The treatment I tried
Botox and Jeuveau, in my forehead and crow’s-feet
My provider
Raleigh, North Carolina, board-certified plastic surgeon Dr. Shruti Tannan
Why I tried both Jeuveau and Botox
I’ve got a bit of a self-control problem when it comes to the release of new skin-care products and/or cosmetic procedures: I don’t have any! Whenever there’s something shiny and new in the beauty world, I’m one of the first people to buy it, get an appointment for it, or, at the very least, spend hours researching every last article or review I can find about it. So when an email newsletter about a new injectable neuromodulator hit my inbox from Dr. Shruti Tannan, a board-certified plastic surgeon in Raleigh, North Carolina, I was all, uh, eyes.
The email subject line said, “Look relaxed and rejuvenated with #NEWTOX,” so naturally, I was curious. After consulting my old pal Google, I learned that “#NEWTOX” was a tagline being used as a part of a marketing campaign for Jeuveau, which was the latest Botox alternative and wrinkle-smoothing injectable toxin to receive FDA approval for cosmetic use in the United States.
What is Jeuveau?
According to Evolus, the brand behind Jeuveau (pronounced ju-voh), the “modern-made injectable” is indicated to “temporarily improve the appearance of moderate to severe frown lines in adults.” In other words, the anti-aging treatment can address those frustrating two vertical wrinkles that often appear between our brows—aka the “elevens”—which are medically referred to as the glabellar lines. Of course, this doesn’t mean that Jeuveau can’t work to smooth out fine lines and wrinkles on other parts of our face when used off-label; this is just what the FDA-approved, on-label use is.
Additionally, studies have shown that Jeuveau could have a faster onset of action and may last longer than Botox, which is considered by many to be the gold standard wrinkle treatment. Upon hearing this, I was immediately interested in trying the injectable myself. So I called up Dr. Tannan and asked if she would be willing to do a side-by-side comparison of Botox vs Jeuveau. I had already been to her twice before for Botox injections, so I knew her approach to injections was personal and meticulous—exactly what you want when you volunteer to be a guinea pig!
Jeuveau vs. Botox: What’s the difference?
Jeuveau is the fourth form of botulinum toxin type A to be introduced in the U.S.—Botox was first, in 2002; then Dysport, in 2009; and Xeomin, in 2011. Out of this foursome, though, Jeuveau is the first toxin to be formulated with the same 900 kDa molecular weight as Botox. Xeomin, on the other hand, has a 150 kDa molecular weight, and Dysport comes in a range of molecular sizes. According to Dr. Sheryl Clark, a board-certified dermatologist in New York City, that similar chemical composition makes Jeuveau the most similar to Botox in terms of outcomes. “Recent data have shown that the complexing proteins that surround the active molecular core in Jeuveau and Botox are necessary for the best results,” she said in an interview with RealSelf, “and other forms of [botulinum toxin], such as Xeomin and Dysport, either lack these complexing proteins or have lesser amounts of it.”
When it comes to pricing, there were a lot of promising reports that Jeuveau would be priced less than Botox. However, Dr. Tannan said, that’s actually not true—at least, not in her experience. “Jeuveau and Botox cost the same,” she confirmed.
Related: What’s the Difference Between Botox, Dysport, Xeomin and Jeuveau?
The consultation
Before Dr. Tannan began with my injections, she walked me through how she was going to divide the two toxins evenly on my forehead. While we talked, she inspected my facial expressions to see how my muscles naturally moved. I remember her doing this very same thing back when I first went to her for Botox, and it made me feel confident she would help make the rejuvenation results of this challenge look as symmetrical and as natural as possible. After all, it’s not exactly standard practice to inject half of one’s face with one toxin and the other half with another, which is why it was important for me to work with a provider I really trusted.
“I always consult with my patients myself and talk to them about the risks and benefits first,” Dr. Tannan said. “I’ll also tell them that [if I see fit,] I’ll limit treatment [of the maximum recommended dose], because we don’t want to risk a potential adverse outcome.”
Next, I held up a mirror while we went over what I was personally hoping to adjust with the use of toxins. I told her that beyond the typical softening of my forehead lines, I would love if she could help give me more of a lift in my brows so that they could be more arched. “When I do a brow lift with a toxin like Botox,” she explained, “I put a little bit in your forehead but not a whole lot first, to see if we can get the brows where we want them, and then we can add more later. If you put in too much, you can give them that Spock look—which is an unattractive telltale sign of too much toxin.”
As Dr. Tannan prepared the syringes of product, I asked her to give me her own medical take on how the two toxins compared. “The main difference that we’re seeing [in my office] is that Jeuveau starts to work sooner,” she said. “So when people need a quick fix, meaning they have an event where they want their toxin working within a couple of days, Jeuveau has an advantage over Botox.”
Unfortunately, from a longevity perspective, she didn’t have such good news to share. “I’m not seeing the same performance that I see with Botox consistently,” she noted. “I’m seeing that sometimes the Jeuveau starts to wear off at two months, sometimes at three months. It’s not the same as Botox, where I get a clear three months.”
Still, it’s important to remember that the longevity of injectable treatments can vary from person to person, depending on how each body metabolizes the toxin. “Some theorize that people who work out a lot metabolize their toxin faster than others,” Dr. Tannan explained. “This is not a rule though.”
