Introduction

In the world of aesthetic medicine, the term “Botox” is often used as a catch-all phrase for all botulinum toxin injections. However, in the United States, there are actually six FDA-approved neurotoxins available for cosmetic use, each with its unique characteristics, benefits, and considerations. 

As a board-certified plastic surgeon with over 20 years of experience, I have extensively used these products and want to share my honest insights on each. 

This comprehensive guide will help you understand the differences between Botox, Dysport, Xeomin, Jeuveau, Daxxify, and Letybo—and reveal which ones I prefer and why. Whether you’re a first-timer or a seasoned patient, this article will help you make an informed decision for your aesthetic goals.

Understanding Botulinum Toxins and Their Cosmetic Use

Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum. In controlled doses, it is used medically and cosmetically to temporarily relax muscles, reducing the appearance of dynamic wrinkles such as frown lines, crow’s feet, and forehead creases. Beyond wrinkle treatment, botulinum toxins are also used to address medical conditions like muscle spasms and excessive sweating.

In cosmetic applications, the toxin blocks nerve signals to targeted muscles, preventing contraction and smoothing the overlying skin. The effects typically last several months, after which treatments are repeated to maintain results.

Knowing the variety of neurotoxins available is important because each product differs slightly in formulation, diffusion, onset time, duration, and cost. These differences can influence your treatment experience and outcome.

Overview of the Six FDA-Approved Neurotoxins in the U.S.

1. Botox (OnabotulinumtoxinA)

Botox is the original and most widely recognized neurotoxin, developed by Allergan. It was the first botulinum toxin approved for cosmetic use in the U.S. and remains the gold standard.

• Onset: 3 to 7 days

   

• Duration: Approximately 3 to 4 months

   

• Diffusion: Moderate, allowing precise targeting

   

• Clinical Use: Effective for glabellar lines, forehead wrinkles, crow’s feet, masseter reduction, and more

   

Botox’s reliability, extensive research, and consistent results make it a favorite among many practitioners and patients.

3. Dysport (AbobotulinumtoxinA)

Manufactured by Galderma, Dysport has a slightly larger diffusion area compared to Botox, meaning it spreads more after injection. Since it spreads more after injection, it usually works more rapidly than other types of neuromodulator.

• Onset: Often 2 to 3 days (faster than Botox)

   

• Duration: 3 to 4 months

   

• Diffusion: Larger spread, useful for treating broader areas or when a softer effect is desired

   

Dysport is popular for patients seeking quicker onset and a more natural, blended effect in larger muscle groups.

3. Xeomin (IncobotulinumtoxinA)

Produced by Merz Aesthetics, Xeomin is unique because it is a “naked” neurotoxin, meaning it contains only the active toxin without accessory proteins.

• Onset: 3 to 7 days

   

• Duration: 3 to 4 months

   

• Benefit: Lower risk of antibody formation, potentially reducing resistance over time

   

Xeomin is often chosen for patients who have developed resistance to other neurotoxins or prefer a purer formulation.

4. Jeuveau (PrabotulinumtoxinA)

Jeuveau, made by Evolus, is marketed as a modern alternative targeting younger patients.

• Onset: Similar to Botox (3 to 7 days)

   

• Duration: 2 to 3 months (in my opinion)

   

• Market Position: Cost-competitive, often called “Newtox”

   

While effective, Jeuveau has not dramatically changed clinical practice but provides an additional option for patients.

5. Daxxify (DaxibotulinumtoxinA)

Daxxify is a newer neurotoxin produced by Revance Therapeutics, notable for its unique peptide that extends duration.

• Onset: 3 to 7 days

   

• Duration: Clinical trials suggest up to 6 months; in practice, around 4 to 5 months

   

• Cost: Higher than other neurotoxins

   

While promising for longer-lasting results, Daxxify’s cost and real-world duration have led me to reserve it for select patients.

6. Letybo (LetibotulinumtoxinA)

Letybo, made by Hugel Pharmaceuticals in Korea (known as Botulax there), was FDA-approved in 2024 and introduced to the U.S. market in 2025.

• Onset: 2 to 4 days (similar to Dysport)

   

• Duration: 3 to 4 months

   

• Cost: Lower than Botox, Dysport, and Xeomin

   

Letybo’s affordability allows me to offer more comprehensive, multi-area treatments without increasing patient costs, making it my current favorite.

Dr. Roy Kim’s Personal Experience and Preferences

Over two decades of injecting neurotoxins have given me a deep understanding of how each product performs in real-world settings. Here’s my candid take:

• Favorites: Botox, Dysport, Xeomin. These products provide reliable onset, duration, and patient satisfaction.

   

• Less Preferred: Jeuveau, due to no significant advantage in duration or cost; Daxxify, because of its high price relative to its actual duration in my patients.

   

• Top Pick: Letybo, primarily because its lower cost enables me to treat more areas (forehead, glabella, crow’s feet, masseter, chin, neck) in a holistic approach, improving overall facial harmony.

   

This cost-effectiveness without compromising quality aligns with my philosophy of providing comprehensive, natural-looking results.

How to Choose the Right Neurotoxin for You

Choosing the best neurotoxin depends on several factors:

• Desired Onset: Need results quickly? Dysport and Letybo tend to work faster.

   

• Duration: Want longer-lasting effects? Daxxify may offer extended duration, but at a higher cost.

   

• Treatment Area: Larger diffusion (Dysport) may be better for broad areas; precise effect (Letybo and Botox) for smaller muscles.

   

• Budget: Letybo offers affordable options.

   

• Personal Response: Everyone metabolizes neurotoxins differently; some trial and error may be needed.

   

Consult with an experienced injector to tailor your treatment plan.

Safety, Side Effects, and Patient Considerations

All six neurotoxins have excellent safety profiles when administered by qualified professionals. Common side effects include mild bruising, swelling, or temporary discomfort. Rare complications like ptosis or allergic reactions are uncommon.

Proper injection technique and patient selection minimize risks. Always disclose your medical history and follow post-treatment care instructions.

Conclusion

With six FDA-approved neurotoxins available, patients have more choices than ever. Each product offers unique benefits, and the best choice depends on your goals, budget, and anatomy. My personal favorites—Botox, Dysport, Xeomin, and Letybo—combine efficacy with safety and value. Letybo, in particular, stands out for enabling comprehensive, affordable treatments.

Ready to find the perfect neurotoxin for you? Schedule a consultation with a board-certified plastic surgeon today to discuss your options and achieve natural, lasting results.