Once upon a time, botulinum toxin was used to simply help people who had strabismus, or crossed eyes. But as is the case with some of the most brilliant medical innovations, doctors noticed that wrinkles between the eyes, aka the 11-lines or glabella, were disappearing with treatment. Botox, as we know it, was a happy accident. Fast forward to today, and using FDA-approved neuromodulators (think: Botox, Dysport, Jeauveau, and Xeomin) for cosmetic purposes is common practice—and innovation is at an all-time high. Most recently, a new neuromodulator called Daxxify received the FDA’s stamp of approval.
“Daxxify is a neuromodulator to relax dynamic muscle movement to reduce lines caused by facial expression,” explains board-certified dermatologist at Schweiger Dermatology Dr. Brian Hibler. “It’s similar to other neuromodulators, such as Botox, Dysport, Xeomin, and Jeuveau, however, it is coated with peptide which helps it bind faster and stay in place longer.”
It claims to last around six months, as opposed to three months, and is by and large reserved for patients that have been around the block with injectables. But its rollout has been slow and Daxxify has only been in the hands of injectors for about three months now. To get all the info on the newest botulinum toxin on the scene, see if it’s right for you, and learn if it seems to be living up to its long-lasting claim, read ahead. We talked with dermatologists and nurse practitioners that were among the first to get their hands on Daxxify.
What Is Daxxify, Anyway?
Daxxify is the fifth FDA-approved neuromodulator on the market, and while the basic principles of muscle paralysis remain the same, its peptide-centric design allows it to behave slightly differently. “It’s the exact same botulinum toxin A as all other neuromodulators on the market, but what differentiates Daxxify is that it’s surrounded by positively charged peptides. Studies done by the company show that this new structure surrounding the botulinum toxin allows it to bind to the receptors at the synaptic junction,” explains board-certified dermatologist and founder of Niche Dermatology Dr. Shari Marchbein. As a result, it’s able to stop neurons from firing and contracting the muscles (bye bye wrinkles), which is true of all neuromodulators.
But, because of this peptide surrounding it, Daxxify can go a step further. “It doesn't get washed away as quickly. It stays in that synaptic junction and allows for a longer duration of action,” she explains. In practice, dermatologists and patients are also noticing that the effects are taking hold quicker, with complete results visible in just around 48 hours. That said, there is no data to support this observation.
Where Does It Get Injected?
The FDA-approval covers 40 units of Daxxify injected into the glabella, aka the 11 lines that commonly creep up between the eyebrows. For reference, this is roughly double the volume used with other neuromodulators. Daxxify is also being used “off label” on other areas of the face, like the forehead and crow’s feet, according to Nurse Tara, the lead injector at Neinstein Plastic Surgery. The biggest difference is how big of a quantity injectors are using around the face.
“I typically do the FDA-approved amount in the glabella and the normal amount everywhere else,” says Dr. Marchbein. “If I put a huge amount on someone's forehead, I’m going to end up pushing their brows down.” It’s a balancing act, which is why it’s important to see a doctor or nurse that is properly trained in Daxxify.
How Long Does Daxxify *Really* Last?
How long your botox lasts boils down to a few factors—the neuromodulator you’re using, how quickly your metabolism works, and how strong your muscles are. With traditional Botox, Dysport, Xeomin, or Jeauvou, patients typically get a three-month payoff. “Daxxify however lasts six to nine months according to Revance Therapeutics studies,” points out Angel Socha, the Nurse Practitioner at Skinney Medspa in New York City. On paper, it checks on. In practice? The jury is still out as most dermatologists have not been able to track patients' progress yet for a full six months.
That said, Dr. Marchbein, who was among the first set of dermatologists to use the new formula, has noticed that the effects of Daxxify might be wearing off quicker than anticipated in the subset of patients with extremely strong muscles. “Some patients, where I actually gave them higher than the FDA-approved dose, have started to call me saying that they have some movement back sooner than six months,” she notes. “The jury is still out and we don’t know yet—I’ve only been injecting it for four months.”
Who Is Daxxify For?
As a rule of thumb, Daxxify is likely not going to be for first time botulinum toxin users. While your dermatologist will be the best source of information in regards to your personal course of treatment, Dr. Marchbein has found that Daxxify is a fit for three categories of people. The first—and most popular: Individuals who have extremely strong muscles that didn’t respond as well to other neuromodulators. “I do have patients who need maximum doses of Dysport or Botox or Jouevau and still have a ton of movement. I've seen very, very nice results with Daxxify,” she explains.
The second cohort that are great candidates are individuals that can’t make it to the dermatologist for retouches every three months. Maybe they live abroad, are traveling, or have back to back special events that prevent them from paying a visit to the office. The third group is interestingly enough women who are trying to get pregnant. “We don't do cosmetic treatments on patients who are pregnant,” says Dr. Marchbein. “For most pregnant women, when their botox wears off at three months, they're sad. So if I can give them something that would last for the majority of their pregnancy, it’s preferred.”
