How Do You Know What the Right Neuromodulator Is for You?
- Posted on: Oct 20 2018
There are even more Neurotoxins out there?!? How do you know what’s the right neuromodulator for you?
After last week’s announcement of Allergan acquiring the latest neurotoxin EB-001 for $195 million, I think all of us in the world of aesthetics are wondering why do we need another neurotoxin? And those of us “in the know” also know that there are three new neurotoxins coming to market shortly. So, what’s the difference between Botox and the other neuromodulators, Xeomin and Dysport, we currently use and the new ones that are coming soon to us.
Here’s how I break them down and explain the current arsenal of neurotoxins:
Botox is the original neurotoxin that everyone has heard about. Before cosmetic use, it was used for years for medical indications. It is owned by Allergan who is basically the McDonalds of neuromodulators, that is if we are comparing it to the world of burgers. It’s the most recognized name in the neuromodulator market. It’s the neurotoxin that all the old clinical trials were done with (since then there have been many clinical trials done with the other two and all 3 are FDA approved for cosmetic and medical use in the US).
Dysport is another cosmetic company’s (Galderma) version of their neuromodulator. I have noticed in my practice its onset of action is slightly shorter (kicks in a day or two quicker) than Botox. I’ve also noticed it has more spread in the area I inject in. This can be a good or bad thing. It’s good because you’ll need fewer injections. It’s bad because if your injector isn’t careful the chances of a brow droop is higher with this toxin. Another difference, the unit equivalents are different from the other two competitors (Botox and Xeomin). For every one unit of Dysport is equal to 3 units of Botox or 3 units Xeomin.
Xeomin is another neuromodulator on the market by the makers of Radiesse, Merz. It is the only neurotoxin (currently) that doesn’t have the complex proteins attached to the neurotoxin. So, it is the “purer/naked neuromodulator.” What does the complex protein do on the other neurotoxins? We have no idea, but some theorize that those are the reason people become “Botox resistant.”
All three work basically the same way and are FDA approved for 3 months duration (obviously sometimes they can last longer depending on the person). Remember, neurotoxins only work on dynamic lines (the lines you see when you are making expression), however, they can impact and prevent static lines (the lines you see when your face is at rest and not making an expression). I tend to like Xeomin because it’s often slightly cheaper for my patients than Botox (the price point is less for me and I pass that savings on to my patients). I have also noticed when I inject Xeomin I tend to see at least 3-month duration sometimes longer (I do think this is injector dependent due to technique).
What’s in the Pipeline?
Allergan’s newest baby EB-001, that I touched on above, is supposed to be quicker acting and only has a longevity of 1.5 months duration. It’s an interesting concept depending on your perspective. Some new to neurotoxin use may only want something that has a month and a half commitment, however, I am of the mindset that if I’m going to pay to have an injection to the head I want it to last as long as possible. There’s a new neurotoxin called Evolus that is completing their clinical trials as we speak that will be a 3-month duration just as the current ones that we offer today. Revance is another neuromodulator everyone is talking about because the company that owns the toxin is trying to get the 6-month FDA approval for it. The only problem with all three is we have no idea when they are coming and we don’t know yet what to expect from any of them.
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It is an exciting time to be in aesthetic medicine, as there is clearly a race to develop and bring to market in a safe and efficacious manner the best neuromodulator possible. For now, the three we do have work very well and it’s really patient and provider preference driving the treatment.
Now, go get rid of those ugly lines no matter what neuromodulator you want to use! –Dr. Barbarino. If you want to follow Dr. B’s daily stories, please follow her on Facebook at Dr.Barbie4Beauty, Austin Cosmetic Surgery, and/or Barbarino Surgical Arts. She’s also on Instagram at AustinCosmeticSurgery or BarbarinoSurgicalArts.
Posted in: Neuromodulators