Q: What are the pros and cons of Daxxify?

Pros Daxxify can minimize the appearance of fine lines and wrinkles for at least six months, longer than any similar treatment. “Daxi results seem to continue at their maximum longer and diminish at a slower rate,” says Dr. Waldorf. It’s a quick, tolerable treatment with no downtime. Since the injectable is free of animal-based additives, it’s appropriate for vegans. Daxxify has been extensively studied and shown to be safe, with minimal side effects. Its active ingredient, botulinum toxin type A, has been widely used for injectable wrinkle treatments for decades. Some providers say it also improves skin texture in the treated area and makes the complexion look more dewey. Cons Many reviewers on RealSelf say Daxxify wasn’t worth the money because it didn’t live up to its claims of being more long-lasting than similar wrinkle treatments. Disappointment in how long results last, coupled with treatment prices that often exceed Botox, is the primary reason it has a Worth It Rating of just type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el . As with other injectable neuromodulators, results are not permanent. Injection-site bruising and swelling are common (though temporary) side effects. Clinical studies showed that headaches were also a potential side effective treatment. Daxxify cannot be reversed. If you have a complication (like drooping eyelids or a crooked smile) or don’t like your outcome, you’ll have to wait for the drug’s effects to wear off over time.

Q: How soon will you see Daxxify results?

In the Phase 3 clinical studies , the average time to onset of a “clinically meaningful response” was three days, but Daxxify’s full effect typically takes one to two weeks to set in.

Q: What are the alternatives?

Botox , Dysport , Xeomin , Jeuveau : Despite slight formulary differences, all FDA-approved “botulinum toxin A products are safe, effective, no-downtime treatments that reduce wrinkles caused by the movement of muscles,” explains Dr. Waldorf. Doctors and patients have preferences based mainly on anecdotal experience, some finding that Dysport kicks in faster or that Xeomin offers a softer freeze. Overall, their similarities are greater than their differences. Results for all four Daxxify competitors last 3-5 months, versus 6-9 months with Daxxify. Dermal fillers , like Juvéderm and Restylane , are water-binding hyaluronic acid-based injectables that add volume and contour and last anywhere from six months to two-plus years. Certain gels can be injected into fine lines, wrinkles, and folds to make them look less obvious. Resurfacing lasers and professional-strength chemical peels refresh the skin’s surface and stimulate collagen production down deep to improve the skin’s tone and texture. Radiofrequency microneedling devices deliver energy into the dermis to ramp up collagen and elastin synthesis for smoother, thicker skin over time.

Question 1

What is Daxxify?

Accepted Answer

Daxxify (daxibotulinumtoxinA-lanm) is an injectable wrinkle treatment that’s FDA approved to improve the appearance of moderate to severe frown lines, the glabellar lines or “elevens” between the eyebrows. In August 2023, the drug was also approved by the FDA for the treatment of cervical dystonia in adults.

This injectable neuromodulator may also be used off-label to treat other facial lines and wrinkles—like forehead furrows, crow’s feet, and bunny lines (on the nose)—as well as platysmal bands in the neck and dimpling of the chin. It can also be injected into the masseter muscles to soften a square, bulky jaw while reducing the clenching and grinding associated with TMJ.

Like Botox, Dysport, and Xeomin, Daxxify (a.k.a. Daxi) works by temporarily blocking the release of the neurotransmitter that makes facial muscles move. This smooths “dynamic wrinkles” and prevents new expression lines from forming.

Revance Therapeutics, the makers of Daxxify, say it’s uniquely long-lasting: clinical studies show an improvement in frown lines for six to nine months, compared to the standard three- to five-month result offered by previously approved neuromodulators, like Botox.

“The studies showed that a two-point or greater improvement in glabellar lines—from severe to mild or moderate to none on the validated scale—was maintained for at least 24 weeks after a single treatment,” says Dr. Hema Sundaram, a board-certified dermatologist in Fairfax, Virginia. “About 50% of the patients maintained improvements in glabellar lines for at least 26 to 28 weeks.”

