Botox That Lasts Twice As Long — Do I Want It?

The FDA just approved the use of a new Botox-competitive injectable that can keep a forehead frozen-smooth for a full six months. Daxxify — or Daxi, "that's what everyone's going to call it," says dermatologist and injector Corey L. Hartman, MD, FAAD — is the latest treatment option for the relaxation of fine lines and wrinkles caused by facial-muscle movement.

Though, in an attempt not to sound like an infomercial, we're breaking down Daxi in its simplest tell-your-friend-at-drinks terms, so you can determine if six-month Botox is really a good idea for you (some people are better suited than others).

Daxxify is manufactured by biotech company Revance Therapeutics. The New York Times asserts that it represents "the first major advance in facial injections in decades." It's an injectable botulinum toxin that's stabilized differently than Botox Cosmetic and Dysport, the most popular injectable products currently in the medical-aesthetic space.

Botox and Dysport have an almost identical makeup: botulinum toxin stabilized by protein. Daxi is also a form of botulinum toxin but instead of protein, Daxi relies on a stabilizing peptide that helps increase its longevity. "The stabilization by the peptide is what's thought to be responsible for the increased duration," Dr. Hartman explains. "That peptide is thought to help bind the complex [botulinum toxin] to the cell membrane. You get a better absorption and a longer duration. The duration is the thing — that's what everyone is super excited about."

The claim is that Daxxify lasts 6 months, which, for context, is impressive as most practitioners find that Botox and Dysport both last 3-4 months on average. If your doctor goes with Xeomin (another option popularized as "naked Botox" because it has no protein or peptide for stabilization), it may lose its effect even faster.

However, we take Daxi's 6-month claim with a pinch of salt because it's been provided by the drug's manufacturer. Daxi's freshly FDA approved, so it's not in medical offices just yet. So, the only data we have relies on Revance Therapeutics' clinical trials. Those results showed patients had a 6-month median duration in results, with some even maintaining treatment results until 9 months. Sounds promising, but we'll have a better concept of results — the pros and cons as compared to other injectable options — once doctors start injecting their Botox users with Daxi and seeing their results.

According to Dr. Hartman, he'll recommend Daxi to patients who are dissatisfied with the duration of results of their current routine Botox, Dysport, or Xeomin. For injection sites, botulinum toxin is usually used on the upper part of the face — forehead, brows, 11s — but also can be used elsewhere, like the masseter muscles (aka TMJ Botox) or above the lip for a Lip Flip.

Daxi's potential is especially promising for people looking to sustain relaxed forehead muscles. "It's is the area that bothers people the most — definitely the area that 27 year olds come in asking about treatment for," explains Dr. Hartman. "It's also one that's the most difficult to perfect and to get a good duration of results."

Most longtime Botox or Dysport users are going to be good candidates for Daxi, says Dr. Hartman. "My patient this morning, a lady who I've been seeing forever, we injected her about four weeks ago with Dysport. But for whatever reason, she has more movement in her forehead than she wants. She would be someone who I'd say, 'Hey, let's try this option.'"

Dr. Hartman also points to people who "go through Botox faster," because they have high metabolism as good candidates for Daxi. Also, there are some people who don't respond to Botox or other products at all, so they might consider Daxi. Of course, this is a conversation even a longtime Botox-user would have to have with a trusted physician because like all forms of botulinum toxin, Daxi is irreversible and you have to live with its effect until your body metabolizes it.

A first-time Botox user might opt out of Daxi and instead consider a shorter-acting option (Botox Cosmetic, Dysport, or Xeomin) just to see how your body reacts to botulinum toxin. "If someone is naive to everything, maybe I wouldn't start with this, just because the duration is longer and if you don't like it for whatever reason, there's no way to reverse any of these toxins." Dr. Hartman explains.

The manufacturer has not released the cost of Daxi yet. "Price is going to be interesting," Dr. Hartman offers, "there are so many variables that determine cost: units, patient variation, locations in the country, some physicians charge a premium. I think the beauty here is that Daxi is something novel and different. But anyone expecting it to be cheaper [than Botox] will probably be disappointed. If you've spent years researching a product that was going to revolutionize the industry, why would you make it cheaper?"

Still, there's the argument that you could pay more per injection appointment, but would pay less over time because the results last longer. "People are saying they'd pay extra to not have to come in as much," Dr. Harman adds. "Time is money."

If you're a Botox user already, ask your provider about Daxi to learn if/when they plan to start offering it to patients. "I should have Daxxify in the next few weeks," Dr. Hartman tells me (his practice is in Birmingham, Alabama). Though, in the mass market, he tells me that a better estimate is early 2023.

It's important to note that Botox currently serves as the Kleenex brand of injectables — the name that people know — but Botox Cosmetic is not necessarily the favored product anymore. "Everyone says 'I want Botox' but when I explain that something else, maybe Xeomin, might be a better option for them, they're like, 'Whatever.' They just want the outcome," Dr. Hartman explains.

Xeomin is an alternative to Botox that's a little more if-you-know-you-know. It's a more "purified" version of botulinum toxin (remember, no stabilizing protein or peptide). Gwyneth Paltrow uses it (and is paid to say so). Personally, for my first injection, I might start here, because I don't know that I want a six-month commitment.

Dr. Doft currently uses Dysport on all of her 'Botox' patients because she finds it has a faster onset. "Given that my practice is in Manhattan, patients want their Botox to work in a New York minute and Dysport works a few days before the other options. I only use Botox when a patient specifically requests it." There's an active community on Botox TikTok that also prefers Dysport.

But now there's Daxi, which offers something else entirely: not a striped-down toxin or something that works fast and smooth, but longer-lasting results. If that's what you want, it's worth talking to your doctor about. "Anytime there's something novel — that's actually novel — it's exciting," offers Dr. Hartman. "We're going to start trying it with patients and then we can follow up and let you know how it's going."