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Have you heard about Daxxify(daxibotulinumtoxinA-Ianm)? Heck yes, we’ve got it! If you are curious and want to know more, read on and stay tuned for the next series of informative (and professionally yet slightly opinionated) posts!

What is Daxxify? This is the latest FDA approved neurotoxin available for use in the United States. It launched late last year with a select number of large clinics picked to unveil it and work out the kinks on how to use, and talk about it. With initial fussing done, 15 additional clinics were added in Washington, and we have now joined the team! I’m a big proponent of not being the first, but not the last to try something new—and then, only if it has robust studies behind it. I love the philosophy of the product, and know it will be well received by a good portion of my clients, though I don’t expect to convert all patients to it. Keep reading to understand why.

US tox market: lets back up because it’s important to remember that we have enjoyed the benefits of cosmetic muscle relaxation for decades now. Our agents of anti-aging come from a variety of manufacturers starting with the notorious Botox, followed by Dysport, Xeomin and Jeuveau. All of these brands utilize botulinumtoxin type A (though there are 7 serologically distinct types from A-G). Each of the type A toxins on the market as noted above are on-label approved for various cosmetic indications, and a couple of them have therapeutic indications as well. If you’re a science nerd like me and want to break it down further, many have different molecular weights from one another, and different stabilizing particles which make them unique. There are even some studies that talk about the activity or bioavailability of each particular brand—of course, all of them having their sales “pitch” as to why their better than the rest. It’s unfortunate that we have to describe them as a toxin because it makes them sound sinister, but it is indeed an exotoxin produced by a bacterium (Clostridium botulinum) which can be found in soil both on land and in the sea. That being said, we have over 20 years of objective data to support their safe use.

What makes this one different? It has been produced with a peptide complement that is touted as the “magic” ingredient that allows it to last up to twice as long as the other neuromodulators on the market, when given in appropriate doses. That may mean that instead of coming in 4 times a year, you only have to come twice to keep your frown neutralized. Data supports it, but I want to see it with my own two eyes…so my calendar is set to analyze my n=2 durability study in Sept/Oct 2023. That’s when I hit our 6 month mark….

Daxxify and unit conversion confusion

The benefit of muscle relaxation that lasts roughly twice as long likely sounds pretty good to you. Only having to come in two (ish) times a year would be a dream, because no one in their right mind wants to voluntarily succumb to a needle in their face more often than necessary. What will it cost you? That’s the next burning question. Before we can answer that we should chat a bit about units.

When it comes to medication units are a measurement of ingredient, not volume. Each of these products comes in a film or powder state and we add sterile fluid to that to allow it to be deliverable through a tiny needle. All pharmaceutical and over-the-counter medication in the US is identified by a dose such as grains, milligrams, units, or some such thing so that there can be uniform delivery. But Botox units do not equal Dysport units, and they do not equal Daxxify units either. Botox and Xeomin units are more closely related, but the bioavailability and activity is different. So, one does not equal one outright, your medical provider should be looked to for guidance on relative equivalents. Let me just say it’s complicated enough to understand how the product is packaged and delivered, then throw on top bioavailability variation and it’s a nightmare to explain even to a mathematical mind.

You will not see RediscoverdU post Daxxify as a cost per unit for several reasons: #1) it’s complicated (as noted above) and the last thing we want to do is muddy the waters of understanding. #2) different muscle groups require different dosing based on the intensity of the muscle’s activity, frequency of dosing, and FDA recommendations. #3) dose equals duration for this product just as it does for the others, but there are some limitations to that as well. If we’re suggesting it will last twice as long as your usual neurotoxin but we underdose you for financial considerations, you won’t appreciate the effects that you dream of—then both of us are disappointed. Here, you just have to trust your provider. It will likely cost you just over half again as much as your usual treatment…as us and we’re happy to give you a ballpark based on your last session, or on your treatment areas that will do good by you, but not go unnecessarily overboard.

Daxxify onset and durability details

If you know me you know that I’m pretty insistent on trying the things I offer (if they are reasonable for me to do). After all, how can I possibly tell you what to expect if I haven’t gone through it on my own? So, on March 10th my brilliant side kick and RN extraordinaire helped me with my plunge and I received my first Daxxify dose. So, this is what we know as of now, and what we’re hoping for in the end.

