If you spend any time on social media looking at beauty blogs, following influencers or health/beauty/spa accounts, you’ve probably seen #NewTox popping up. The NewTox is Jeuveau™, a newly-FDA approved wrinkle relaxer by Evolus.
YES …….and NO, but mostly YES.
YES- because Jeuveau™ is in the same class of drugs as Botox™ and does the same thing; both medications prevent muscles from contracting and forming wrinkles.
NO-because they are produced by different companies and in different countries. Jeuveau™ , or prabotulinum toxin A, is made by Evolus in Seoul, South Korea . Botox™, or onabotulinum toxin A is made by Allergan in Westport, Ireland. However, both drugs have the same effect, act via the same mechanism, and list the same risks and potential side effects.
Supporters of Jeuveau™ have suggested that it may set up faster or last longer, but when the same dosages are used there is no clear data showing that there is any noticeable difference.
Botox™ and Jeuveau™ are in a class of drugs called neuromodulators. Basically, they alter (“modulate”) the way a nerve (“neuro” ) signal is delivered to a muscle. Neuromodulators temporarily stop the nerve signal from reaching the muscle so that the muscle doesn’t contract and form a wrinkle. Voila!
Botox™ was the first neuromodulator available and was initially used for various medical issues such as relaxing spastic muscles for patients with contractures, helping those patients with physical therapy, relieving severe bladder spasms that cause incontinence, treatment of involuntary blinking and excessive drooling, and more. Botox™ received FDA approval for cosmetic use in 2002 and has been gaining acceptance and popularity ever since.
There are 4 neuromodulators, or wrinkle relaxers, with FDA approval in the US right now:
Botox™ from Allergan, with FDA approval for cosmetic indications in 2002
Xeomin™ produced by Merz and receiving FDA approval in 2010
Dysport™ from parent company Galderma, receiving FDA approval in 2015
Jeuveau™ from Evolus in 2019.
The most common areas for using these drugs to relax lines and wrinkles are:
Frown lines between the brows, also known as glabellar lines or “elevens”, (because in many people those wrinkles form 2 parallel lines that look like the number 11).
Lines around the eyes that are often called “crow’s feet”
There are also some lesser-known uses for neuromodulators in the lower face and neck that may work for some patients:
Treatment of “gummy smile”-a smile so wide that a person’s gums are exposed
“Bunny lines”, or little wrinkles along the upper sides of the nose
Peau d’orange- French for “peel of the orange”-some people will develop a strong muscle in their chin that resembles an orange peel
Strong, overdeveloped masseter or jaw muscles that can make the shape of the face more squared
Down-turned corners of the mouth causing a person to look like they are permanently frowning
Strong muscles in the neck causing vertical bands
Weakening of the orbicularis oris muscle around the mouth that causes “smoker’s lines”
In the past few years botulinum toxin A has been shown to be very effective for prevention of migraines and frequent tension headaches and in treating hyperhidrosis, or excessive sweating. Even more recently they are proving to be a great solution for bruxism; severe grinding and clenching of the teeth that can lead to aching jaws, headaches, bone loss and even broken teeth. There are also very promising studies showing excellent results in overall skin rejuvenation using very dilute amounts of botulinum toxin A.
No. Neuromodulators typically last about 3 months in most people, although it is being used by younger and younger patients to prevent wrinkles, a practice known as “pre-juvenation”. In these patients who start using neuromodulators at the earliest sign of wrinkles, it tends to require less drug to relax the muscles because there is less muscle mass-the muscle hasn’t been getting stronger and stronger over the years. The neuromodulators also tend to last longer for these patients, possibly because they haven’t really formed “muscle memory” yet.
They all feature botulinum toxin A as their primary ingredient. Differences in their non-active proteins may cause them to have some minor differences in things like how they are packaged and stored (for example, Botox brand is unstable and must be kept frozen until it is mixed, Xeomin is stable at room temperature), however, despite occasionally claims that 1 sets up faster or lasts longer than another, there has been no reliable, consistently reproducible data that there is any statistically significant difference between Botox and Xeomin. In double-blind studies, or studies in which neither the injector nor the patient knows which drug is being used, there has not been a noticeable difference between those 2.
Jeuveau is new so there is little data available to compare it to the others, but It will probably also prove to be almost indistinguishable from Botox and Xeomin.
Dysport, on the other hand, does show some different properties which may make a difference to some injectors and consumers. Once mixed, the drug spreads farther than the other botulinum toxin formulas. This can be a benefit is some situations, but can also make a heavy brow or lid droop (potential side effects for all the toxins) more likely. There are also reports of non-responders, or patients that do not respond to the Dysport molecule but do respond to the other neuromodulators.
Some medical providers price the neuromodulators by area, and others price by “unit”. If you are basing your decision on where to get your injections by price, be aware that Dysport tends to cost only about 1/3rd what the other s cost per “unit”, so it seems to be a much better price. However, Dysport is less potent so generally 3x the number of units will be used in an area to get the same effect. Therefore, when shopping by price per unit, multiply your Dysport price by 3 to compare its final cost to the others.
Regarding the pricing of NewTox, or Jeuveau™, the price is not likely to be much different than the others. Because it is so new, some providers are offering introductory specials but whether it will be a lower priced option in the future is doubtful.
There are at least 2 more new neurotoxins that will probably be getting FDA approval before the end of 2020. Although information about them is not readily available yet, one of them is going to be very short-acting. This might be a nice option for someone who would like to try It out but is afraid they might not like it and doesn’t like the idea of committing to 3 months.
All the formulas have pros and cons which may vary depending on your particular situation. Perhaps a better question is, “Who should perform my injections?” Find an experienced medical professional, an RN or MD with knowledge of the anatomy (muscles, nerves, arteries and veins) of the face who can safely determine which formula is best for you, where you can benefit from an injection and how much of the medication is appropriate. The cost and effect of all formulas will probably be about the same, so make a smart decision in whom you trust to do the injections and let them guide you towards which medication to use.