Daxxify owes its longevity to a novel peptide, which allows it to bind more effectively to the nerve cell membrane, where the receptors for botulinum toxins reside. According to Dr. Jason Bloom, a board-certified facial plastic surgeon in Philadelphia, pairing the peptide to the toxin molecule gives it a positive charge, drawing it to the negatively charged cell membrane.

The proprietary peptide in Daxxify also eliminates the need for animal-derived stabilizing proteins, like the human serum albumin found in all other neuromodulators.

“Each botulinum toxin differs in formulation—in particular, the components used to ‘hold’ the toxin peptides as a stable active complex for absorption,” explains Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York, who was an investigator on the Daxxify clinical trials. “Daxxify contains no human serum albumin [HSA], which is used by the other companies as a stabilizer, to keep the botulinum toxin complexes from sticking onto the vial surface. Although HSA poses no additional risk, some patients may prefer a product without human components.” (The human albumin used in Botox is derived from purified, donated blood.)

New York City-based, board-certified dermatologist Dr. Ron Shelton, says that he and other providers have noticed another unique benefit of Daxxify, one they haven’t seen with other toxins: the skin’s texture often looks improved post-treatment. “It is a more dewey, brighter, and smoother complexion,” he notes.

Related: 5 Reasons Daxxify Is the Most Unique Neurotoxin

Question 2

What are the pros and cons of Daxxify?

Accepted Answer

Pros

Daxxify can minimize the appearance of fine lines and wrinkles for at least six months, longer than any similar treatment.
“Daxi results seem to continue at their maximum longer and diminish at a slower rate,” says Dr. Waldorf.
It’s a quick, tolerable treatment with no downtime.
Since the injectable is free of animal-based additives, it’s appropriate for vegans.
Daxxify has been extensively studied and shown to be safe, with minimal side effects. Its active ingredient, botulinum toxin type A, has been widely used for injectable wrinkle treatments for decades.
Some providers say it also improves skin texture in the treated area and makes the complexion look more dewey.

Cons

Many reviewers on RealSelf say Daxxify wasn’t worth the money because it didn’t live up to its claims of being more long-lasting than similar wrinkle treatments. Disappointment in how long results last, coupled with treatment prices that often exceed Botox, is the primary reason it has a Worth It Rating of just type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el.
As with other injectable neuromodulators, results are not permanent.
Injection-site bruising and swelling are common (though temporary) side effects.
Clinical studies showed that headaches were also a potential side effective treatment.
Daxxify cannot be reversed. If you have a complication (like drooping eyelids or a crooked smile) or don’t like your outcome, you’ll have to wait for the drug’s effects to wear off over time.

Question 3

How much does Daxxify cost?

Accepted Answer

Your Daxxify treatment price will depend on how many units you have and how much your injector charges per unit, depending on their practice location and level of experience.

Daxxify tends to cost more than Botox: $15 to $25 per unit, compared to $10 to $15 per unit for Botox. The price difference for these frown line treatments is due to Daxxify’s expected longevity, and it makes sense if you only need two treatments per year, compared to three.

As we mentioned above, not all patients are seeing the kind of longer-lasting results they’re expecting when they pay more. These patients may have been under-treated, as this new wrinkle treatment has a reputation for being stronger than its predecessors, or this new formula may just not work as well for them.

It remains to be seen if prices will come down a bit to better align with the patient experience, or if some patients may be better off, price-wise, sticking with the more affordable Botox or Dysport.

Question 4

Who makes a good candidate?

Accepted Answer

Daxxify is considered safe and effective for any adult in good health, but certain patients may be better candidates than others, due to the drug's potency.

