The Beginner's Guide to Neurotoxins: A Nurse Injector's Perspective

As a nurse injector in Idaho Falls, Idaho, one of the most common questions I get from clients is: "What’s the difference between all the different types of Botox?" Now, technically speaking, Botox is a brand name that frequently is used as an umbrella term for all neurotoxins - similar to when you write "Tylenol" or "Ziploc" bags on your grocery list. Though you may not necessarily buy the brand name pain killer or plastic storage bag - you may purchase the store brand or a trendy brand or whatever it may be - you inherently know what type of product you are referring to when you wrote the brand names on your sticky note.

With six neurotoxin brands currently FDA approved and available in the US today, it's important to understand what defines each product so that you can ask your injector about options that interest you or try something new if what you have been using in the past isn't producing the results you were once used to. Dive in with me below as I will briefly break down the six  neurotoxins currently available in US markets: Botox Cosmetic, Dysport, Xeomin, Jeuveau, Daxxify, and Letybo so you can get a basic understanding of each.

Botox Cosmetic (OnabotulinumtoxinA)
FDA Approval: 2002
Manufacturer: Allergan
Botox is the original FDA-approved neurotoxin for cosmetic use, setting the standard for wrinkle-relaxing treatments. It works by temporarily blocking nerve signals to muscles, helping to soften dynamic lines like crow’s feet, frown lines, and forehead creases. Known for its consistent performance, Botox is widely trusted with decades of data supporting its efficacy and safety. It contains protective or accessory proteins along with the active neurotoxin.

Dysport (AbobotulinumtoxinA)
FDA Approval: 2009
Manufacturer: Ipsen/Galderma
Dysport is often noted for its quicker onset, typically around 2-3 days, compared to Botox’s 3-5 days. It has a slightly larger diffusion area, which can be beneficial in larger treatment zones like the forehead but may require more precise dosing in smaller areas. Like Botox, it also contains accessory proteins.

Xeomin (IncobotulinumtoxinA)
FDA Approval: 2011
Manufacturer: Merz Aesthetics
Xeomin is often called a “clean” neurotoxin because it does not contain accessory proteins. This makes it a good option for clients concerned about potential antibody development over time. Its onset and duration are similar to Botox, making it a viable alternative for those seeking minimal additives.

Jeuveau (PrabotulinumtoxinA-xvfs)
FDA Approval: 2019
Manufacturer: Evolus
Nicknamed "Newtox," Jeuveau is a newer product that specifically targets the aesthetic market. Its formulation is similar to Botox, and studies suggest comparable efficacy and safety profiles. Some clients and injectors report a slightly faster onset and a more budget-friendly option without compromising results.

Daxxify (DaxxibotulinumtoxinA-lanm)
FDA Approval: 2022
Manufacturer: Revance Therapeutics / Crown Laboratories 
Daxxify is the newest player in the market and offers a potential for longer duration - up to 6 months in some patients. It uses a proprietary peptide stabilizer instead of human serum albumin, which may appeal to those looking for vegan or non-animal-based products. While long-lasting, it may not be ideal for first-time clients who prefer shorter-term results initially. Daxxify is also the only option of these six that is manufactured in the USA.

Letybo (LetibotulinumtoxinA)
FDA Approval: 2024 (U.S.)
Manufacturer: Hugel (South Korea)
Letybo is the most recent addition to the U.S. market, though it has been widely used internationally. It is said to have similar efficacy and duration to Botox, with some preliminary feedback suggesting a smooth, natural finish. As with any newer product, ongoing clinical experience and general feedback from patients will continue to shape its place in clinics and medical spas.

Final Thoughts
All six neurotoxins share the same core mechanism: blocking acetylcholine at the neuromuscular junction to relax muscles and reduce dynamic wrinkles. The differences lie in the formulation, onset time, spread, duration, and additional ingredients. As a nurse injector, my role is to help clients navigate these options, making personalized recommendations based on anatomy, lifestyle, aesthetic goals, and past treatment history.

I believe that education empowers my patients to be able to make informed choices, and understanding these details ensures we can create results that are not only beautiful but also safe and sustainable.