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Botulinum Toxin is the most common cosmetic procedure performed worldwide, with more than 7.4 million people receiving it in the US alone. First researched In the 1950s, it was discovered that it could also relax frown lines. Therefore, Botox cosmetics were approved by the FDA in 2002 for the treatment of glabellar lines. We have been treating patients with this in my practice since its release. 

A number of other neurotoxins have been approved since the  Botox brand. Dysport was released in 2009, Xeomin in 2011, and Juveau in 2019. Like Botox, these are all short-acting neurotoxins, but they didn’t offer any additional benefits. 

I first saw a short presentation by Michael Kane on a topical Botox being tested by Revance in 2011. They were experimenting with a topical neurotoxin that could be applied to the skin and used special custom peptides that allowed the Botulinum toxin A (BoNT/A) to be absorbed through the skin. This never made it to the market but someone discovered that this dramatically improved the effectiveness and duration when injected and Daxxify was born. 

Why is Daxxify Important?

Current neuromodulators on the market last 3-4 months on average. And while 45% of physicians believe that patients follow their injection interval recommendations every 3-4 months, studies show that only 13% of patients actually are able to do this. due to busy work and family schedules.

With the current treatments only lasting 3-4 months on average, patients look great immediately after their treatment but then it wears off before they can return. They have peaks and valleys in their appearance. This effectively is leaving many patients untreated for 4-6 months out of every year.

Studies have shown that 90%of patients want a treatment that lasts longer and 2/3 of doctors say they would switch to a longer-lasting neuromodulator to offer a more consistent correction of appearance if available. When I ask my patients if they would like a long-acting neuromodulator they look at me with a smile and say, “Dr. Hall, we really like coming to see you, but why would I want a shot 3-4 times a year when I could get it only twice a year!?” 

With Daxxify, patients can enjoy results for 6 months and up to 9 months in some patients! Daxxify is also the first and only long-lasting peptide-enhanced neuromodulator with the same botulinum toxin (BoNT/A)  at the core as Botox.

How Does Daxxify Work?

Peptides are short chains of amino acids linked by peptide bonds. Long chains of amino acids are called proteins. Botulinum toxin is formulated with a custom peptide and with polysorbate, buffers, and sugars. The custom peptide in Daxxify is a sequence of 35 amino acids. This peptide binds to the botulinum toxin A ( Bont/A) and stabilizes it, allowing for the elimination of human serum albumin. This keeps the Bont/A from sticking to the glass of the vial and syringe and prevents the Bont/A from clumping together, stabilizing it. 

Traditional neurotoxin attaches to the nerve cell and is taken in, temporarily blocking the nerve/muscle junction. But it doesn’t stick very well, and like Teflon on a pan, it gets washed away by the normal fluids around cells.

The custom peptide in Daxxify is highly positively charged and helps anchor the BoNT/A molecule to the negatively charged cell membrane. Like static electricity, it acts like velcro to hold the BoNt/A molecule to the cell longer, which allows more to be taken in by the nerve cells.

There is no human serum albumin in Daxxify, unlike the other neurotoxins. Although there has been no reported disease transmission with the human serum albumin in the current neurotoxins, it’s nice not to need any human or animal products in your treatment.

Both Botox and Daxxify have similar amounts of core neurotoxin (0.18 ng) in their respective glabellar line dosage ( 40 units Daxxify and 20 units Botox). It’s important to note that units of neurotoxins are not interchangeable. One unit of Daxxify is not equal to one unit of Botox or one unit of Dysport. 

How Do We Know Daxxify Lasts?

A large study (the Sakura study) was performed on more than 2,600 patients who received a total of 4,200 treatments looking at the treatment of frown lines in the glabellar line area, sometimes called “the 11’s”.  

The median duration of response was 6 months. 80% of patients had no or minimal wrinkles at 4 months and 50% of patients still had no or minimal wrinkles at 6 months after their treatment. And In some patients, the effect lasted up to 9 months. 

How Do We Know Daxxify is Safe?

The safety profile of Daxxify was found to be essentially identical to Botox. It was generally well tolerated and no serious treatment-related adverse events were reported. The most common adverse reactions were:

• Headache in 6% vs 2 % in the placebo group. 
• Eyelid ptosis in 2% (Drooping of the eyelids/the same as reported in studies with Botox).
• Facial weakness in 1%. (This was a broad term and included 1 patient with a “Spock brow “on one side and 4 patients with weakness of the forehead muscles.

Common reactions included:

• Injection site pain in 4%. 
• Injection site redness in 3%.
• Swelling in 2%.
• Bruising in 1%.
• A bump at the injection site is less than 1%.
• Itching at the injection site is less than 1%.

The incidence of adverse reactions did not increase with multiple treatments.  

Daxxify may be better for patients who have first tried a short-acting neuromodulator such as Botox. Because the effect with Daxxify may last up to twice as long, it’s probably best to make sure that you like the effects of the short-acting neurotoxin with the specific injection pattern first. Once you are happy with the injection pattern with the doctor that you have established a relationship with it may then be the best time to switch over to a long-lasting neuromodulator. 

While pricing hasn’t yet been released, Daxxify is expected to cost more than treatment with a short-acting neuromodulator such as Botox/Dysport/Xeomin or Juveau.  

Contact Us Today

Daxxify is expected to be more generally available in the second quarter of 2023 but will be available at the end of December in selected practices. We are excited to welcome Daxxify, the first and only peptide-enhanced long-lasting neuromodulator. Contact our Stoneham, MA office today to learn more.