QDo you have a favorite neuromodulator, or is it case dependent?

Nina Copeland, APRN, FNP-C, CANS

Nina Copeland, APRN, FNP-C, CANS


While multiple studies show that all FDA currently approved toxins have similar effects, in my practice, I find deciding which to use is very case dependent. I personally do not have a favorite neuromodulator however I do lean towards specific neuromodulators for specific concerns and desires. For example, if I have a very cost-conscious patient then I may just use whichever neuromodulator has the most coupons/rebates/discounts at the time. If a patient complains about longevity, then I will likely offer Daxxify which has the longest FDA approved duration. If a patient is very nervous about side effects or has safety concerns, then I reach for Botox because it has been in our hands the longest, so it has the most safety data and I have the most experience with that specific neuromodulator. If I have a patient that really wants to keep more movement, I reach for Jeuveau instead of the technique of some injectors which is injecting less units. If I have a patient that maybe wants more relaxation for a longer period or says they want “frozen” then I might offer them Dysport. Sometimes patients just want to switch, and I have no problem in my practice injecting Botox then 4 months later injecting Dysport then 4 months later Xeomin then 4 months later Jeuveau if the patient just asks me to try different neuromodulators so they can find their favorite.

Ultimately an experienced injector can get very similar results with all the neuromodulators. It’s important to remember it’s not the injection, it’s the injector that gets great results. My recommendation to novice injectors is learn one neuromodulator and how it acts really well first, and then slowly add each into your practice one by one to learn all the small differences of each option. In my experience the following is always true. First, most injectors can see the nuances of each product, but most patients cannot. Secondly, most patients will judge you off the experience you gave not the results you delivered. Lots of new neuromodulators are trying to work their way to the states so we will all be learning them together likely for the rest of our careers! How exciting!