Botulinum neurotoxins (BoNTs) are cornerstone agents in both cosmetic and therapeutic medicine, with decades of research supporting their efficacy and safety for wrinkle reduction, muscle spasticity, dystonia, and pain management. At Cosmetic Injectables Center Medspa, all neurotoxin procedures are performed by certified expert injectors under the direct, on-site supervision of Dr. Sherly Soleiman, MD, a board-certified physician and national leader in medical aesthetics.

What Are Botulinum Neurotoxins?

Botulinum neurotoxins are purified proteins derived from Clostridium botulinum. They temporarily block acetylcholine release at neuromuscular junctions, causing reversible muscle relaxation. This mechanism, elucidated in the mid-20th century, underpins both their cosmetic and medical applications (PMC12323300).

Historical Perspective

The therapeutic journey of BoNTs began with 18th-century botulism outbreaks and advanced through key milestones:

1822: Justinus Kerner described botulinum toxin’s effects and theorized therapeutic uses.
1895: Emile van Ermengem isolated C. botulinum.
1940s: Arnold Burgen identified neuromuscular blockade.
1970s-1980s: Alan Scott pioneered BoNT-A for strabismus, leading to the first FDA approval in 1989 (PMC10374179).
2002: FDA approved Botox for cosmetic use in glabellar lines.

Mechanism of Action

BoNTs are zinc-dependent metalloproteases with two chains:

Heavy chain: Binds to neuronal receptors (e.g., SV2, synaptotagmin).
Light chain: Cleaves SNARE proteins (e.g., SNAP-25), blocking acetylcholine release.

This results in targeted, temporary muscle paralysis lasting 3–6 months, depending on the formulation (PMC12323300).

Clinical Applications

Cosmetic Indications

Wrinkle Relaxation: Forehead lines, glabellar lines, crow’s feet, bunny lines, chin dimpling, platysma bands (Botox for Platysma Bands FDA Approval, 2024)
Facial Slimming: Masseter reduction
Brow Lift: Subtle elevation of brow position
Lip Flip: Relaxation of the upper lip (Lip Flip)

Therapeutic Indications

Spasticity: Post-stroke, cerebral palsy, multiple sclerosis
Dystonia: Cervical dystonia, blepharospasm
Migraine Prevention: Chronic migraine (Botox for Migraines)
Hyperhidrosis: Excessive sweating (Botox for Underarm Sweating)
Pain Syndromes: Neuropathic pain, hemifacial spasm, TMJ (Botox for TMJ)

Formulation Comparison

Multiple BoNT-A formulations are FDA-approved, each with unique properties:

Formulation	Onset	Duration	Immunogenicity Risk	Primary Uses
Botox® (onabotulinumtoxinA)	3–5 days	3–4 months	Moderate	Cosmetics, dystonia, migraine
Dysport® (abobotulinumtoxinA)	2–3 days	3–5 months	Higher	Spasticity, wrinkles
Xeomin® (incobotulinumtoxinA)	3–4 days	3–6 months	Lower	Dystonia, blepharospasm
Jeuveau® (prabotulinumtoxinA)	2–3 days	3–4 months	Moderate	Glabellar lines
Daxxify™ (daxibotulinumtoxinA)	1–2 days	6 months	Lower	Wrinkles, peptide-stabilized

Key Differences:

Xeomin lacks complexing proteins, potentially reducing antibody formation (PMC12306683).
Daxxify uses a peptide stabilizer, extending duration to 6 months (FDA Daxxify Approval).
Botox remains the most widely studied and used for both cosmetic and medical indications.

