Pick Your Toxin! - Appalachian Spring Dermatology

Botox, Xeomin and Jeuveau

Did I say toxin? Yes! Today we’re talking about Botulinum toxin to relax facial wrinkles and lines. And yes, real people in WV get injected with Botulinum toxin in our office every day. Since 2005, we have been injected patients starting with Botox, now with newer toxins Xeomin and Jeuveau . Since 2005, we have injected almost 1500 vials of Botulinum toxin, with about 5 patients treated per vial, that’s over 7500 treatments. If you think you are missing out, you are. I speak from experience. I have had Botulinum toxin injections every 3-4 months for over 15 years, except when I was pregnant and breastfeeding. And yes, I inject myself.

First, let’s review the science. Botulinum toxins have been used for almost 20 years to relax muscles. Botox was first FDA approved in 2002, followed by Dysport in 2009. Xeomin in 2011 and Jeuveau in 2019. These toxins work by binding the neuromuscular junction. Once bound, botulinum toxin blocks the release of Acetylcholine, which sends the signal from the nerve to the muscle, preventing muscles from contracting. The effect of relaxing the muscle generally lasts 3-4 months. In that time the Botulinum toxin molecule is degraded and no longer performs its relaxation function. The effect is in no way permanent.

Which toxin is best? Well, that’s like asking a car salesman which car runs better. They’re all pretty equally effective. However, if you look at the scientific details, there are slight differences. Scientifically, Xeomin and Jeuveau are newer, cleaner molecules. The BOTOX molecule has some accessory proteins attached to it. Xeomin and Jeuveau removed those extra proteins. In real-life patient use, the three can be used interchangeably because Botox, Jeuveau, and Xeomin are all dosed the same. Dysport performs and is dosed differently, so Dr. Rosenberger very very rarely uses Dysport.

Which product does Dr. Rosenberger use the most? Primarily, Dr. Rosenberger uses Botox since founding Appalachian Spring Dermatology in 2005 because that is the name people know and expect. We have used Xeomin and Jeuveau as well as soon they were available for commercial use.

Here’s a summary of each toxin:

Botox (Onabotulinumtoxin A)– FDA approved in 2002. Botox is made and marketed by Allergan. Onset in 3-4 days, lasting 3-4 months. Botox is the gold standard to which all other toxins are compared. Excellent rewards program called Alle, previously called Brilliant Distinctions. www.Alle.com

Xeomin (Incobotulinumtoxin A) – FDA approved in 2011. Made and marketed by Merz. One small study showed a slightly faster onset of action and longer duration. However, in our practical real-life experience, the difference is negligible. Their rewards program has floundered a lot in the past, using PIN codes for VISA gift cards. The problem we have experience in the past is the PIN codes were only available sporadically, and we were only provided one PIN code per vial. They are rolling out a new program (March 2021) called Virtual Xperience + Program with up to $50 per treatment rebate.www.xperiencemerz.com

Jeuveau (Prabotulinumtoxin A) – Nicknamed “Newtox” FDA approved in 2019. Made and marked by Evolus. Onset and duration of action were similar to Botox in scientific studies. However, in real-life use some find that Jeuveau doesn’t last as long as the other toxins, 2-3 months instead of 3-4 months. The Evolus Rewards program works through text. Patients can receive up to $40 off each treatment, up to $160 per year. www.evolus.com.

I still can’t get past the word toxin, is it safe? Yes, all Botulinum Toxins are extremely safe when it is REAL product administered by an EXPERIENCED medical professional.

What do you mean “real”? A lot of black market product is available at a lower cost. You can know you are receiving real product by verifying that the physician purchases product from the only legitimate source. We only purchase directly from the makers listed above.

What qualifies as experienced? Well, this is harder to judge, but use your gut. Dr. Rosenberger was trained to administer BOTOX during her residency and received a certificate from her training at a BOTOX®Cosmetic National Education Facility in 2004. Personally, Dr. Rosenberger has administered well over 7500 BOTOX treatments. That’s experience. We encourage patients to ask about the injector’s experience and ask to see some before and after photos. Check out our website to see some of our before and afters.

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