This product is injected very similar to other neurotoxins. The same tiny needle in roughly the same places as you might have enjoyed it before. Current on-label indications are for the frown lines between your eyebrows, but it is already used for areas such as the forehead, and crow’s feet around the eyes as well as other industry standard locations off-label. I personally thought it stung ever so slightly more than the others, but that didn’t last. My little depots of product were pink for about 10 minutes longer than usual, then they disappeared as expected. At 36 hours after injection, I could see it starting to work: that’s about a week and a half earlier than I usually appreciate it. It “feels”, how should I say it, stronger? than the others, but maybe that’s because I’m scrutinizing a ton more than I normally would.

At 2 weeks after initial injection I am confident I’m at maximal “freeze”, and I expect it to very gradually begin to soften just as the others do. The peptide which is unique to Daxxify is reported as the reason it “stick” to the synapse longer, allowing for longer effectiveness. For study purposes the area between the brow lasted the longest, then crow’s feet then forehead—which incidentally corresponds to our usual dose range. Makes perfect sense to me!

I know what my usual dose behaves like durability wise, so I’ll be curious to see how it compares—won’t know that til Sept/Oct. I based my treatment dosing on an equivalent that I think is reasonable per data points during Daxxify’s studies. Let’s hope I calculated well!

Daxxify side effects & contraindications

What about Side Effects—how does that compare to other neuromodulators already on the market? Makes sense that with something new, you want to be sure you know what you’re getting into. And while the efficacy and safety of botulinumtoxinA has been well studied by all manufacturers, how does this compare? Well….pretty darn similar for the lot!

The most common adverse side effects from administration of daxibotulinumtoxinA-Ianm include headache (6%) and eyelid droopiness (2%) during the drug trial. These side effects were also identified in the other toxins on the market during their trials. Keep in mind, EVERY oddity that is noted by a subject during a drug trial must be reported on the report. If you read the potential side effects from taking acetaminophen (Tylenol) your mind would be blown too! Other ASE include injection site pain, redness, bruising, edema or asymmetry. If you’re a total nerd, check out the full prescribing insert found in your product box, or online with the FDA.

None of neurotoxins are deemed okay to use during pregnancy or breastfeeding, we just don’t study this protected group and we go with a better-safe-than-sorry stance. It stands to reason that if you have a skin infection (also known as cellulitis) in the area being treated, you should postpone care. For those with difficulty in swallowing or breathing issues, you should talk to your provider before considering treatment. And if you have an uncontrolled auto immune disease, speaking with your specialist to get their okay is a respectful and smart thing to do.

If you’re allergic to other neurotoxins, avoid this one too. And if you’re a non-responder to the other formulations of botulinumtoxinA, you’re likely going to be a non-responder to this one as well. We have seen a little more immunogenicity over the years—another reason to get a real dose less often, rather than a little bit frequently to limit your exposure to both the toxin as well as the other ingredients.

Considering Daxxify? Candidates with calendar limitations vs budget limitations

In my first post on Daxxify I mentioned that I think this will have strong appeal to part of my client base, but I don’t expect to convert everyone. Why is that? Well, if you love your current tox and are satisfied with its effects, why would you change? I can’t think of one reason! But if you are hoping for longer lasting, solid results; or have one of those social/life/work calendars that make getting in for an appointment challenging, then you just might want to check this out! For those who really want to try it but are on a tight budget, plan ahead to save a few extra buckaroo’s—maybe not get it this dose, but mark your calendar for next treatment. Sure, it is going to cost you a few more pennies on treatment day, but overall requiring fewer treatments per year will neutralize that cost… and you get back your time as well (there’s nothing more precious than that!).

For those who only treat one area on the regular (most commonly, that’s the scowl between your eyebrows—scientifically known as the glabellar complex). If that’s the case I say check out Daxxify. That will run you somewhere around $500 (give or take fifty bucks). If you’re sitting on the fence of whether or not to convert, you might consider going Daxxifyâ for your most stubborn treatment area, or your highest priority for correction. We refuse to low ball treatment with this product because it would be counter intuitive. As with all neurotoxins we provide there is a minimum per session, but we will work with you, your anatomy, and your goals to customize your care plan just for you! Want more time with less lines? This may just be your look that lasts!

* Prices based on time of writing and are subject to change. All sales final, no guarantees of any specific response or durability. Heck-- you're different...embrace it!

As a nurse practitioner, and educator, and a business owner I often wonder what it is you want to know, how can I best guide you to understanding and feeling like your part of the process? How can I learn what burning questions you have in your head so that I can respond? Then BAM! I get one or two text messages asking the same thing and I have my next blog subject!

