How Does Botox (and other neurotoxin brands) Work?

Botox, Dysport, and Xeomin are botulinum toxin A. They work by preventing acetylcholine release from the nerve cell. Acetylcholine is the messenger signal between the nerve and the muscle. With no message getting across, no muscle contraction occurs.

Over time the nerve cell develops new connections to the muscle cell, which is why you need to repeat the treatment in 3-4 months.

What are the brands of neurotoxin?

  • onabotulinumtoxin A (Botox) made by Allergan
  • abobotulinumtoxin A (Dysport) made by Galderma
  • incobotulinumtoxin A (Xeomin) made by Merz
  • prabotulinumtoxin A (Jeuveau) made by Evolve

Which neurotoxin has been around the longest?

Botox has been around the longest; it was FDA approved for medical use in 1989. In 2002 it was approved for glabellar frown lines as Botox Cosmetic, and then got approval for eyes and forehead lines as well.

  • Dysport was approved in 2009.
  • Xeomin was approved in 2011.
  • Jeauveau was approved in 2019.

Does it matter that Botox is approved for more treatment areas than the other toxins?

Not at all. Doctors are allowed to use medications “off-label,” meaning we can use them in a way not specifically approved by the FDA, and we do this all the time. For example, the antidepressant trazodone is commonly used for insomnia, even though it was never approved for that purpose. So even though Botox isn’t approved for use in the upper lip, we inject it there to achieve a fuller upper lip (aka lip flip).

Which neurotoxin lasts the longest?

Longevity depends on a lot of things – the dose used (more = longer result), how long you’ve been getting regular treatments, and the individual person. Muscles atrophy after several months of regular treatment, so the neurotoxin lasts longer. And some people seem to need treatment more often.

Most people need repeat treatment at 3-4 months. Dysport’s claim to fame is that it lasts a bit longer (4 months) and kicks in faster – when I tried it, I saw results two days after treatment, instead of the 5-10 days for Xeomin and Botox.

How do you make Botox last longer?

You can try having your injector use a higher dose. But if you’re one of those people who seems to burn through neurotoxin at a rapid rate, you may want to try taking zinc.

Zinc is a cofactor that allows Botox to bind to the receptor in the nerve synapse. People who work out a lot are deficient in zinc, so Botox can’t bind as effectively. You can try supplementing with 50mg/day of zinc starting a week prior to treatment, and continue after treatment for at least several weeks.

Which neurotoxin takes effect the soonest?

In my personal experience Dysport is definitely the fastest. And I think Xeomin might be a bit faster than Botox, but I haven’t actually studied this.

What happens if you stop getting neurotoxin treatment? Do you suddenly look old?

The good news is you don’t suddenly age like Alison Doody’s character in Indiana Jones and the Last Crusade when she drinks out of the wrong cup. If you stop getting regular toxin injections your wrinkles will return to how they looked before you got Botox.

Does getting injected with Botox or Dysport prevent wrinkles?

Yes! There are two types of wrinkles: static and dynamic. Dynamic wrinkles only appear with motion (e.g. when you frown, squint, or raise your eyebrows). Over time, these movements cause static wrinkles to develop, i.e. wrinkles that are present even when you aren’t moving. These will still be present after getting treated with neurotoxin. They do improve over time, and this improvement can be accelerated with chemical or laser peels. But the best time to start neurotoxin treatments is when those static rhytids are just starting to show. Regular neurotoxin treatments will nip them in the bud and prevent them from getting deeper.

What is the best Botox brand to use?

Whichever gives you the best result! Seriously though, although the package inserts say they’re not interchangeable, after nearly a decade of treating patients, I can tell you I use the same amount of each type of neurotoxin when switching between them.

The product manufacturer will also tell you not to switch between types because they may not last as long. Physiologically this doesn’t make a ton of sense: the product lasts longer because the muscle starts to atrophy (weaken). Once the muscle is weaker, it seems logical that one toxin will last as long as another (barring any intrinsic differences in longevity).

Why can’t you lay down or work out after Botox?

Neurotoxins take a little while to get into the nerve cell, and until that happens, they can migrate away from the injection site. This can give you a droopy upper eyelid or heavy brow. Studies show the toxin is all in the nerve cell after about 90 minutes, so I recommend waiting this long after your treatment to work out or lay down.

How much does Botox cost?

Most offices charge by the unit, so the cost depends on how many units you need. And that depends on what areas you’re treating, and how strong your muscles are. We’ve created a handy infographic to give you a better idea of cost. Dysport isn’t on there, but it costs the same as Xeomin.

Greer Plastic Surgery