Botox alternatives: every FDA-approved wrinkle relaxer compared (Botox, Dysport, Xeomin, Jeuveau, Daxxify, Letybo)

A neurotoxin — also called a wrinkle relaxer or neuromodulator — is an injectable prescription drug that temporarily reduces muscle activity in the area where it is placed.

Botulinum toxin blocks the release of acetylcholine, the chemical nerve endings use to tell a muscle to contract, by cleaving a protein called SNAP-25.

The result is a partial, localized reduction in muscle activity, and the effect is temporary: the label explains that the muscle slowly regrows its nerve connections (reinnervation), which reverses it.

Because these are drugs, not cosmetics, each brand has an FDA label that names the exact areas it is approved to treat, the dose for each, and the warnings — which is why "which brand" is a real question rather than a marketing one.

Cleveland Clinic describes botulinum toxin as treating dynamic wrinkles, the lines that appear when a muscle contracts, as in frowning or smiling, and notes that people whose lines stay deep even at rest may benefit from adding a filler.

The category is large.

The American Society of Plastic Surgeons' 2025 Procedural Statistics report says neuromodulator injections (it names Botox, Dysport, Letybo, Xeomin, Jeuveau and Daxxify) accounted for about half of all minimally invasive procedures performed in 2025, with hyaluronic acid fillers another 30%.

For context: the Botox label states there have been no definitive serious adverse event reports of distant spread of toxin effect with dermatologic use at the labeled cosmetic doses (20 units for frown lines, 24 for crow's feet, 40 for forehead lines treated with the frown lines) or 100 units for underarm sweating — a statement scoped to those labeled doses, not to off-label areas or higher doses.

Six botulinum toxin products hold US cosmetic approvals, and the six labels are not the same.

Each names its own areas, its own doses and its own limits, so a brand comparison has to start from the table below.

Botox is the category's original.

The toxin was first approved in the US in 1989; the cosmetic frown-line approval came on April 12, 2002; crow's feet followed on September 11, 2013; forehead lines on October 2, 2017; and platysma bands on October 18, 2024 — which makes Botox Cosmetic the only US toxin currently labeled for the neck bands. Xeomin is the only other brand whose label now covers all three upper-face areas: after its July 20, 2011 frown-line approval, its label was expanded in July 2024 to simultaneous treatment of glabellar, forehead and crow's-feet lines at up to 64 units.

Two names, one drug: Botox and Botox Cosmetic contain the same active ingredient in the same formulation but carry different labeled indications — underarm sweating, for example, is a therapeutic Botox label use, not a Botox Cosmetic one.

Read the labels closely and the limits are blunt. Dysport's cosmetic indication stops at frown lines and is limited to adults younger than 65. Jeuveau's boxed warning states outright that it is not approved for any condition other than glabellar lines.

Daxxify's frown-line approval is its only cosmetic indication — its other approval, from 2023, is cervical dystonia, a medical condition — and Letybo's label covers frown lines alone.

The cosmetic uses you will see advertised beyond these — lip flips, jaw (masseter) slimming, brow lifts, bunny lines, gummy-smile treatment, "traptox" — are off-label: none of those areas is on any current US label for any of the six brands, whichever one a practice uses.

A seventh product is in the pipeline but not approved.

As of October 16, 2026, we found no FDA approval of Galderma's relabotulinumtoxinA (Relfydess); Galderma announced on February 2, 2026 that the FDA had accepted its resubmission for frown lines and crow's feet.

Galderma says the product showed onset as early as day 1 and six-month results in its READY trials — a manufacturer claim about a product that has no US approval, not a label statement.

The brands also differ chemically, in ways that matter to some patients.

Botox Cosmetic and Dysport carry their toxin alongside accessory (complexing) proteins; Xeomin is purified to the 150 kDa neurotoxin without those accessory proteins; Daxxify is formulated with a 35-amino-acid peptide excipient (RTP004) and contains no human albumin; Dysport contains human serum albumin and lactose; Jeuveau is a botulinum toxin type A complex with human serum albumin.

Storage differs too: unopened Botox Cosmetic must be refrigerated at 2-8°C (36-46°F), unopened Xeomin stores at or below 25°C (77°F) with no refrigeration required, and Daxxify may be kept at room temperature or refrigerated.

Those formulation differences have fueled "antibody" and "resistance" marketing, and the label data are low-rate: in Botox Cosmetic crow's-feet trials, 1.5% of 916 treated subjects developed binding antibodies and none developed neutralizing antibodies, and across 2,649 Xeomin clinical-trial patients, 0.2-0.3% developed or tested positive for neutralizing antibodies.

Neither figure is a head-to-head comparison — the Xeomin label makes no immunogenicity claim versus other toxins, so "antibody-proof" is not a claim any label supports.

One allergy difference is printed on a label: Dysport is contraindicated in people allergic to cow's milk protein, because it may contain trace amounts.

Onset. The Botox Cosmetic label says muscle relaxation in the frown-line area typically begins 1 to 2 days after injection and builds through the first week.

The direct head-to-head evidence is a single trial: a 2025 randomized study in JAMA Dermatology (143 women, at a single center) compared Botox 20 units, Dysport 60 units, Jeuveau 20 units and Xeomin 20 units for the frown area and found Dysport and Jeuveau fastest at day 3, with Jeuveau and Xeomin still measurably different from baseline at day 180 — one study, measuring muscle strain in three dimensions rather than standard wrinkle scores, so a data point rather than a ranking. (Dysport's 60 units was that study's dose; its label dose for frown lines is 50.)

