How the neuromodulators actually compare.

This is the single most misunderstood thing in aesthetics, and it matters the moment you start comparing prices.

Every one of these products carries FDA labeling stating that its potency units are specific to that product’s own preparation and assay, and cannot be converted into units of any other botulinum toxin product. That is not fine print — it is why the FDA required each one to have a distinct generic name.

In practice, injectors do use working conversions. Xeomin is generally used at roughly one-to-one with Botox, supported by a randomized double-blind trial at matched 20-unit dosing. Jeuveau likewise, supported by a 540-patient noninferiority trial. Dysport is the outlier: clinical practice commonly uses somewhere between two-and-a-half and three Dysport units per Botox unit, and trials have used ratios in that range safely — but there is no single correct number, and a mouse potency assay put the true ratio closer to two-to-one than to three.

Daxxify is not on the same scale at all. Its labeled glabellar dose is 40 units against Botox’s 20.

What this means for you: a per-unit price is only comparable within a product. Our Letybo at $11 and our Botox at $14 are not “the same treatment, cheaper” — they are two products whose units happen to be used at similar dosing. Anyone comparing per-unit prices across Dysport and Botox without saying so is comparing numbers that do not describe the same thing.

Standard-dose Botox, Dysport, Xeomin, Jeuveau and Letybo all land in a similar range in practice — most people see three to four months, with results building over about two weeks.

Daxxify is the one with a genuine duration claim behind it. In its pivotal placebo-controlled trials, “none or mild” glabellar severity was maintained for a median of about 24 weeks — roughly double what standard dosing of the others typically delivers. That is real randomized trial evidence, not marketing.

The caveat that almost never gets said: those pivotal trials were against placebo, not against Botox. The only head-to-head against Botox was an earlier phase 2 study that compared 40 units of Daxxify to 20 units of Botox. So the duration advantage is real, and it is also confounded by dose — it has not been isolated as a pure formulation effect at matched units. And a median is a median; individual patients vary.

You will read that Dysport works faster. The evidence does not consistently support it.

One split-face trial did find earlier onset with Dysport. But a randomized double-blind three-arm trial found Xeomin fastest at about three days, with Botox and Dysport statistically indistinguishable from each other. Two rigorous studies, two different answers. Anyone stating “Dysport is faster” as an established fact is picking the study they like.

Spread is better supported. Direct measurement of the anhidrotic halo found Dysport produced a significantly larger area of effect than Xeomin at conventional dosing. Whether that is an advantage depends entirely on where it is going — helpful across a broad forehead, unhelpful near the brow or the eyelid, where unwanted spread is exactly what causes a dropped brow.

Worth noting that this was measured at a conventional dose ratio, meaning more total product went in on the Dysport side. Some of that larger halo is dose, not an inherent property.

Xeomin genuinely contains no complexing proteins, where Botox and Dysport do. That part is simply true, and the reasoning that fewer accessory proteins should mean less immune stimulation is mechanistically sound.

What has not been shown is that this produces a measurably lower rate of losing response in cosmetic patients. Neutralizing antibody formation is already rare at aesthetic dosing — a meta-analysis across roughly 30,000 subject-records found about 0.5% overall for onabotulinumtoxinA, with a handful classified as secondary nonresponders. Most of the literature behind the switch-to-Xeomin story comes from neurology, where patients receive many times the cosmetic dose on a tighter schedule.

So: real mechanism, plausible reasoning, extrapolated from a population that is not you. If you have genuinely stopped responding to a product after years of treatment, switching is reasonable. As a first-line reason to choose Xeomin over anything else, the evidence is not there yet.

Letybo is the newest of the six in the United States, approved in February 2024. We stock it and we price it at $11 per unit, and it is the product behind our current offer.

Two things you should know, because we would rather say them than have you find out later.

Its US trials — about 1,270 patients across three randomized studies — were placebo-controlled. Unlike Xeomin and Jeuveau, there is no published head-to-head trial against Botox. The 20-unit, five-point glabellar regimen mirrors Botox’s, but that is a design assumption carried into the trials, not a demonstrated equivalence. A 2026 systematic review of those trials says so directly: head-to-head studies are still needed.

And it has the shortest US track record of the six. That is a real difference in accumulated post-market data, though it is worth saying that Letybo has a considerably longer commercial history outside the US, in South Korea and elsewhere.

None of that makes it a bad product. The trial results against placebo are strong and the safety profile is good. It means the honest way to describe it is “well supported against placebo, not yet compared head to head,” and that is how we describe it.

For most people, most of the time, it does not matter as much as the injector does. Dose, placement, and understanding of your anatomy determine your result far more than which of six very similar molecules was in the syringe.

Where product choice does matter:

Broad forehead, generalized treatment. Dysport’s larger field of effect can be an advantage.

Near the brow or a heavy upper lid. Tighter spread is safer. Botox, Xeomin, or Letybo.

You want the longest interval between visits and you accept the tradeoffs. Daxxify, with the dose caveat explained above.

You have stopped responding after years. Xeomin is a reasonable switch to try.

You want the lowest per-unit price on a product with strong placebo-controlled data. Letybo, with the head-to-head gap disclosed.

Planned and injected by Adam Medlin, FNP-BC, an autonomous nurse practitioner licensed in Virginia. Botox is $14 per unit and Letybo is $11 per unit — both published, because you should know the number before you book.

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