Neuromodulators (NM), what is in there and how to pick the right one?


In current market there are four major, well known neuromodulators: Botox (Onabotulinum toxin), Dysport (Abobotulinum toxin), Xeomin (Incobotulinum toxin) and Jeuveau (Prabobotulinum toxin), these are the gold standard treatments for dynamic wrinkles in the face.

We briefly talk about each of them here in this blog:

It has been a while since the first neuromodulator (NM) got the approval from the FDA (2002); since then there is a clear track of using them in Aesthetic and their effects/ side effects. 


Botox (from Allergan company) is the first NM introduced in the market and because it was the first one, everybody knows this class of medication (neuromodulators) as Botox. 


Dysport (from Galderma company) is the next one introduced, and it has been around since 2009, not as old as Botox but still long enough to earn customers’ trust. It is the only NM that is different in terms of equipotency and its dosage is calculated differently, the equipotency of Botox to Dysport is 1:2.5, it means to obtain the same effect of one unit of Botox we need 2.5 units of Dyport. 


Xeomin (from Merz USA company) earned trust of the FDA in 2011, it has been used since and has been claimed to be the “pure” version of the NM. 


Jeuveau (by Evolus company) gained its FDA approval in 2019 so it the “new kid on the block”. It is used successfully by many Aesthetic practicing physicians and providers and is opening his place in the market and is gaining trust of the providers.


Which one to choose:

Between the four, Dysport is claimed to have tendency to spread more so its effects is more homogenous in large areas like forehead but providers claim that they have to be cautious when they want to treat small areas like “lip flip” as it may cause relaxation of the muscles we don’t want them to relax.

Between the other three (Botox, Xeomin, and Jeuveau), Xeomin’s molecule is a bit different as it doesn’t have the accessory protein molecules attached to it, so it is called “naked toxin” or pure toxin, some claim that because of this property there is less chance of having allergic reaction to the NM’s molecule and less chance of becoming “resistant” to the effect of NMs.

Between Botox and Jeuveau, they are almost the same, but it has been claimed that the effect if Jeuveau appears sooner than of the Botox (2-4 days vs 5-7 days). other than that, since Jeuveau is newer and tries to compete with the other established brands it is provided cheaper and with more rebates and incentives.

In conclusion: 

If you really dint want to change your routine and have trust issues, stick with the Botox. If you want a NM which is “organic” with less chance of allergic reactions and resistance, then Xeomin is yours. If you are jsut treating wide areas 9like forehead or glabellar area and don’t treat delicate areas, Dysport it is. And if you are brand new to the Nm market, you will get a better bang for the buck with Jeuveau.

One thing you need to remember is that since each 2.5 units of Dysport equals to 1 unit of Botox (and it’s vials come in 200 units, vs 100 units for Botox or Jeuveau) it is provided cheaper “per unit” but the eventual cost would be the same since you need X2.5 to get the same effect.

Here at Orchid Wellness & medical Spa we provide all four of them and we can discuss these matters in more detail during your consult.

We are located in Edmonds, WA and we cover King county, Snohomish county, Edmonds, Seattle, Kirkland, Bellevue, Shoreline, Mukilteo etc. 

Please call us today with any questions you may have, and we gladly answer them for you!


Shahriar Khezri MD

Dr. Khezri is a long time physician who works in two different capacities, as an acute healthcare provider/ Anesthesiologist and as an Aesthetics/ Cosmetologist provider. In his first role he saves lives in the hospital and in his second role he makes impact on clients lives towards a better self by improving their appearance and by giving them more self confidence. He is double broad certified in Anesthesiology and has been practicing medicine since 1996. He also has had a long term passion towards Aesthetics and has been participating in many Aesthetics/ cosmetology educational courses to broaden his knowledge in Aesthetics and keeps his knowledge up to date follows the path of the pioneers in this field. He believes that patient safety is the most important aspect of practicing medicine and treats each and every client with respect and tries to provide the best service possible. He is evidence-based and utilizes the best technology since he believes his clients deserve the best and safest.

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