What the treatments were like
In total, there were 18 units of Jeuveau injected into my forehead and crow’s-feet on the left and 18 units of Botox into the equivalent spots on the right. The only place where we ultimately decided not to do a direct comparison was on my elevens, because it was too difficult to inject side by side there. Instead, we settled on four units of Botox in that spot.
When I inquired how she typically decides how many units of toxin to use, Dr. Tannan had a really fascinating response. “We figured out in our office that on average, what we end up treating people with is right around their age,” she said, noting that this rule pertained to both Botox and Jeuveau. “People right around 40 years of age end up getting 40 units. People who are 50 get 50 units. But that’s for full treatments [using the maximum recommended dose in the three approved areas: forehead, glabella, and crow’s-feet]. Some people who say, ‘I just want to soften but I still want to express myself,’ [so] then I wouldn’t go full treatment, I would just do a very light smattering.”
(Side note, readers: If you’re doing the math in your head, just know that while I am still a few years from turning 40, Dr. Tannan’s formula worked for me.)
Ultimately, the pain level on both the Jeuveau side (my left) and the Botox side (my right) was exactly the same—as in very minimal. I felt a slight pinch at the injection site every time the needle went in, but the tingly feeling went away within seconds. The biggest “crunch” (yes, I felt it crunch and heard it crunch) was at the same spot on both sides of my forehead: right at the highest point, where it’s much more bony. For those tender spots, Dr. Tannan immediately rubbed a small plastic-encased block of ice over them, and she had me continue to do so when she was done. The amount of temporary skin bubbling on both sides (due to the fluid being injected underneath the surface) was the same, as was the light amount of blood that was emitted.
When she was done, Dr. Tannan advised me to keep icing as needed. She also requested that I avoid working out for 24 hours. “People worry that it can lead to it diffusing or getting metabolized quicker,” she noted before adding, “Also, don’t go get a facial massage or be facedown on a massage table. You don’t want it to migrate away from where I intended it to be used.”
Related: When Is It Time to Quit Toxins and Get a Brow Lift?
My postinjection diary
Day 1
I get a stiff headache on the Jeuveau (left) side in the hours following my afternoon appointment, and it continues when I wake up the next morning. I don’t feel pressure at all on the Botox side. This reaction potentially aligns with Evolus’ own clinical trials, which indicate that headaches were one of the most commonly reported side effects of Jeaveau. Thankfully, Ibuprofen dulled the pain.
I do feel like the Jeuveau side has already started to settle in and do its job. While I can still lift my brows pretty much the same as I could before my appointment, the lines appear to be softening
Days 2–5
My results are continuing to progress in the same fashion—the Jeuveau side is still clearly taking effect, while the Botox side hasn’t yet. My husband didn’t even need me to coax him for his opinion; he took one look at my forehead and was impressed with the significant difference. If you look at my photos, you’ll be able to see the most contrast in the images of me making a surprised face. And I’ve made it easy for you to know which is the Jeuveau side—it’s the area of my forehead where a monster of a red blemish resides. Hey, at least you know these images weren’t doctored!
Day 6
Wow! Woke up this morning with a dramatic shift in the way my forehead is able to (or, well, unable to) flex and move. I notice it the most when I attempt to raise my brows to apply mascara. The Jeuveau side feels even more locked in place, but for the first time, the Botox side has also started to produce that feeling of muscle immobilization. I can also tell that my brow lift has started to kick in—again, even more so on the Jeuveau side, where I’m seeing more of an arch starting to form.
Day 7
Today is the first day I see the lines between my brows—which, as a reminder, were treated solely with Botox—start to dissipate. Also, the Botox side is settling even more.
Day 8
Not many other changes to report from yesterday, except that when I do my scrunching-face selfie, I notice my elevens are even more smoothed out.
Days 9–10
Ah! My face feels the most rejuvenated today. I can officially call it—this is the sweet spot for my body to embrace the Botox and let it do its thing. Now that the injections on both sides are basically set, I’m happy to report that there’s no noticeable difference in the way my forehead feels or looks. It’s a smooth canvas all the way across, just the way I had hoped.
Two months update
It’s been just over two months since my appointment with Dr. Tannan. Now when my face is at rest or when I am smiling, the lines on my forehead and between my brows still look equally smoothed out on both sides. I’m starting to get more movement back in my forehead, but it’s very subtle and usually only noticeable when I am doing things like applying mascara or plucking brow hairs.
However, in order to go beyond my own general observations in the mirror, I also asked my husband and a few friends to weigh in. All parties pointed out that as I naturally engaged in conversation—particularly when I looked surprised or curious—there were more obvious lines starting to reappear near the temples on the side of my face injected with Botox! The difference is subtle enough though that I don’t think it’s anything anyone else would notice without specifically paying attention. At the end of the day, everybody metabolizes products differently, so what lasted longer for me may not necessarily be the same for you.
Final verdict: Jeuveau vs Botox
While it’s a bit of a bummer that going with Jeuveau won’t necessarily save you money, its faster onset of action was pretty remarkable. We live in a world where instant gratification is not only commonplace but expected, so I think the introduction of this #NEWTOX is really iconic of our culture today.
However, Botox is proven effective through and through and the difference between the two neurotoxins hasn’t proven to be too dramatic. So when it comes down to choosing which one to try yourself, speak with your injector to weigh your options.
