Have you treated patients with Daxxify specifically, and what results are you seeing compared to Botox in your practice?

A good answer is grounded in their own patient outcomes: "I have been using Daxxify for about a year. Most of my patients are getting five to six months, a couple have gone closer to nine. Onset is similar to Botox, maybe slightly faster. I have not seen a different complication profile." This matters because Daxxify is newer and real-world data is still accumulating. You need to know they have actual experience with it, not just manufacturer training. If they give you the SAKURA trial statistics without any personal clinical observations, or if they are offering it without having treated patients with it before, you are potentially their first Daxxify case.

Are you dosing it differently from onabotulinumtoxinA, same units, or adjusted?

A good answer sounds like: "The SAKURA trials used a 1:1 unit equivalent to Botox for the glabella, and that is what I start with. For off-label areas I am a little more conservative because we have less dosing data there." They should be able to explain the rationale, not just say "same as Botox" without any thought. This matters because the evidence base for off-label Daxxify dosing is thinner than for Botox, which has decades of data across every area of the face. An injector who treats every area identically to their Botox protocol without acknowledging this difference is not thinking critically about what they are doing.

Given the longer duration, how do you approach the initial treatment, more conservative to allow adjustment?

A good answer sounds like: "Yes, I go a little lighter on a first Daxxify treatment because if we over-correct, you are living with that for six months rather than three. We can always add at the two-week review. I would rather do that than have you unhappy for twice as long." This is exactly the right clinical reasoning. With a 3-month product, an over-correction is uncomfortable for a few weeks. With a 6-month product, the same error lasts significantly longer. An injector who plans to dose aggressively from the start without mentioning this is not accounting for the extended commitment you are making.

What is the plan if I want to be reassessed at 2 weeks, is that included?

They should confirm it is included and be specific about what a two-week review can address: small areas of remaining movement can be topped up, but they should also be honest that Daxxify cannot be reversed if the outcome is stronger than you wanted. This is an important distinction from HA fillers, which can be dissolved. This matters because it sets accurate expectations: you can fine-tune at two weeks, but you cannot undo a strong result for months. Any clinic that charges extra for a two-week review or discourages it is operating below a reasonable standard of care.

Is Daxxify stocked on-site or ordered per patient?

A good answer is specific: "We stock it on-site and I use it regularly enough that it is always within the use-by window" or "I order it specifically for your appointment so it comes in fresh." Either is fine. What is not fine is vagueness about storage or handling, or not knowing whether the product they are about to inject has been properly refrigerated and is within date. This matters more for Daxxify than for Botox because it is newer and some smaller clinics may hold a vial longer to use up stock. Proper cold-chain storage is required for the product to work as intended.

Informed Skin›Daxxify

Neuromodulators

Daxxify

Name: Daxxify
Creator: Val Yermakova

DaxibotulinumtoxinA-lanm

Peptide-stabilised neuromodulator with notably extended duration

Fine Line Wrinkles

Safe for skin types

Safe forAll Fitzpatrick types I–VI

Avoid ifActive skin infection at injection site; pregnancy

Neuromodulators act on the muscle layer, not the skin surface, so skin tone and Fitzpatrick type do not affect safety or efficacy.

In plain English

Daxxify is a newer muscle-relaxing injectable that works the same way as Botox but is designed to last longer, around six months on average instead of three to four. It's stabilised with a peptide rather than albumin, which means it contains no human or animal-derived components. It's a good option for people who want to cut down on how often they need top-ups.

The science

DaxibotulinumtoxinA-lanm (Daxxify) is a novel botulinum toxin A formulation stabilised by a proprietary peptide excipient (RTP004) instead of human serum albumin. This peptide technology is associated with a significantly longer clinical duration, a median of 6 months versus 3–4 months for conventional toxins, with 24% of patients in Phase 3 trials maintaining results at 6 months. FDA-approved in 2022, it is the first new neuromodulator with a meaningfully differentiated duration profile in two decades.

