Your First Botox Appointment: What to Expect, Step by Step
Most first-time Botox nerves come from not knowing what happens in the room. Here is the whole visit, from the first question to the two-week check, in plain language.
Comparing the Neuromodulators: How Botox, Dysport, Xeomin, Daxxify and Jeuveau Differ
Five FDA-approved neuromodulators, one goal: softer lines. Dr. Arora explains how Botox, Dysport, Xeomin, Daxxify and Jeuveau differ, and what matters more.
Patients often arrive with a screenshot of a social media post claiming one brand is “stronger,” “faster,” or “longer lasting” than another. Some of those claims have a grain of truth. Many are marketing. My job is to separate the two.
This is an educational comparison of the botulinum toxin type A products approved by the FDA for frown lines. It is not a ranking, and it is not a list of what any particular clinic stocks. At Serene, we use Botox and other FDA-approved neuromodulators, and we choose based on your anatomy, history, and goals.
What they all have in common
Every product in this group is a purified form of botulinum toxin type A. Each one temporarily blocks the release of acetylcholine at the nerve-muscle junction, so the treated muscle contracts less and the overlying skin creases less. All are prescription drugs, all carry similar warnings about the possible distant spread of toxin effect, and all wear off as nerve endings form new connections.
One important point the FDA has emphasized since 2009: units are not interchangeable between brands. Twenty units of one product are not equal to twenty units of another. That is one reason “price per unit” comparisons across brands can be misleading.
The five, one at a time
Botox Cosmetic (onabotulinumtoxinA)
The first to be approved for cosmetic use, in 2002, and the most studied. Botox Cosmetic now carries FDA approval for frown lines, crow’s feet, forehead lines, and platysma (neck) bands. Its therapeutic sister product, Botox, is approved for conditions like chronic migraine, severe underarm sweating, and cervical dystonia. Results typically last three to four months.
Dysport (abobotulinumtoxinA)
Approved for glabellar lines in 2009. Dysport is dosed in different units, and more units are needed for a similar effect. Some injectors feel it spreads a bit more across a treatment area, which can be useful in broad areas like the forehead and less desirable near the eyes. Some patients report an earlier onset. Duration is broadly similar to Botox.
Xeomin (incobotulinumtoxinA)
Approved for glabellar lines in 2011. Xeomin is manufactured without the accessory “complexing proteins” that surround the toxin in some other products. In theory this may lower the chance of forming neutralizing antibodies, although antibody-related loss of effect is uncommon with any product at cosmetic doses. It can be stored before reconstitution without refrigeration.
Jeuveau (prabotulinumtoxinA-xvfs)
Approved in 2019 and indicated only for glabellar lines. It was developed specifically for the aesthetic market. In head-to-head and placebo-controlled trials it performed similarly to Botox for frown lines.
Daxxify (daxibotulinumtoxinA-lanm)
Approved in 2022. Daxxify uses a stabilizing peptide rather than human serum albumin. Its phase 3 trials (SAKURA 1 and 2) reported a median duration of about six months for frown lines, with some participants lasting longer. That longer duration is its main selling point, though individual results vary and real-world experience is still accumulating.
What matters more than the brand
In my experience, these factors drive your result far more than the name on the box:
- Accurate assessment. Which muscles are creating the line, how strong they are, and how your brows sit at rest.
- Dose. Under-dosing is a common reason people think a product “didn’t work” or wore off early.
- Placement. A few millimeters can change whether a brow lifts nicely or feels heavy.
- Consistency. Sticking with a product lets us learn your personal response and fine-tune it.
Who should not receive any neuromodulator
Regardless of brand, I do not treat patients who are pregnant or breastfeeding, who have an active infection at the injection site, or who have had an allergic reaction to a botulinum toxin product. People with neuromuscular disorders such as myasthenia gravis need specialist input first, and some medications, including aminoglycoside antibiotics, can increase the effect. Switching brands will not fix a contraindication.
Should you switch brands?
Sometimes. If a patient has had consistent, adequately dosed treatment and the effect seems to fade early, trying a different formulation is a reasonable conversation. I cover that in more depth in my article on why Botox can seem to wear off faster. But switching back and forth every visit makes it harder to learn what works for you.
Frequently asked questions
Which neuromodulator lasts the longest?
In clinical trials, daxibotulinumtoxinA (Daxxify) showed a longer median duration for frown lines than the other products typically show. Individual results vary, and dose and anatomy also affect duration.
Is one brand safer than the others?
All five are FDA-approved with similar safety profiles and share the same class warnings. Safety depends more on appropriate dosing, placement, and patient selection than on the brand.
Why does Dysport need more units?
Each company measures potency with its own assay, so units are specific to each product. A higher unit number does not mean a stronger treatment.
Does Serene offer every brand?
We use Botox and other FDA-approved neuromodulators. If you are interested in a specific product, ask during your consultation and we will discuss whether it fits your goals.
Talk it through with us
Choosing a neuromodulator should be a conversation, not a guess. Schedule a complimentary, no-commitment consultation and we will review your history, watch your expressions, and recommend a plan. Current rates are listed on our pricing page.
- Hudson, OH: 50 W Streetsboro St, Suite 2 · (330) 460-5915
- Barboursville, WV: 1 Chateau Grove Ln · (304) 520-0461
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References: BOTOX Cosmetic (onabotulinumtoxinA) Prescribing Information. Allergan/AbbVie. · U.S. Food and Drug Administration. Information for Healthcare Professionals: OnabotulinumtoxinA, AbobotulinumtoxinA, RimabotulinumtoxinB (distant spread and non-interchangeable units). FDA. 2009. · Carruthers JD, Fagien S, Joseph JH, et al. DaxibotulinumtoxinA for injection for the treatment of glabellar lines: results from each of two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). Plast Reconstr Surg. 2020.
This article is for general information only and is not medical advice. Treatments are provided only after consultation and evaluation by a licensed provider. Individual results vary.
About the authorDr. Robin Arora, MD, MBA is the founder and medical director of Serene Med Spa and a Biote Certified Provider. He is board-certified in internal medicine, nephrology and hypertension, and addiction medicine, and in aesthetic medicine through the American Academy of Aesthetic Medicine (AAAM).
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