Comparing Neuromodulators: The Latest Innovations and Techniques

As one of the most popular cosmetic treatments worldwide, neuromodulators (often referred to by brand names such as Botox, Dysport, Xeomin, Jeuveau, and Daxxify) continue to evolve with exciting new developments. Whether you’re looking to smooth forehead lines, soften crow’s feet, or explore cutting-edge techniques like shoulder contouring, staying up-to-date on the latest advancements is key to achieving natural, beautiful results.

FDA-Approved Neuromodulators in the U.S.

Currently, there are five botulinum toxin type A products approved by the U.S. Food and Drug Administration (FDA) for cosmetic use:

1. OnabotulinumtoxinA (Botox Cosmetic)

2. AbobotulinumtoxinA (Dysport)

3. IncobotulinumtoxinA (Xeomin)

4. PrabotulinumtoxinA (Jeuveau)

5. DaxibotulinumtoxinA (Daxxify)

Each formulation has its own nuances in terms of dosing, onset of action, and duration. For example, Daxxify is renowned for potentially longer-lasting results—an appealing feature for those seeking fewer maintenance treatments.

Table 1: Quick Comparison of FDA-Approved Neuromodulators

New Neuromodulators on the Horizon

The world of neuromodulators is rapidly expanding beyond the well-known options like Botox®, Dysport®, Xeomin®, and Jeuveau®. Exciting new formulations—such as LetibotulinumtoxinA, RelabotulinumtoxinA, and even Botulinum Toxin Type E—promise a range of advantages, from faster onset to longer-lasting effects. These upcoming products could transform how we tailor treatments to our patients’ unique goals and lifestyles. By staying informed about these developments, patients can explore alternatives that best align with their desired results and scheduling needs.

• LetibotulinumtoxinA

  • Similar efficacy to Botox (onabotulinumtoxinA)

  • May last approximately 16 weeks; some see improvement within 24 hours

• RelabotulinumtoxinA

  • “Ready-to-use” liquid formula (no reconstitution required)

  • Phase III trials show rapid onset and results lasting 4–6 months

• Botulinum Toxin Type E

  • Fastest onset (often within 24 hours) but shortest duration (2–4 weeks)

  • Possible “trial” option for those new to neuromodulators

Updated Techniques for the Face

Injection strategies have evolved significantly in recent years, driven by a deeper understanding of facial anatomy and muscle function. For example, refined glabellar techniques often favor fewer injection points to minimize the risk of brow ptosis while maintaining a natural brow arch. We start to delineate the “line of convergence”—the transitional zone where the lower forehead elevates the eyebrows and the upper forehead depresses the hairline—to achieve optimal wrinkle reduction without inadvertently lowering the brows. Furthermore, lower-face injections targeting muscles such as the depressor anguli oris (DAO) or the platysma can lift and improve midface contours, highlighting the versatility of modern neuromodulator injections beyond the classic forehead and crow’s feet areas.

Refined Glabellar Approach

• A 3-point technique primarily targeting the procerus and medial corrugators can help avoid brow ptosis and maintain a pleasing arch.

Forehead (Frontalis) Strategy

• Respecting the “line of convergence” (where the lower forehead elevates brows and the upper forehead depresses the hairline) helps you smooth wrinkles without dropping the brow.

Lower-Face Injections Affecting the Midface

• Treating the depressor anguli oris (DAO) and the platysma can lift the upper face, improve infraorbital hollows, and enhance cheek contours.

Off-Face Applications

Neuromodulators aren’t just for the face anymore:

• Trapezius Reduction: Slims an overly bulky trapezius for a delicate, feminine neck and shoulder line.

• Deltoid or Calf Contouring: Can refine the appearance of bulky arms or lower legs, though care must be taken to avoid weakening essential muscles.

Table 2: Typical (Off-Label) Dosing for Muscle Reduction

Using Neuromodulators to Improve Skin Quality

Many patients already doing neuromodulator injections know this or have noticed it. The skin texture and quality can change after injections. Beyond erasing expression lines, micro-injections of neuromodulators can:

• Reduce sebum (oil) production and minimize pore size (sometimes called “micro-Botox”)

• Diminish redness and flushing often seen in rosacea

• Potentially boost collagen and enhance overall skin texture with consistent use

Pregnancy and Lactation Considerations

Because large-scale studies in pregnant or breastfeeding individuals are lacking, most experts suggest delaying purely cosmetic neuromodulator injections until after:

• Pregnancy: Although the dosage is low and the molecule is unlikely to cross the placenta, it remains an elective procedure.

• Breastfeeding: No direct evidence shows neuromodulators harm nursing infants, but practitioners often take a conservative approach.

Key Takeaways

1. Multiple Choices: With five established neuromodulators (Botox, Dysport, Xeomin, Jeuveau, Daxxify) and new ones coming soon, you can pick a product tailored to your longevity goals or budget.

2. Advanced Techniques: Refined injection methods minimize complications and maximize results.

3. Off-Face Applications: From the shoulders to calves, neuromodulators can help create graceful lines and contours.

4. Skin Quality: Micro-Botox can address excess oil, large pores, and rosacea-related flushing for a smoother, clearer complexion.

5. Pregnancy & Lactation: Carefully weigh risks vs. benefits or postpone until after pregnancy and nursing.

References

• (2023). 3. Updates on Neuromodulators. Advances in Cosmetic Surgery, doi: 10.1016/j.yacs.2023.11.002

• Chong, Hyun, Won., Hyun, Kyu, Kim., Beom, Joon, Kim., Hoon, Kang., Joon, Pio, Hong., Su-Young, Lee., Chung-Sei, Kim. (2015). 1. Comparative trial of a novel botulinum neurotoxin type A versus onabotulinumtoxinA in the treatment of glabellar lines: a multicenter, randomized, double-blind, active-controlled study.. International Journal of Dermatology, doi: 10.1111/IJD.12627

• Ruth, Hill, Yeilding., John, P., Fezza. (2015). 2. A Prospective, Split-Face, Randomized, Double-Blind Study Comparing OnabotulinumtoxinA to IncobotulinumtoxinA for Upper Face Wrinkles.. Plastic and Reconstructive Surgery, doi: 10.1097/PRS.0000000000001255

Ready for a Customized Neuromodulator Plan?

If you’re in New York City and considering neuromodulator injections—classic or cutting-edge — our office is here to guide you. We use the latest research to personalize each treatment, ensuring it fits both your goals and anatomy. Whether you’re aiming for a subtle brow lift, smoother forehead lines, or even a refined neck and shoulder silhouette, our practice offers the precision and artistry you need.

Contact us today to schedule a consultation and discover how a neuromodulator treatment plan can help you look and feel your best with confidence.