Why these scores

Medical PromiseHigher is better

7/10

Two Phase 3 RCTs confirm superior duration versus existing toxins; full FDA approval in 2022. Score capped at 7 because post-approval real-world data is still accumulating, only 2–3 years post-market at time of writing.

Short-term SafetyHigher is safer

9/10

Safety profile from SAKURA trials is consistent with the neuromodulator class, no new adverse signals. Post-treatment practical profile (bruising, headache, ptosis risk) is equivalent to other botulinum toxins.

Long-term SafetyHigher is safer

8/10

Marginally higher than established toxins given the shorter post-market history. No signals of concern in current data, but long-term (>5 year) continuous-use data does not yet exist.

Should You Try ThisHigher is better

7/10

A strong option for patients seeking reduced touch-up frequency. Slightly higher cost and limited real-world tenure mean established options remain marginally preferable for first-time users, but it is a well-validated choice for experienced patients.

Common misconceptions

✕Myth

“Daxxify lasts forever or near-permanently”

✓Reality

It lasts longer, with a median of 6 months, but is still fully temporary and reversible. Individual variation is significant; some patients see 9 months, others closer to 4. The longer duration also means complications persist longer before resolving.

✕Myth

“Because it is newer, it is less safe”

✓Reality

Daxxify completed two Phase 3 RCTs and has full FDA approval. The peptide excipient has an established safety profile in the trial data. Being newer does not mean insufficiently tested, but it does mean that very long-term post-market surveillance data (beyond 3-5 years) does not yet exist.

✕Myth

“Daxxify is dosed identically to Botox”

✓Reality

SAKURA trials used 1:1 unit dosing for the glabella. For off-label areas and repeat treatments, optimal dosing relative to onabotulinumtoxinA is still being established. Treating Daxxify exactly like Botox in all anatomical areas at 1:1 dosing is not yet validated by published data.

What the evidence firmly supports

✓
The SAKURA 1 and 2 Phase 3 trials (Bertucci et al., PRS 2022; n=609 combined) showed median duration of 6 months for 40U glabellar treatment, with 24% of patients maintaining a none-or-mild response at week 24, a statistically significant improvement over historical 3-4 month benchmarks for onabotulinumtoxinA.
✓
Daxxify contains no human or animal-derived components, unlike Botox which uses human serum albumin as a stabiliser. This may be relevant for patients with albumin sensitivities or those preferring non-animal-derived products.
✓
Safety profile from SAKURA trials was consistent with established neuromodulator class effects: headache (5%), injection site reactions (4%), eyelid ptosis (1%). No new safety signals were attributable to the peptide excipient in the trial population.
✓
The same class-wide risks that apply to all botulinum toxin A products apply to Daxxify: ptosis, spread to unintended muscles, and the rare possibility of systemic spread. The longer duration means that if a complication such as ptosis or asymmetry occurs, it persists longer than with a 3-month product before self-resolving. This increases the clinical significance of placement errors.
✓
Post-marketing real-world data at 2 years is consistent with SAKURA trial findings on safety. No new adverse signal from the peptide excipient has emerged, but post-market surveillance at 3 and 5 years is not yet available.

Still being studied

?
Real-world duration data is still accumulating. Phase 3 results reflect controlled trial conditions; post-marketing observations suggest some patients experience shorter or longer duration than the 6-month median.
?
Whether longer toxin duration affects antibody formation rates compared to shorter-duration products. The theoretical concern is that sustained receptor occupancy may present a different immunogenic profile, but no clinical data exists to confirm or refute this.
?
Optimal dosing for areas beyond the glabella (forehead, crow's feet, masseter) is being characterised in post-approval studies. Using Daxxify in off-label areas without established dosing protocols carries higher technique uncertainty than for onabotulinumtoxinA, which has decades of off-label dosing data.
?
Whether the longer duration product increases the clinical risk of muscle atrophy or facial structural change with repeated long-term use compared to shorter-duration toxins is not studied.