What Does It Look Like?
Daxxify is not for everyone—it’s heavy duty and doesn't give a natural, soft look. “The initial onset of the neurotoxin can result in a ‘frozen’ appearance which is undesirable for many patients,” explains Dr. Hibler. “Thus, there is a tradeoff between using too many units and looking frozen (but having the muscle relaxation effect lasting longer) versus using a lower dosage and achieving a nice softening of the lines and more natural expression (but needing to come back more frequently for touch-ups).”
Dr. Marchbein adds that while the higher units in the glabella do stop movement, it’s still possible to have a softer look with Daxxify on other areas of the face. “It is definitely stronger and you will feel tighter. That's going to be a personal decision whether or not you like that look,” she says. “I do have it in other areas of my face where I’ve done my typical injection pattern and I do have movement.”
What Are the Risks?
First and foremost: “Daxxify is generally well tolerated and safe,” says Socha. “In their clinical trials, researchers did not find any serious treatment side effects. The most common side effects were headache (six percent of users), drooping eyelids (two percent of users), and facial asymmetry (one percent of users).”
Still, the risks and side effects that accompany other neuromodulators do exist. “Patients may experience redness, swelling, bruising, or mild discomfort at the injection site for up to seven days after treatment,” says Nurse Tara. That’s typically resolved on its own—or with a pack of frozen peas. While uncommon, there is also the possibility for more severe complications. To get the complete list of potential side effects, consult your board-certified dermatologist.
What Does It Cost?
You’re going to have to cough up some serious money if you want Daxxify. “In New York City, one area of botox costs $300 per area (forehead) whereas Daxxify costs $500 to $600 per area,” says Socha. “It's significantly more expensive for us to buy as dermatologists and plastic surgeons and therefore, that price then trickles down to the patient.”
But double the price theoretically gets you double the duration. “If it lasts six months, then you end up paying the exact same amount. It ends up working out exactly the same,” says Dr. Marchbein.
Meet the Experts
Dr. Shari Marchbein is a board-certified dermatologist and a fellow of the American Academy of Dermatology. Dr. Marchbein’s academic and clinical interests include the treatment of acne, in particular adult female acne, acne scarring, and rosacea. She also specializes in various aesthetic procedures and laser surgery. Dr. Marchbein has been sought out as a leader in her field for the treatment of acne and rosacea and has published multiple articles on acne pathogenesis and treatment. She has presented at renowned national conferences on the topics of acne and rosacea, including the annual American Academy of Dermatology and Advances in Dermatology meetings. Dr. Marchbein earned her Bachelor of Science degree from the State University of New York at Binghamton where she graduated Summa Cum Laude and became a member of the Golden Key National Honor Society and Phi Beta Kappa National Honor Society.
Nurse Tara brings her extensive training and advanced degree as a Nurse Practitioner to the Neinstein Plastic Surgery Team as lead nurse injector. To provide the exceptional results she is known for, Nurse Tara has a commitment to patient safety, pursuing higher levels of education through continuous training, an enthusiasm for advancing her practice and honing her skills whilst giving patients a personalized one-on-one experience. Nurse Tara believes in naturally enhanced beauty, and working with her patient’s to achieve their unique aesthetic goals. Nurse Tara’s ultimate goal is for her patients to look in the mirror and see the best version of themselves!
Dr. Brian Hibler is a board-certified and Harvard-fellowship trained medical and cosmetic dermatologist at Schweiger Dermatology Group in Midtown Manhattan. Dr. Hibler obtained his bachelor’s and a medical degree from the University of Wisconsin. He then completed a residency in internal medicine at Memorial Sloan Kettering Cancer Center and another one in dermatology at New York-Presbyterian Hospital / Weill Cornell Medical Center. Following residency, Dr. Hibler completed a prestigious fellowship in laser and cosmetic dermatology at Harvard Medical School, Massachusetts General Hospital, and the Wellman Center for Photomedicine, one of the leading laser and cosmetics centers in the world.
Angel socha is a nurse practitioner licensed in nyc, nj, and pa. She earned her master of science in nursing from the University of Pennsylvania to become a family nurse practitioner. She obtained a bachelor of science in biobehavioral health from Penn State University and a bachelor of science in nursing from thomas jefferson university graduating with the highest distinction. angel’s clinical experience at penn medicine includes emergency room medicine, cardiology, women’s health, and dermatology. angel specializes in botox and filler injections and has completed training with industry leading practitioners. angel’s unique patient centered approach allows her to provide her clients unparalleled results while delivering an aesthetic plan that suits their long-term beauty and wellness goals. angel is trained in advanced lasers that help with anti-aging, pigmentation, acne scarring, hair removal, brown spots, and overall skin complexion. angel is an avid learner and continues to educate herself on the latest techniques in beauty and wellness.
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