Six FDA-approved botulinum toxin products are currently available in the United States: Botox, Dysport, Xeomin, Jeuveau, Daxxify, and Letybo. All six use the same active ingredient, botulinum toxin type A, and work the same way at a cellular level. But their formulations differ in meaningful ways that affect how long they last, how they spread, and what they’re best suited for.
How Botulinum Toxin Works
Every botulinum toxin product relaxes muscles by blocking the chemical signal (acetylcholine) that tells a muscle to contract. The toxin binds to nerve endings, gets absorbed into the cell, and then disables the machinery that releases that signal. Without acetylcholine crossing the gap between nerve and muscle, the muscle can’t fire. This is what smooths wrinkles and treats conditions like muscle spasms or excessive sweating.
The effect isn’t permanent. Your body gradually builds new nerve connections over the course of months, which is why repeat treatments are necessary.
The Six FDA-Approved Brands
Botox (OnabotulinumtoxinA)
Botox is the original and the most widely recognized brand. It contains the neurotoxin along with several complexing proteins that form a larger molecular complex, roughly 5 nanograms of clostridial protein per 100 units. This formulation gives it a relatively precise, targeted diffusion pattern, meaning it stays close to where it’s injected. That precision makes it popular for detailed work around smaller areas like the eyes or between the brows.
Botox also holds the broadest range of FDA-approved medical uses. Beyond cosmetic wrinkle treatment, it’s approved for chronic migraine (defined as 15 or more headache days per month), cervical dystonia, overactive bladder, excessive underarm sweating, upper limb and lower limb spasticity, eyelid spasms, and crossed eyes. Results typically appear within one to four days, with full effect developing over one to four weeks. The effects last roughly three to four months.
Dysport (AbobotulinumtoxinA)
Dysport uses the same type A toxin but in a different formulation that allows it to spread more broadly from each injection point. This wider diffusion can be an advantage when treating larger areas like the forehead, since fewer injection points may be needed to cover the same surface. For smaller, more targeted areas, that same spread can be a drawback.
Dysport is measured in different units than Botox, which causes frequent confusion. The conversion ratio isn’t exact, but most published research and manufacturer recommendations place it between 2:1 and 3:1. For cosmetic wrinkle treatment, the commonly recommended doses work out to about 2.5 units of Dysport for every 1 unit of Botox. The two products are not interchangeable unit-for-unit, so this distinction matters if you’re switching between them.
Xeomin (IncobotulinumtoxinA)
Xeomin’s defining feature is its “naked” formulation. While Botox and Dysport contain accessory proteins bundled with the neurotoxin, Xeomin is purified down to just the active 150 kilodalton neurotoxin molecule, with roughly 0.6 nanograms of clostridial protein per 100 units compared to Botox’s 5 nanograms. The practical significance: stripping away those extra proteins may reduce the chance that your immune system forms antibodies against the product over time. If you’ve noticed diminishing results from another brand after repeated treatments, Xeomin is sometimes suggested as an alternative for this reason.
Xeomin doesn’t require refrigeration before opening, a minor difference that primarily matters to clinics and pharmacies rather than patients.
Jeuveau (PrabotulinumtoxinA-xvfs)
Jeuveau launched in 2019 and is the only one of the six designed exclusively for cosmetic use. It has no approved medical indications. Its formulation includes complexing proteins similar to Botox and Dysport, and its onset, duration, and dosing are comparable to Botox. Some providers market Jeuveau at a slightly lower price point, which has made it a popular option for patients focused purely on wrinkle treatment.
Daxxify (DaxibotulinumtoxinA-lanm)
Daxxify stands apart from every other option in one major way: duration. In pooled data from two phase 3 clinical trials, Daxxify maintained its wrinkle-smoothing effect for a median of 24 weeks, or about six months. Traditional type A products typically need retreatment every three to four months. That means roughly two to three appointments per year instead of three to four.
Instead of the complexing proteins found in Botox and Dysport, Daxxify uses a synthetic peptide to stabilize the toxin. The formulation contains no human or animal byproducts. It was FDA-approved in 2022 and is still newer to the market, so fewer providers carry it compared to more established brands.
Letybo (LetibotulinumtoxinA)
Letybo received FDA approval in 2024, making it the newest option available. Like Dysport, it contains complexing proteins alongside the active toxin. It’s approved for cosmetic treatment of frown lines. Because it entered the U.S. market so recently, long-term real-world data from American patients is still limited, though the product has been used in South Korea and other markets for years.
Type A vs. Type B
All six brands above use botulinum toxin type A. There is one FDA-approved type B product: Myobloc (rimabotulinumtoxinB). It’s used for medical purposes, particularly cervical dystonia (involuntary neck muscle contractions), not cosmetics.
In a head-to-head clinical trial comparing the two serotypes for cervical dystonia, both provided equivalent improvement at four weeks. However, type B came with significantly higher rates of dry mouth (80% vs. 41%) and difficulty swallowing (48% vs. 19%). Type A also lasted modestly longer in patients who responded to treatment: 14 weeks versus 12.1 weeks. Because of those side effect differences, type B is generally reserved for patients who don’t respond well to type A or who have developed resistance to it.
How to Choose Between Them
For most people getting cosmetic treatment, the practical differences come down to a few factors: how long the results last, how widely the product spreads, cost, and provider preference. If you want the longest gap between appointments, Daxxify’s six-month duration is unmatched. If you’re treating a broad area like the forehead, Dysport’s wider diffusion pattern may work well. For precise, small-area treatment, Botox and Xeomin are common choices. If you’ve been getting injections for years and feel like the results are fading, Xeomin’s protein-free formulation may help.
Your provider’s experience with a specific product matters more than most patients realize. A skilled injector who knows Dysport’s spread characteristics will get better results with Dysport than with a product they rarely use. The units aren’t interchangeable between brands, injection patterns differ, and the way each product behaves in tissue varies. If you’re considering switching products, discuss the reason with your provider rather than simply requesting a brand you read about.
Medical Uses Beyond Wrinkles
Cosmetic wrinkle treatment gets the most attention, but botulinum toxin’s medical applications are arguably more significant. Botox alone holds FDA approval for nine distinct conditions. Chronic migraine treatment involves injections across the head and neck roughly every 12 weeks. For overactive bladder, the toxin is injected directly into the bladder muscle, reducing urgency and incontinence episodes in people who haven’t responded to oral medications. Excessive sweating (hyperhidrosis) treatment targets the sweat glands in the underarms.
Spasticity treatment in both children and adults helps reduce the tightness and involuntary muscle contractions that follow stroke, cerebral palsy, spinal cord injury, or multiple sclerosis. Cervical dystonia treatment relaxes the neck muscles responsible for painful, abnormal head positioning.
Side Effects Across All Types
Side effects are generally mild and short-lived, typically appearing within the first week. The most common reactions at the injection site include pain, swelling, redness, and bruising. Because the toxin works by weakening muscles, the injected muscle and occasionally nearby muscles may feel weak. This is usually temporary but can last weeks or, rarely, longer.
Side effects vary by treatment area. Cosmetic forehead treatment may cause a temporary headache or drooping eyelid if the product migrates. Cervical dystonia treatment commonly causes difficulty swallowing, neck pain, and upper respiratory symptoms. Bladder injections carry a risk of urinary tract infections and urinary retention. People with pre-existing neuromuscular conditions like myasthenia gravis or ALS face higher risks of serious complications, including severe swallowing difficulty and breathing problems, even at standard doses.
An allergy to any botulinum toxin product or an active infection at the injection site are the main reasons treatment would be ruled out entirely.