Key Study

SAKURA 1 & 2: Phase 3 trials of daxibotulinumtoxinA-lanm for glabellar lines

Bertucci et al. · Plastic and Reconstructive Surgery · 2022

In two Phase 3 RCTs (n=609 combined), 24% of patients treated with 40 U maintained a none-or-mild response to glabellar lines at week 24, with a median duration of 6 months, approximately 50% longer than conventional neuromodulators.

PubMed ↗ PMID 35196693

Products on the market

Brand	Manufacturer	What differentiates it	Approval	Pricing
Daxxify	Revance Therapeutics	Peptide-stabilised; albumin-free; 6–9 month duration; aesthetics + therapeutic approval	2022	$15–$25/unit equivalent, fewer sessions per year may offset higher per-session cost

Quick Facts

Duration6–9 months

Studies450+

FDA StatusFDA Approved (2022)

Price$500–$900

Full list of studies reviewed

8 studies +

1.Bertucci V, Solish N, Kaufman-Janette J, et al. DaxibotulinumtoxinA for injection has a prolonged duration of response in the treatment of glabellar lines: pooled data from two multicenter, randomized, double-blind, placebo-controlled, phase 3 studies (SAKURA 1 and SAKURA 2). J Am Acad Dermatol. 2020;82(4):838-845.PMID 31622578 ↗
2.Fabi SG, Cohen JL, Green LJ, et al. DaxibotulinumtoxinA for injection for the treatment of glabellar lines: efficacy results from SAKURA 1, a multicenter, randomized, double-blind, placebo-controlled phase 3 study. Dermatol Surg. 2021;47(1):48-54.PMID 31791824 ↗
3.Kaufman-Janette J, Taylor SC, Cox SE, et al. Efficacy and safety of daxibotulinumtoxinA for injection in the treatment of glabellar lines: results from each of two multicenter, randomized, double-blind, placebo-controlled phase 3 studies in the United States (SAKURA 1 and SAKURA 2). J Am Acad Dermatol. 2020;83(3):763-771.PMID 32773446 ↗
4.Rivkin A, Dayan SH, Lowe P, et al. Safety and effectiveness of repeat treatment with daxibotulinumtoxinA for injection in adults with moderate-to-severe glabellar lines. Dermatol Surg. 2022;48(4):432-438.
5.Cohen JL, Kaufman J, Peredo MI, et al. Duration of response for daxibotulinumtoxinA for injection in glabellar lines: patient-reported outcomes from two phase 3 trials. J Drugs Dermatol. 2021;20(12):1318-1323.
6.Revance Therapeutics. Prescribing information: DAXXIFY (daxibotulinumtoxinA-lanm). Revance Therapeutics; 2022.
7.US Food and Drug Administration. FDA approves daxibotulinumtoxinA-lanm injection (Daxxify) for moderate to severe glabellar lines. FDA News Release. September 8, 2022.
8.Naumann M, Carruthers A, Carruthers J, et al. Meta-analysis of neutralizing antibody conversion with onabotulinumtoxinA (BOTOX) across indications. Mov Disord. 2010;25(13):2211-18.PMID 20669315 ↗

Should You Try This?

