Daxxify vs. Botox Cosmetic for Wrinkles

Daxxify (daxibotulinumtoxinA-lanm) and Botox Cosmetic (onabotulinumtoxinA) are two injectable medications used to improve the appearance of facial wrinkles.

When comparing Daxxify versus Botox Cosmetic, both products work similarly. But Botox Cosmetic gained FDA approval 20 years before Daxxify. And there are some other major differences between the two products — especially when it comes to how long each one lasts.

What is Daxxify?

Daxxify is the newest FDA-approved botulinum toxin product. It’s used to improve the appearance of moderate to severe frown lines (vertical lines that form between the eyebrows). Daxxify uses may expand beyond frown line treatment in the future, including non-cosmetic uses.

What is Botox Cosmetic?

The main ingredient in Botox Cosmetic — onabotulinumtoxinA — was first used in the 1970s to treat certain eye conditions. But it was found to be effective in other ways, too. This led to its approval for many medical conditions over the past few decades.

OnabotulinumtoxinA is available as two different brand names — Botox Cosmetic and Botox. But the conditions they’re approved to treat differ. Botox Cosmetic is FDA approved to treat various types of wrinkles. This includes frown lines, forehead lines, and crow’s feet around the eyes. Botox is approved for several non-cosmetic conditions. This includes muscle spasms, bladder spasms, and migraines.

In this article, we’ll be comparing Daxxify versus Botox Cosmetic for wrinkle treatment.

How do Daxxify and Botox Cosmetic work?

The active ingredient in Daxxify and Botox Cosmetic is a toxin. It comes from the Clostridium botulinum bacteria, known as botulinum toxin. This toxin blocks nerves from firing in the muscle where it’s injected, which prevents these muscles from contracting for a period of time. This results in a temporary smoothing of lines in the face.

While Daxxify and Botox Cosmetic are made from the same toxin, Daxxify contains a unique protein. This protein allows Daxxify to stick to the nerve cells near the site of injection for longer. This may be why Daxxify’s anti-wrinkle effects last longer than Botox Cosmetic (more on that below).

Are Daxxify and Botox Cosmetic given the same way?

The number of units given per treatment may be different for Daxxify and Botox Cosmetic. But they’re both injectable medications that are given into a muscle. And they both need to be administered by a healthcare professional. Daxxify and Botox Cosmetic shouldn’t be administered more frequently than every 3 months.

How do you choose between Daxxify or Botox Cosmetic for wrinkles?

Both medications are effective at improving the appearance of wrinkles. But Daxxify’s effects may last up to 6 months, whereas Botox Cosmetic may only last about 4 months or less. So you might not need Daxxify treatments as frequently as you would with Botox Cosmetic.

Daxxify and Botox Cosmetic have been studied individually. In the studies discussed below, most participants were Caucasian women between 45 to 50 years old. 

• In two randomized control trials (RCTs) of over 600 people, close to 100% of participants had no frown lines or minimal frown lines 4 weeks after receiving Daxxify. By 24 weeks (about 6 months) after treatment, over 30% of participants still had no or minimal frown lines.

• In two RCTs of over 400 people, 80% of people using Botox Cosmetic had no or minimal frown lines within 30 days of treatment. At 17 weeks after treatment (about 4 months), 25% of participants maintained this level of improvement. 

One study also directly compared Daxxify versus Botox Cosmetic. It included over 250 people of similar demographics to the studies discussed above. Participants received Daxxify, Botox Cosmetic, or placebo (an injection with nothing in it). The results showed that the FDA-approved dose of Daxxify (40 units) was more likely to result in no or minimal frown lines than the FDA-approved dose of Botox Cosmetic (20 units) for frown lines. 

At 4 months after treatment:

• Over two-thirds of people who received Daxxify had mild or no frown lines. 

• One-third of people who received Botox Cosmetic had mild or no frown lines. 

At 6 months after treatment:

• Over 30% of people who received Botox Cosmetic maintained no or mild frown lines.

• About 12% of people who received Botox Cosmetic maintained no or mild frown lines. 

What are the common side effects of Daxxify and Botox Cosmetic?

Both Daxxify and Botox Cosmetic are usually well-tolerated. But as with any medication, side effects are possible. The most common side effects of both medications are headache. It’s slightly more likely with Botox Cosmetic versus Daxxify. Injection site reactions can also occur with these injectable medications. This can include redness, bruising, or pain at the injection site.

Other side effects are also possible. This includes droopy eyelid (eyelid ptosis) and the inability to move facial muscles (facial paresis). But these are rare. They may occur in less than 2% of people receiving these medications for frown lines. But eyelid ptosis may be more likely in people receiving Botox Cosmetic for forehead lines (up to 20% of people).

Will any of my other medications interact with Daxxify or Botox Cosmetic?

It’s possible. Daxxify and Botox Cosmetic may interact with some medications. Give your healthcare provider and pharmacist a list of the medications and supplements you take. This will help them check for interactions.

In general, medications that can interact with Daxxify and Botox Cosmetic may worsen their side effects. For example, muscle relaxers, like cyclobenzaprine (Fexmid, Amrix) and methocarbamol, may interact with Daxxify and Botox Cosmetic and cause excessive muscle weakness.

Comparing the cost of Daxxify and Botox Cosmetic

Daxxify and Botox Cosmetic are only available as brand-name medications. Health insurance won’t cover these medications for cosmetic uses.

A single unit of Botox may cost between $10 to $15. An average treatment ranges from 20 units (for frown lines) to 40 units (for forehead lines). So this means one treatment may cost as low as $200 or as high as $600 dollars. And there may also be additional fees involved since the injection is given by a healthcare provider. Check with your local provider’s office to see if they run promotions on Botox Cosmetic. The manufacturer of Botox Cosmetic also runs a rewards program.

We can’t say exactly how much Daxxify costs because it’s so new. The first clinics started receiving Daxxify in December 2022. But it’s possible that Daxxify will cost more than Botox Cosmetic, since it’s thought to last longer.

Can you receive both Daxxify and Botox Cosmetic?

No, you shouldn’t receive both Daxxify and Botox Cosmetic. Using them at the same time, or within less than 3 months of each other, could cause serious side effects. Your healthcare provider can help you decide which medication would be best for you.

Keep in mind: Daxxify and Botox Cosmetic aren’t interchangeable. This means that 20 units of Daxxify doesn’t equal 20 units of Botox Cosmetic.

Why trust our experts?

Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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