin, Dysport and Jeuveau are different types of neurotoxins that block the release of neurotransmitters from the junction between nerves and muscles,” explains Dr. Elliot Hirsch, a Sherman Oaks, California, plastic surgeon. “The result of this is that the muscles cannot contract and, instead, become temporarily paralyzed. When this is injected into the face, the visible effect is a smoothing of wrinkles.”

Related: I Put Botox in Half my Forehead and Jeuveau in the Other … and Here’s My Review

Just as Botox was originally developed for spasms, Dr. Hirsch says that there are also therapeutic doses for all these neurotoxins beyond their cosmetic indications. “They are effective in relieving congenital torticollis [a muscular condition in which an infant’s neck is twisted] due to muscle spasms,” Dr. Hirsch explains, adding that they are also useful in the prevention of migraines and, most recently, in treating TMJ dysfunction. “[The four neurotoxin brands] all differ in their chemical structure, but the end result is effectively the same for each of them,” he says.

Here, learn more about the specifics of all the neurotoxins considered to be alternatives to Botox.

Botox

Point of differentiation: The OG 

Because it was the first of its kind to hit the market, Botox, or onabotulinumtoxinA, is a household name at this point. Botox is FDA-approved to treat moderate to severe lines and wrinkles between the eyebrows (the “11s”) and on the forehead as well as crow’s feet. Many doctors also commonly use Botox off label, to treat excessive sweating, migraines and jaw clenching. Botox, which is prepared from a powder into a liquid, is kept in a freezer before mixing, since the purified proteins attached to the toxins must be stored at a specific cold temperature. These proteins are believed to protect the toxin. There is also some belief that the presence of these proteins may have an effect on the stability of the product or the duration of its effects, but research points to it not making a difference compared to nonprotein toxins. 

According to Dr. Gretchen Frieling, a Boston board-certified dermatopathologist, antibodies can potentially form against these proteins, so there’s a risk that Botox will stop working for the patient. However, true Botox resistance isn’t common: according to clinical trials conducted by Botox’s manufacturer, Allergan, only 1.5% of patients developed neutralizing antibodies.

How long does Botox last?

Patients can expect to see results within 10 to 14 days after treatment that can last anywhere from two to five months. Dr. Frieling also says that there’s a small chance some wrinkles may go away completely. One 2014 study showed that Botox increased elasticity of the skin—which means, in theory, it may change the structure of the skin and prevent new wrinkles from forming or old ones from coming back.

How much does Botox cost?

Cost varies between providers but is generally determined per unit and can range from $10 to $20.

Interested in Botox?
Find Doctors Near You

Related: 10 Botox Myths, Debunked

Dysport vs. Botox

Point of differentiation: Spreads faster 

What is Dysport?

Dysport, known as abobotulinumtoxinA, is approved by the FDA to treat cervical dystonia (a painful condition involving involuntary spasms of the neck muscles), limb spasticity and, for cosmetic purposes, frown lines. “It’s recommended for people with moderate or severe frown lines,” says Dr. Frieling. Dysport has similarities to Botox, such as requiring refrigeration due to the presence of proteins. While the proteins in Dysport are smaller than those in Botox, Dr. Frieling says that it still holds the risk of antibody formation and eventual resistance.

One difference between Dysport and Botox is its molecular weight. Dysport’s proteins have a lower molecular mass, resulting in a greater chance of diffusion. Dysport’s higher diffusion rate allows it to spread faster and to a larger coverage area, so it’s best for the forehead, while Botox’s lower diffusion rate makes it better for smaller wrinkles.

How long does Dysport last?

It varies from patient to patient, but anecdotal evidence suggests Dysport may kick in a few days sooner than Botox and last longer. Recent studies by Galderma, the makers of Dysport, have shown that the neurotoxin may last up to five months and that 95% of 120 individuals reported “high satisfaction” with just two treatments per year.  “Patients report that Dysport tends to feel ‘less tight’ and slightly more ‘flexible’ than Botox. This is where personal preference comes in,” Dr. Frieling says.