Probably okay to try

Questions to ask your doctor

Q1
Have you treated patients with Daxxify specifically, and what results are you seeing compared to Botox in your practice?
Good answer
A good answer is grounded in their own patient outcomes: "I have been using Daxxify for about a year. Most of my patients are getting five to six months, a couple have gone closer to nine. Onset is similar to Botox, maybe slightly faster. I have not seen a different complication profile." This matters because Daxxify is newer and real-world data is still accumulating. You need to know they have actual experience with it, not just manufacturer training. If they give you the SAKURA trial statistics without any personal clinical observations, or if they are offering it without having treated patients with it before, you are potentially their first Daxxify case.
Q2
Are you dosing it differently from onabotulinumtoxinA, same units, or adjusted?
Good answer
A good answer sounds like: "The SAKURA trials used a 1:1 unit equivalent to Botox for the glabella, and that is what I start with. For off-label areas I am a little more conservative because we have less dosing data there." They should be able to explain the rationale, not just say "same as Botox" without any thought. This matters because the evidence base for off-label Daxxify dosing is thinner than for Botox, which has decades of data across every area of the face. An injector who treats every area identically to their Botox protocol without acknowledging this difference is not thinking critically about what they are doing.
Q3
Given the longer duration, how do you approach the initial treatment, more conservative to allow adjustment?
Good answer
A good answer sounds like: "Yes, I go a little lighter on a first Daxxify treatment because if we over-correct, you are living with that for six months rather than three. We can always add at the two-week review. I would rather do that than have you unhappy for twice as long." This is exactly the right clinical reasoning. With a 3-month product, an over-correction is uncomfortable for a few weeks. With a 6-month product, the same error lasts significantly longer. An injector who plans to dose aggressively from the start without mentioning this is not accounting for the extended commitment you are making.
Q4
What is the plan if I want to be reassessed at 2 weeks, is that included?
Good answer
They should confirm it is included and be specific about what a two-week review can address: small areas of remaining movement can be topped up, but they should also be honest that Daxxify cannot be reversed if the outcome is stronger than you wanted. This is an important distinction from HA fillers, which can be dissolved. This matters because it sets accurate expectations: you can fine-tune at two weeks, but you cannot undo a strong result for months. Any clinic that charges extra for a two-week review or discourages it is operating below a reasonable standard of care.
Q5
Is Daxxify stocked on-site or ordered per patient?
Good answer
A good answer is specific: "We stock it on-site and I use it regularly enough that it is always within the use-by window" or "I order it specifically for your appointment so it comes in fresh." Either is fine. What is not fine is vagueness about storage or handling, or not knowing whether the product they are about to inject has been properly refrigerated and is within date. This matters more for Daxxify than for Botox because it is newer and some smaller clinics may hold a vial longer to use up stock. Proper cold-chain storage is required for the product to work as intended.

Clinic checklist

Universal

Check the practitioner is licensed and registered. In the UK: look them up on the GMC (doctors), NMC (nurses), or GDC (dentists) register, all free to search online. In the US: search your state medical board. Takes 2 minutes. If they cannot tell you their regulatory body, leave.
Ask to see the product box before treatment. It should be factory-sealed with a visible lot number and expiry date. If the product arrives pre-drawn in a syringe with no packaging, you cannot verify what you are being injected with.
You should receive a written consent form before treatment. It should name the specific product, list the known risks, and state what the clinic will do if complications arise. A single generic form with no product name is not adequate.
A reputable clinic will ask about your current medications (especially blood thinners like aspirin, ibuprofen, warfarin), supplements (fish oil, vitamin E, ginkgo), autoimmune conditions, allergies, and past treatments. If no one asks, they are skipping a safety step.
Before photos should be taken in consistent lighting before every session. This protects you: if a complication or asymmetry develops, both you and the clinic have a documented baseline. If a clinic does not take before photos, they are not tracking outcomes.
Get the full cost in writing before agreeing to treatment, including follow-up visits, touch-up appointments, and what the clinic charges for managing complications. Verbal quotes are not binding.

Procedure-specific

Ask: have you treated patients with Daxxify specifically, and what duration are you seeing in your own practice? Daxxify is newer, and you deserve to know whether your injector has real experience with it or is switching from Botox without Daxxify-specific practice.
Ask: how do you approach the first Daxxify treatment, do you start more conservative than you would with Botox? Because Daxxify can last six months or longer, an over-correction persists significantly longer than with a 3-month product. An injector who plans to dose aggressively from the start without mentioning this is not accounting for the extended commitment you are making.

Educational content only. This page summarises published clinical research and is not medical advice. Consult a qualified healthcare provider before making decisions about your care.

Researched by

Val Yermakova

Informed Girl · informedgirl.com