Efficacy and Safety: Evidence Summary

Meta-Analyses and Clinical Trials

Study Type	Key Example	Findings	Source
Meta-Analysis	Immunogenicity in CD/Spasticity	Lower secondary treatment failure (STF) and neutralizing antibodies (NAb) with Xeomin; no STF in exclusive users	PMC12306683
Meta-Analysis	Pain in Post-Stroke Spasticity	Small-moderate late-stage benefit; no dose-response	PMC12116153
Clinical Trial	MBA-P01 vs. Botox (Glabellar Lines)	87% response; higher satisfaction with MBA-P01 at 12–16 weeks	PMC12031167
Clinical Trial	RelabotulinumtoxinA (Frown/Crow’s Feet)	6-month effect; favorable safety	Galderma News
Regulatory	Daxxify FDA Approval	Longer duration than Botox; comparable safety	FDA Daxxify Approval

Histological and Long-Term Effects

Short-Term: Muscle degeneration, reduced mitochondrial density, and bone resorption observed in animal models, with partial recovery by 4 weeks (Nature 2025).
Long-Term: Systematic reviews confirm muscle atrophy and fibrosis; rare granulomatous reactions reported (ScienceDirect 2024; Wiley 2025).
Safety: FDA boxed warnings for distant toxin spread; updated labels include ptosis and hypersensitivity (Harley Academy 2024; FDA Jeuveau).

Regulatory Updates

Daxxify approved in 2022 for glabellar lines, offering the longest duration among BoNT-A products (FDA Daxxify Approval).
Botox received expanded approval for platysma bands in October 2024 (AbbVie News).
CMS guidelines support use for FDA-labeled indications (CMS LCD).

Procedure Experience at Cosmetic Injectables Center Medspa

All neurotoxin treatments at Cosmetic Injectables Center Medspa are performed by certified expert injectors, with Dr. Soleiman providing direct medical oversight and advanced training. The team employs advanced comfort techniques, including topical numbing, vibration, and the smallest needles, to minimize discomfort and bruising. Each patient receives a thorough medical evaluation and informed consent process, with safety and natural results as the highest priorities.

“My favorite procedure is doing what makes the face look natural… Injectables are a wonderful tool to enhance a person’s confidence, but the result has the opposite effect if they look awkward and out of proportion.” – Dr. Sherly Soleiman, MD (Beverly Hills Magazine)

Internal Links to Related Procedures

Frequently Asked Questions

What are neurotoxins used for in medical aesthetics?

Neurotoxins like Botox, Dysport, Xeomin, Jeuveau, and Daxxify are used to temporarily relax muscles that cause wrinkles, treat facial lines, and address conditions like jaw clenching, migraines, and excessive sweating.

How do different neurotoxin brands compare?

Botox and Dysport offer similar durations (3–4 months), while Daxxify lasts up to 6 months. Xeomin has lower immunogenicity risk, and Jeuveau is optimized for glabellar lines. Choice depends on patient needs and clinical goals.

Are neurotoxin injections safe?

When administered by certified experts, neurotoxin injections are considered safe. Common side effects include mild swelling or bruising. Rare risks include ptosis or distant toxin spread, as noted in FDA warnings.

How soon will I see results after a neurotoxin procedure?

Most patients notice effects within 2–5 days, depending on the product. Full results typically appear within 1–2 weeks.

How long do neurotoxin results last?

Duration varies by formulation: Botox and Dysport last 3–4 months, Xeomin up to 6 months, and Daxxify up to 6 months.

Can neurotoxins be used for medical conditions?

Yes, they are FDA-approved for conditions such as spasticity, dystonia, chronic migraine, and hyperhidrosis. Each indication has specific dosing and protocols.

What is immunogenicity, and why does it matter?

Immunogenicity refers to the body’s immune response to the toxin, potentially reducing effectiveness over time. Xeomin has the lowest risk due to its lack of complexing proteins.

Are there long-term risks with repeated neurotoxin use?

Short-term muscle changes and rare bone resorption have been observed in studies, but most effects are reversible within weeks. Long-term impacts are still being studied.

Who should perform neurotoxin injections?

Only certified expert injectors under direct physician supervision should perform these procedures to ensure safety and optimal results.

Is a consultation required before neurotoxin treatment?

Yes, a comprehensive medical evaluation and informed consent are required to assess suitability and discuss risks, benefits, and alternatives.

For more information or to schedule a consultation with certified experts under the leadership of Dr. Sherly Soleiman, MD, visit Cosmetic Injectables Center Medspa in Sherman Oaks, serving the greater Los Angeles area.

Botulinum Toxin Type A in Aesthetic Medicine: Comparative Evidence on Botox®, Dysport®, Xeomin®, Jeuveau®, and Daxxify™