A Brief History of Neuromodulator and Preservative Proteins

The advent and distribution of Botox® forever elevated aesthetic plastic surgery by providing a safe, reproducible, and reliable treatment for the prevention and removal of small to medium facial wrinkles. Botox was originally released over 30 years ago, and since that release, there have been many new additions to the market for treatment.

Effective Wrinkle Reduction with Advanced Safety

The first such competitor was Dysport®. This injectable has a good track record of safety and efficacy in the reduction of wrinkles, but it was patterned similarly to Botox in that it was kept refrigerated and had a litany of preservative proteins within the drug. Botox started the trend of preservatives in its formulation, and similarly, Dysport followed with the same overall strategy.

The liability of these preservatives is three-fold:

They are not necessary for the intervention to work. Botox and Dysport do not need the preservatives to create their effect, nor does the preservative increase or improve outcomes. It is only used to maintain product integrity during shipping.
As we use these neuromodulators (Botox, Dysport), patients develop a tolerance not to the active drug component. Rather, they develop a resistance to the preservatives. This resistance works against the drug’s efficacy over time, as your body will attack the preservatives before the Botox starts to work, removing the ability of the Botox or Dysport to work. This is mediated by the production of antibodies to the preservatives in Botox or Dysport, not by producing antibodies to the actual Botox or Dysport molecule that is hidden by the preservative.
Because of the preservative proteins, the preservative must release the Botox or Dysport before it starts to work. That’s why it takes a “week or so” for your Botox to “kick in.”

Advanced Neuromodulators for Longer-Lasting, Preservative-Free Results

Due to this clinical behavior, Merz Aesthetics produced Xeomin®. Unlike any other neuromodulator, Xeomin has NO PRESERVATIVE PROTEINS. NONE. This allows us to take patients with resistance to preservatives and change them over to a non-preservative formulation, saving them money while re-creating the desired clinical effect. Xeomin has the exact same core molecule as Botox, but it does not require preservatives. Xeomin was a big breakthrough for nonsurgical wrinkle reduction, and it continues to be the fastest-growing neuromodulator on the market.

Now, enter Daxxify®. Daxxify is a new addition to the plastic surgery armamentarium against the aging face. With Daxxify, the company designed the preservative protein to not only protect the product before injection, but their protein can also increase the duration of outcome to almost six months in 50% of patients.

In the real world, we all want our injection results to last longer, plastic surgeons, injectors, dermatologists, medspas, all of us. Our clients want this too! This was the impetus for Revance to develop Daxxify. With this neuromodulator, the preservative protein actively stabilizes the neuromodulator, leading to a longer duration. Per their FDA approval, they can produce results that last up to six months in 50% of patients.

At Ocean Drive Plastic Surgery in Vero Beach Daxxify has been a valued partner since its initial release. We are very happy with this product, but our experience with Daxxify shows:

We have seen extended results in 40% of patients.

Daxxify appears to have greater longevity in patients over the age of 50 as compared to patients under the age of 50, but only in about 20% of patients. We have most commonly seen up to twice as long as your prior treatment longevity.

At the very least, Daxxify will always last the same as Botox or Xeomin, but in some patients, it will last longer.

Patients who use a higher dose of Daxxify will always get a longer duration of effect. This can be done without changing your cosmetic outcome through our specific injection technique that Stephanie and I developed together.

Unfortunately, we cannot determine who will get greater longevity prior to treatment. There is no test we can run to see what your durational outcome will be. The only way we have to define who gets greater duration is by treating.

This is just our experience. Others may vary, but for us, we do favor at least attempting this product in patients over 50 years of age. Daxxify is similar to other neuromodulators in that their relative risk of treatment is the same. By attempting Daxxify treatment, this will reduce your annual number of visits for neuromodulator treatments, freeing valuable time to achieve your other aesthetic goals in our treatment plan and reducing that bothersome “in between tox” movement time. Treatments in this age group are not designed to provide a frozen appearance, our goal is to preserve some natural movement with consistency and convenience.

Daxxify Specials at Ocean Drive

There are a lot of factors that determine how long your neuromodulators last, and everyone is different. Traditional neuromodulators provide, on average, three months of wrinkle reduction. Daxxify is unique to the other neuromodulators with proprietary peptides that enable the neuromodulator to bind to the treatment site longer than traditional injectables. In some instances, the median length of time is up to 6 months which is approximately up to twice as long as an equivalent dose of your previous neuromodulator. We offer three approaches at Ocean Drive:

Daxxi Dusting 79 Units or less

Like pixie, just better. This is the dusting of the cake, that fine sugar coating to take the proverbial edge off those fine wrinkles. At this dosing, Daxxify will at least perform the same as Botox or Xeomin. We recommend starting here at this level (unless you are a pro already) and growing into this new treatment paradigm.

Daxxi Lift 80 to 140 Units

Our signature brow lift is designed to elevate your brows a little longer than traditional neuromodulators. It is not designed to freeze all your movement but to raise those stubborn lids, brightening your eyes. This will brighten your eyes and work seamlessly with Upneeq. This can be done as a standalone procedure or in combination with the Daxxi Dusting below.

Daxxi-mum 140 to 200 Units

This full-face treatment is designed to minimize movement (glabella, forehead, nose, crow’s feet) for maximum time. This treatment is not designed for a frozen or plastic appearance, our goal is natural appearing wrinkle reduction with some preservation of natural movements. As well, this technique includes the Daxxi Lift effect and then marries it to maximal duration and effect.