According to Dr. Waldorf, the best candidates have limited volume loss or laxity in the areas they intend to treat.
Compared to other neuromodulators, Daxxify is reputed to have a strong effect, making it especially suitable for people with bulkier muscles and deeper creases.
Dr. Waldorf says Daxxify works well for patients who generally need a lot of toxin to see results and those whose results are typically short-lived. “I have several men in that category with extra-strong forehead and glabellar muscles who have been waiting for Daxxify,” she says.
It may also benefit patients with low-set brows, who would ordinarily be poor candidates for forehead toxin (because it could worsen their brow position). “Anecdotally, patients whose frown lines were treated with Daxxify [in the clinical trials] also had improvement in forehead lines without additional injection points,” Dr. Waldorf says. The product’s range of action may allow it to minimize wrinkles adjacent to the treatment area. “That can be very helpful for patients who want treatment of both glabellar and forehead lines, but already have heavy brows and rely on their forehead muscles to keep their brows elevated,” Dr. Waldorf explains. “The key will be starting with fewer units in those patients.”

The standard Daxxify dose for glabellar lines is 40 units, twice the standard number of Botox units for that area. However, Daxxify units are not interchangeable with Botox units. This 2020 study published in the Journal of the American Academy of Dermatology concludes that both doses contain an identical quantity of the active molecule, and that the longer duration of Daxxify results are due to its unique formulation.

Because it's so new, everything we know about the drug at this point stems from the clinical trials. As more injectors start offering it, will we truly know who it’s best for and how it can be finessed to treat various wrinkles and other muscle-related aesthetic issues.

The biggest uncertainty doctors face right now is whether or not “baby” doses of Daxxify—dosages smaller than the 40 units injected in the clinical trials—can be used to create the subtle, less-frozen effects that many modern patients desire. Typically, dose influences duration, with smaller quantities of neuromodulator producing more short-term effects.

“Are we going to be able to offer patients a little bit less in the forehead, say, and still get the longevity while making them look natural? That remains to be seen,” says Dr. Bloom.

Question 5

What should you expect during a Daxxify treatment?

Accepted Answer

Like other neuromodulators, Daxxify is a quick lunchtime procedure. Here’s what you can expect during your Daxxify appointment.

First, your injector will evaluate you and review your concerns, goals, and medical history. “The evaluation should include viewing the patient from the front and sides—both at rest and during movements that highlight muscle effects—as well as a discussion in front of a mirror,” Dr. Waldorf tells us.
Your doctor should inform you about Daxxify risks, benefits, and alternatives before asking you to sign consent forms.
Your injector (or a medical assistant) will take photos of your face at rest and while making various expressions (frowning, smiling, raising eyebrows).
They should then talk through their treatment plan, to ensure that you're aligned. “Some like to mark the patient with a makeup pencil; others, like me, make the plan on paper and pick the specific injection points during treatment while asking the patient to make expressions,” says Dr. Waldorf.
Your injector will cleanse the area and prep injection sites with alcohol.
The injections themselves should take only a few minutes. You’ll feel a slight pinch.
Injection sites will be red and raised (resembling bug bites) after treatment, but these bumps usually fade within an hour or two.

Question 6

Do Daxxify injections hurt?

Accepted Answer

Your treatment shouldn’t hurt too much, though some areas of the face (like the upper lip and base of the nose) can be more painful than others.

Since the needles used to inject Daxxify and other toxins are very small, most patients find neuromodulator injections to be quite tolerable, even without numbing cream.

“I use a special 34-gauge ‘invisible’ needle to inject botulinum toxin rather than the standard 30- gauge most people use, so there’s no need for anesthetic,” says Dr. Waldorf. The higher the gauge number, the smaller the needle.

The basic 30-gauge needle is still relatively tiny and painless. For comparison, most vaccines are given with a 22- to 25-gauge needle.

Question 7

What should you avoid after Daxxify injections?

Accepted Answer

Neuromodulator injections are truly no-downtime treatments. You can apply your usual products and go back to normal activities immediately after your appointment.

A few additional tips to help maximize your outcome:

Daxxify is taken up by the nerve endings in 90 minutes. “I ask patients to make muscle movements several times an hour, for a few hours after treatment—movement reduces the ‘bug bite’ appearance and there is some evidence that movement may speed the onset of the toxin,” says Dr. Waldorf.
Avoiding saunas in the first few hours after Daxxify injections may theoretically prevent swelling and the unwanted spread of toxin, adds Dr. Waldorf.
Patients who have a tendency to bruise, even with the finest needles, should avoid anticoagulants—aspirin, nonsteroidal anti-inflammatory agents, vitamin E, gingko, garlic, St. John's wort, alcohol—for one week before Daxxify injections and two to three days after. “Don’t discontinue any drug prescribed by a physician without specific instructions from that physician,” Dr. Waldorf stresses.

