Since it was first approved by the FDA in 2002, Botox has become the Kleenex of wrinkle-relaxing injectables; a brand name virtually interchangeable with the category itself. The most common cosmetic procedure in the United States is a form of botulinum toxin type A, the most acutely lethal toxin known, a neuromodulator that can both cause disease and treat it — which, injected in small doses into the underlying muscles of the face, paralyzes the muscular function responsible for wrinkles to create smooth, furrow-free skin.
Even with newer competitors like Dysport and Xeomin on the market, Botox remains the gold standard: It's safe, it's effective, and it's proven. But this past February, the FDA greenlit Jeuveau, the first new neurotoxin approved for aesthetic usage in nearly a decade (and most likely the first ever to earn a New York Times piece about a controversial advisory board meeting-turned-launch party at the Ritz-Carlton in Cancun).
Despite being structurally identical to the others (it's even branding itself as #NEWTOX), Jeuveau is slated to be sold at a slightly lower price point as it rolls out in doctors' offices this summer, and it's poised to give its predecessors a run for their money — literally.
So, what's the difference between Jeuveau and Botox?
Like Botox, Dysport, and Xeomin, Jeuveau is used to temporarily improve the appearance of frown lines between the eyebrows — technically called the glabellar lines, but often referred to as the "11s." (Off-label, wrinkle relaxers are also used to treat other areas, like crow's feet around the eyes and smile lines.) Like Botox, Jeuveau has a molecular weight of 900 kDa, but they're produced in different facilities and are derived from different strains of the same toxin. (Botox, or onabotulinumtoxinA, is made by Allergan in Westport, Ireland; Jeuveau, or prabotulinumtoxinA, comes out of Seoul, South Korea.) The risks and potential side effects listed by the companies are also identical.
The main draw for consumers is that Jeuveau's parent company, Evolus, has announced plans to price the product at a premium; outside analysts estimate a 20-30% price reduction on the market overall. Whereas Botox has medical indications (treating migraines, etc.), and was in fact first used in the medical market before it was approved for cosmetics, Jeuveau is purely cosmetic and not subject to any insurance coverage or reimbursement. Skirting medical-industry vetting saves the company and providers money, and patients by extension. The company is also offering customer incentives, including a $75 consumer coupon (called "#NEWTOXNOW") launching July 1 and a full loyalty program on the way.
Then there's the marketing strategy, which is perhaps most essential of all to understanding why Jeuveau is rocking the neurotoxin world, and how Evolus predicts it will gain a competitive advantage. "The most novel thing about Jeuveau is its unique marketing strategy — targeting younger millennials in a fresher way, with emojis, an app, diverse models, and lots of pink," says Lara Devgan, MD, a New York City plastic surgeon and RealSelf chief medical officer who attended the industry event in Cancun.
In fact, Dr. Devgan says, the main reason that patients are curious about Jeuveau in the first place is because they've seen its marketing efforts. "I don’t think Jeuveau is converting current Botox patients, necessarily," she says. "Rather, I suspect that it is appealing to a whole new group of consumers that is aging into the aesthetic marketplace today."
Is one wrinkle relaxer "better" than the other?
In a word, no. "Each wrinkle relaxer on the market has a similar effect but slightly different personality — not necessarily better, but just different from others," says celebrity cosmetic dermatologist and PFRANKMD & Skin Salon founder Paul Jarrod Frank, MD, who has not yet used Jeuveau nor is affiliated with the brand. "I use all of them regularly, often at the same time on the same patient. Jeuveau certainly won't replace the other neuromodulators."
If there's one thing about Jeuveau that's "better" than the mainstays it'll be competing with, it's the affordability. "While cost is important, we do not want to sacrifice quality," says dermatologist and Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital Joshua Zeichner, MD, who is not currently affiliated with Allergan but has worked as a consultant and speaker for the brand in the past. "Different manufacturing processes can affect the quality of a product, its effectiveness, and its safety. One thing that history tells us is that even though ingredient lists are identical, two products may perform very differently in the real world."
For what it's worth, the Allergan factory that produces Botox is notoriously meticulous, a 61-acre fortress with 25 years of neurotoxin-making history behind it. The company isn't exactly forthcoming about the process, which hasn't changed since it was first approved by the FDA as a medical product to treat eye-muscle disorders in 1989; in fact, it's top secret. Evolus is similarly tight-lipped, though claims in its press release that Jeuveau is produced in a modern "state-of-the-art facility" using a trademarked purification method known as Hi-Pure. Jeuveau received FDA approval five years after Evolus submitted a license application for its particular preparation.
As for anecdotal evidence from subjects that the results of Jeuveau may last longer than those of its competitors based on the company's initial data, Dr. Devgan, who's already using it in her practice, isn't buying it. "I think that is an inaccurate statement that represents liberties being taken with the data interpretation," she says. "There has been no research that demonstrates a statistically significant difference in duration as compared to other neurotoxins."
Where can you get Jeuveau?
Jeuveau is currently rolling out nationwide in the offices of board-certified dermatologists, plastic surgeons, and other licensed medical professionals; as always, exact prices will vary between doctors. Some providers are already using it, so it's worth asking your doctor if you're interested — even if their invite to the Ritz got lost in the mail.