Where labels are silent, manufacturers supply numbers, and theirs should be read as marketing: Galderma's Dysport site says results may last up to 5 months and cites post-hoc, patient-reported trial analyses with a median time to response of 2-3 days — the FDA label itself says up to four months — and Evolus says Jeuveau results can start in as little as two days and last up to four months, citing a phase 3 trial.

Longevity. The labels are specific where they are specific.

The Botox Cosmetic label gives 3 to 4 months for frown lines, and the Dysport label says its effect may last up to four months.

Dysport, Xeomin, Jeuveau and Daxxify all cap retreatment at no more often than every three months, and Botox Cosmetic's label says the safety and effectiveness of dosing more often than every 3 months has not been clinically evaluated.

Daxxify is the outlier.

Its label contains no duration statement; the "six months" reputation rests on Revance-sponsored trials.

In the pivotal SAKURA 1 and 2 trials (609 adults given 40 units), frown lines stayed none or mild for a median of 24.0 and 23.9 weeks, and a pooled analysis reported a median of 24.0 weeks.

In the two label trials (406 treated with 40 units), 74% achieved treatment success at week 4, against 0% on placebo, with follow-up of at least 24 weeks.

Those are trial medians, not label claims and not a promise for any individual.

Price. Toxins are priced per unit or per treatment area, and the labels' recommended doses give a unit count for a standard treatment of each area — which is where cross-brand comparison breaks down.

The labels direct 20 units of Botox Cosmetic, Xeomin, Jeuveau or Letybo for frown lines, 50 units of Dysport and 40 units of Daxxify, and those units are not interchangeable (more on that below), so a per-unit price for one brand is not a per-unit price for another.

There is no verified national average to anchor the comparison either: the ASPS 2025 statistics report gives procedure shares but omits average fees for minimally invasive work, and we could not confirm a current national average fee for neuromodulators from primary sources.

Prices are set clinic by clinic, so ask for the total for your planned area, with the brand and the unit count named.

Loyalty programs attach to these drugs, with terms set by each maker.

Evolus says its Club Evolus membership covers 20 units of Jeuveau per treatment with at least 90 days between treatments, and its site advertised $40 off every 90 days through Evolus Rewards as of October 2026.

Allergan Aesthetics' Allē and Galderma's ASPIRE exist as well, but we could not verify their current terms, so confirm any point values or discounts directly with the practice running them.

They do not, and that is not an editorial caution — it is printed on the labels.

Botox Cosmetic's label states that its units cannot be compared to or converted into units of any other botulinum toxin product, and Dysport, Xeomin and Daxxify say the same in their own labels.

The Xeomin and Daxxify labels tie their units to their own product-specific test methods, so a unit measures that product, not a universal amount of toxin.

The familiar dose ratios come from studies, not labels, and mostly from neurology rather than aesthetics.

A 2016 systematic review of head-to-head trials in movement disorders concluded that a Botox-to-Dysport dose ratio between 1:2.5 and 1:3 gives comparable safety and efficacy, and a 2016 review in Toxins reported Xeomin was as effective as Botox with a comparable adverse-event profile at a 1:1 dose ratio.

No label endorses either figure — there is no official way to convert one brand's units into another's.

The labeled doses make the same point concretely: for the same frown-line area, the labels direct 20 units of Botox Cosmetic, Xeomin, Jeuveau or Letybo, 50 units of Dysport and 40 units of Daxxify.

Different numbers, same area — because the numbers are different currencies, not different amounts of one ingredient.

Switching brands carries its own label caution.

Botox Cosmetic's label says the effect of giving different botulinum toxin products at the same time or within several months of each other is unknown, and that excessive weakness may be worsened by giving another toxin before a previous one has worn off.

And because the units do not convert, a switch cannot carry the old unit count across — the new brand is dosed from its own label.

No — not in the way the marketing implies.

Products pitched as "natural Botox" or "Botox-like" are creams and serums marketed around peptides such as acetyl hexapeptide-8 (argireline).

A 2025 review found these are cosmetic ingredients with limited skin penetration, and that whether argireline even reaches the nerve-muscle junction it would need to affect remains uncertain.

They are not botulinum toxin.

No topical product is FDA-approved to relax wrinkle muscles — that approval category belongs to the six injectables — and the published evidence for topical peptides is limited. "Alternative to Botox" on a skincare label is marketing positioning, not an FDA finding, and not evidence that a cream works like an injection.

Which brand a practice carries is a purchasing decision each one makes for itself, and it is the one thing this page cannot tell you — the way to know is to ask before you book.

The brand matters for a concrete reason: it decides whether your treatment area is on a label at all.

Crow's feet and forehead lines are on the labels of only Botox Cosmetic and Xeomin; the neck bands only on Botox Cosmetic; Dysport's cosmetic label stops at frown lines and at adults younger than 65; Jeuveau, Daxxify and Letybo are frown-line products on their US labels.

Price quotes only compare cleanly when they name the same thing: brand, unit count and total for the planned area.

Because units do not convert between brands, the same per-unit figure quoted for Dysport and for Botox is not the same purchase — and a quote that names only an area ("frown lines, one price") is not one you can check against a label dose.

Here is what to ask before you book:

If the answers are vague — no brand named, no unit count, a price that only works out per visit — those are reasons to keep looking, not details to trade away.