How much does Dysport cost?

Because Dysport is more diluted than Botox, it initially appears to be cheaper (Dysport costs around $4 to $6 per unit)—but that also means more of it is needed, so the price for the treatment ends up being comparable to that of Botox.

Interested in Dysport?
Find Doctors Near You

Related: 8 Dermatologists Say These Are Must-Dos Before Any Injectables Appointment

Xeomin vs. Botox

Point of differentiation: No protein 

What is Xeomin?

Xeomin, or incobotulinumtoxinA, is FDA-approved to treat patients with chronic sialorrhea (excessive drooling), eye spasms, limb spasticity and frown lines. One of the biggest differences between Xeomin and Botox is that it lacks the stabilizing proteins, which means it doesn’t require refrigeration before opening. “Theoretically, patients are less likely to develop antibodies to Xeomin, due to lack of attached proteins,” Dr. Frieling says. So if a patient is starting to notice that Botox isn’t working for them anymore, Xeomin may be a good option. The lack of additional proteins is also why Xeomin is considered to be a more “natural” alternative to Botox, Dysport, and Jeuveau. While it’s true that the Xeomin molecule is technically more pure (as defined by not having the ancillary ingredient), it still functions the same as other neuromodulators

How long does Xeomin last?

How long it lasts varies, though Dr. Frieling says that the average duration for Xeomin among her patients is about three months. “People believe the results look and feel like [those from] Botox,” she adds. When it comes to how fast you can see results with Xeomin—or any of the toxins, for that matter—this can vary from patient to patient as well.

How much does Xeomin cost?

Some providers offer Xeomin injections at a lower price point than that of Botox ($7 to $12 per unit), while others will charge the same amount.

Interested in Xeomin?
Find Doctors Near You

Jeuveau vs. Botox

Point of differentiation: Aesthetics use only

What is Jeuveau? 

Jeuveau, or prabotulinumtoxinA-xvfs, is the new toxin on the block—it hit the market in 2019. Marketed as “Newtox,” it’s been FDA-approved to treat moderate to severe lines between the eyebrows, often called “11” lines. Similar to Botox and Dysport, Jeuveau has proteins attached to the toxin and has to be refrigerated; however, it is the only neurotoxin that was developed solely for aesthetic purposes versus medical treatment of muscle spasms. 

Dr. Frieling says that it’s been reported to have a quicker onset of action compared to other neurotoxins, but since it’s still very new to the market, time will tell how it stacks up compared to the others toxins. 

How long does Jeuveau last?

Dr. Sheryl Clark, a board-certified dermatologist in New York City, says that clinical trials have shown Jeuveau to last an average of four months. “Clinicians who have been using Jeuveau for months to years have seen Jeuveau is often more potent than Botox, such that many dermatologists are using seven units of Jeaveau for an effect equivalent to every 10 units of Botox they used previously. Patients have shared the impression as well that it comes on and wears off very naturally.”

How much does Jeuveau cost?

Jeuveau cost can range from $12 to $17 per unit, but as Dr. Hirsch points out, the price comparison between all four toxins ultimately depends on various factors. “The cost of each of these is going to vary from practice to practice and be dependent on who is performing the injections—whether it’s a nurse, PA or doctor,” he says.

Interested in Jeuveau?
Find Doctors Near You

The bottom line

When choosing the right toxin for you, it will ultimately come down to personal preference and trial and error. “The interesting thing about these neurotoxins is that everybody metabolizes them differently,” Dr, Hirsch says. “Some people may notice that Dysport or Jeuveau has a faster onset of action, while others may notice the same about Botox—or that one of these neurotoxins lasts significantly longer than the others. It is important to have a board-certified plastic surgeon, dermatologist or facial plastic surgeon who is familiar with each of these neurotoxins, to help evaluate the patient and determine the optimal treatment plan,” he says.