Botulinum Toxin Type A ® is one of the most widely known brands of botulinum toxin injections. Botulinum toxins are neurotoxins that affect nerves and cause muscle weakening. You might get a botulinum toxin injection for cosmetic or medical reasons. Healthcare providers inject small amounts of Botulinum Toxin Type A into specific muscles to smooth wrinkles, prevent migraine headaches and treat a wide range of other health conditions.
Botulinum Toxin Type A has been used for decades in the medical industry. These injections may be recommended for the treatment of:
Crossed eyes (strabismus).
Excessive muscle contractions (dystonia).
Excessive sweating (hyperhidrosis).
Eyelid twitching.
Chronic migraines.
Overactive bladder.
Pediatric upper limb spasticity.
Adult spasticity.
Blepharospasm.
Cervical dystonia.
Your dose, the number of injections, the site of injections, and how often you receive the medication will be determined by your condition and your response to therapy. For children, the dose is also based on weight. Most people start to see an effect within a few days to 2 weeks, and the effect usually lasts 3 to 6 months.
Wrinkle relaxing botulinum toxin type A injections ‘neurotoxins’ are the most common non-invasive aesthetic procedure in the U.S. While they are commonly called “Botulinum Toxin Type A ,” there are actually four different FDA-approved neurotoxins: Botulinum Toxin Type A , Dysport, Jeuveau, and Xeomin.
Just as brands like Band-Aid have become synonymous with adhesive bandages and Kleenex with tissues, “Botulinum Toxin Type A ” has been the go-to term for wrinkle relaxing neurotoxins. All four of these brands contain the same active ingredient (BoNT-A) and are FDA approved to treat the same aesthetic concerns.
So, how do you differentiate between the four? Double board-certified dermatologist Dr. Zeena Al-Dujaili of New Orleans Aesthetics explains.
FDA Approval: Botulinum Toxin Type A was first approved by the FDA as a temporary aesthetic treatment to improve the appearance of frown lines between the eyebrows in April 2002. It has since been cleared to treat forehead lines and crow’s feet, too (in addition to all its “off label” uses). Botulinum Toxin Type A was the first product of it’s kind.
The Background: Botulinum Toxin Type A , or onabotulinumtoxinA, is a product of Irish drugmaker Allergan, and it currently holds an estimated 80 percent of the BoNT-A injection market. With a molecular weight of 900 kDa, Allergan formulates botulinum toxin type A with protective proteins that a subset of patients may develop an antibody against over time, lessening the effectiveness of the treatment. The inactive ingredients in Botulinum Toxin Type A ® include human albumin (i.e. plasma proteins) and sodium chloride. There is also a therapeutic version of product that can be used to treat medical conditions like migraines, excessive sweating, and eye spasms (to name a few.
The Results: Botulinum Toxin Type A is effective but not permanent. It takes about three to five days post-treatment for the results to appear (though it can take up to two weeks for the final effect to be visible), and it lasts about three to four months in most patients. The longevity depends on everything from the way a patient’s body metabolizes the product to the area being treated.
FDA Approval: Dysport was first approved to treat frown lines in April 2009, and, like Botulinum Toxin Type A , also has therapeutic uses to calm muscle spasticity.
The Background: A product of Medicis Pharmaceutical, Dysport (a.k.a. abobotulinumtoxinA) is slightly less potent than Botulinum Toxin Type A ® due to its molecular weight. While both have the same 150 kDa of BoNT-A at their core, the weight of the protective proteins in Dysport® are not uniform like those in Botulinum Toxin Type A . As a result, Dysport has a higher rate of diffusion, which makes it ideal for treating larger areas (think: foreheads) — though more product may be needed to achieve results. Nonetheless, the cost is generally comparable to Botulinum Toxin Type A . Like Botulinum Toxin Type A , it is formulated with human albumin, and Dysport also contains lactose and cow’s milk protein — making it unsuitable for patients with milk allergies.
The Results: While the effects of Dysport may show up sooner (within 24 hours) than Botulinum Toxin Type A , some studies have shown that they may not last as long. The shorter lifespan could make it a good choice for patients who are unsure about whether they will like the results of BoNT-A injections.
FDA Approval: The new kid on the block was approved exclusively for cosmetic use in February 2019.
The Background: You may recall the splashy launch party that branded Jeuveau (i.e. prabotulinumtoxinA) as “#NEWTOX.” Maker Evolus is hoping the newbie will prove to be a worthy competitor to Botulinum Toxin Type A , as they both carry a molecular weight of 900 kDa, are formulated with human albumin and sodium chloride, and offer similar results. But, with a price point 20 to 30 percent less than Botulinum Toxin Type A and marketing campaigns largely targeted at millennials, it would appear Jeuveau is seeking to carve out its own patient niche.
The Results: Clinical data is limited due to the newness of the product, but trials have shown Jeuveau to have a similar safety and efficacy profile to Botulinum Toxin Type A . Patients generally begin to see results in three to five days, and they last for three to six months.
FDA Approval: Xeomin was first approved by the FDA in 2010 for treating blepharospasm, or involuntary blinking, and cervical dystonia, an involuntary contraction of neck muscles. In 2015 it was approved for treating upper limb spasticity, and in 2018 it was approved for treating chronic sialorrhea.
The Background: Xeomin® is made through a unique precision manufacturing process that isolates the therapeutic component of the molecule and removes the complexing/unnecessary proteins that don’t play an active role in treatment. Xeomin® is a uniquely purified neurotoxin. Studies have not been performed to determine whether the presence or absence of complexing/unnecessary proteins has a long-term effect on safety or efficacy.
The Results: Most patients begin to see their results in about four days, which is just slightly longer than with Botulinum Toxin Type A , which offers signs of improvement within 72 hours. Both injectables last anywhere from three to six months, and you can opt to schedule another treatment when the first one wears off.