Question 8

How soon will you see Daxxify results?

Accepted Answer

In the Phase 3 clinical studies, the average time to onset of a “clinically meaningful response” was three days, but Daxxify’s full effect typically takes one to two weeks to set in.

Question 9

Daxxify before and after pictures

Accepted Answer

The Daxxify photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 10

Daxxify side effects: is it safe?

Accepted Answer

“All botulinum toxins have an excellent safety profile,” says Dr. Waldorf. “Daxxify’s profile is the same as all the prior FDA-approved botulinum toxins.”

In the clinical trials, the most common side effects of Daxxify were mild and temporary. They included:

headaches that lasted two days, on average
injection site pain and swelling for about one day

Eyelid ptosis occurred in 1.3% of study subjects, a similar complication rate to Botox and other neurotoxins.

While some injectors have speculated that Daxxify complications may take longer to resolve than those incurred by toxins with less staying power, that doesn’t seem to be the case. In fact, the study authors acknowledge that while “it might be anticipated that a [botulinum toxin] with a longer than usual duration of response could have adverse events with a longer than usual duration, the limited data that are available suggest that the duration of adverse events with DAXI is consistent with that from other products.”

For example, with the standard 40 units of Daxxify used in the trials, eyelid ptosis lasted a median of 58 days—which is comparable to the ptosis duration for both Botox (51 days with the clinically studied dose) and Dysport (39 to 85 days with the clinically studied dose).

Question 11

What are the alternatives?

Accepted Answer

Botox, Dysport, Xeomin, Jeuveau: Despite slight formulary differences, all FDA-approved “botulinum toxin A products are safe, effective, no-downtime treatments that reduce wrinkles caused by the movement of muscles,” explains Dr. Waldorf. Doctors and patients have preferences based mainly on anecdotal experience, some finding that Dysport kicks in faster or that Xeomin offers a softer freeze. Overall, their similarities are greater than their differences. Results for all four Daxxify competitors last 3-5 months, versus 6-9 months with Daxxify.

Dermal fillers, like Juvéderm and Restylane, are water-binding hyaluronic acid-based injectables that add volume and contour and last anywhere from six months to two-plus years. Certain gels can be injected into fine lines, wrinkles, and folds to make them look less obvious.

Resurfacing lasers and professional-strength chemical peels refresh the skin’s surface and stimulate collagen production down deep to improve the skin’s tone and texture.

Radiofrequency microneedling devices deliver energy into the dermis to ramp up collagen and elastin synthesis for smoother, thicker skin over time.

DAXXIFY

Ron Shelton, MD

Jolene Edgar

BEFORE & AFTER PHOTOS

Ron Shelton, MD

Jolene Edgar

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	Botox nonsurgical	Dysport nonsurgical	Juvéderm nonsurgical	Restylane nonsurgical	Laser Resurfacing nonsurgical	Chemical Peel nonsurgical	Microneedling RF nonsurgical
Worth It Rating	97%	95%	91%	85%	90%	85%	76%
Average Cost	$600	$451	$890	$1136	$2810	$438	$1018
Downtime	No downtime	No downtime	No downtime	No downtime	1–12 days of downtime (depending on intensity)	Up to 2 weeks of downtime	Little to no downtime
Anesthesia	No anesthesia	No anesthesia	Topical anesthesia	Topical anesthesia	Topical anesthesia	No anesthesia	Topical anesthesia

Ron Shelton, MD

Jolene Edgar

BEFORE & AFTER PHOTOS

Ron Shelton, MD

Jolene Edgar

DAXXIFY QUESTIONS

TMJ - is Daxxify better than Botox?

How many days after applying Daxxify is it possible to touch it up?

Has anyone had luck with Daxxify for patients immune to other neurotoxins?

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