Pressing inquiry this week: Can filler be dissolved?

Accurate (though irritating) simple answer: maybe? But there’s a little more to it than that.

First let’s talk about filler in general. Most of the volumizing fillers used in the United States are made of Hyaluronic Acid (HA, a kind of sugar molecule) as its core base. It’s pretty similar to the HA your body makes naturally with a few scientific modifications to make it softer, firmer, stretchy, last longer, etc. Ever have the feeling that you’re shriveling up as you get older? Well, you’re making less natural HA as you age, that’s part of the situation.

In addition to making HA, your body makes and enzyme that is designed to break down HA called hyaluronidase. The amount of that enzyme that you make can be different than your bestie, so you will both metabolize things differently. So, a combination of the type of HA filler used, what those scientific modifications were (i.e. how soft or stiff the filler was to start with) and knowing about this enzyme is key to the whole how-long-will-it-last and the can-it-be-undone thing.

Other fillers cannot be reversed. Fillers like calcium hydroxyapatite, polymethyl methacrylate (PMMA), biogels or poly-L-lactic acid, cannot be easily undone with hyaluronidase and may require surgery or a tincture of time to reduce.

Those of us who provide HA filler services keep on hand the pharmaceutical equivalent of your natural hyaluronidase (sold under a few different brand names). The primary reason we carry it is a safety release in event of an injection concern. But more and more we are using it to expedite filler dissolving to start fresh. Pillow face is OUT (thank goodness), as is the trout pout (phew!). So for those who need to rediscover what they were before they went overboard, we can help them get there quicker than simply waiting for their own body to degrade it over a variably predictable amount of time.

If you’re in a situation where you liked the HA filler you received, but it’s no longer your thing, or it’s moved, or it’s swelling more than it did because it’s in its breakdown phase and you want to kick it out faster, yes—I can inject hyaluronidase in the region of question. This is technically an off-label use of the product, but remains within industry standards.

And while you are contemplating this as a personal option, I want to share a few things with you about the process to help you decide if you want to go in that direction:

  1. As HA filler breaks down it can grab hold of more water (after all, the sole reason for HA to exist is to hold on to water—about 1000 x it’s weight). This is felt to be part of the reason you can see an increase in swelling occur even years after filler was originally injected.

  2. Hyaluronidase is an enzyme with no clear on-label use for dissolving HA filler. When hyaluronidase is injected, it's a bit uncomfortable (I say spicy, some say “hurts like heck”). I can add a little lidocaine to help, but it still stings a bit.

  3. The injector cannot completely or exactingly control where it goes as it’s injected. It’s a very thin liquid and it travels wherever it wants within the area being treated. Of course, we certainly do our best to focus it to the area of swelling and desired breakdown.

  4. Your body makes hyaluronidase and hyaluronic acid, but everyone has varying amounts of both. The enzyme breaks down all hyaluronic acid, including that which your natural HA. Most of the effect is immediate, though ongoing reduction can be seen for up to a week or so. Most injectors will not inject hyaluronidase and new HA filler on the same session.

  5. Hyaluronidase is sold by the unit or the vial, depending on who you see for treatment. It is most common for me to start with one vial, inject, then reassess 2 weeks later. You may need repeat treatments to get you to your goal, or you may not—we just have to be patient, wait and see.

  6. If you seek reversal because you are frustrated by an increase in swelling near a region where filler was previously placed, remember the swelling could be something other than filler. One such example is impaired lymphatic drainage (from infection, injury, age, trauma, radiation, surgery)—so injecting hyaluronidase is not a guarantee the swelling will completely resolve.

Before we go, lets address the elephant in the room. Filler migration. Ain’t gonna be no finger pointing by me…unless you do the dirty and self-inject, or don’t heed the chill-out rest instructions we give as you depart (particularly with lip filler). Filler migration can result as a result of many different things, and in my professional opinion, is more likely a little bits of more than one thing. Remember HA fillers are gel. And we’re placing them in a hidden region that has layers of tissue and muscles that squeeze (some areas this is nearly constant). You talk, kiss, chew, suck on a straw, you put your face into a massage ring, your eyes dart around even when you’re sleeping. Fillers are manufactured in varying consistencies too, from relatively thin to thicker and sticky dependent on where we are placing them and what end goal is desired. How well they integrate with your own soft tissue is part of it. Technique used to inject can also play a role. And then there’s the natural break down process too. Guaranteed no injector purposely mis-guides, mis-selects or mis-injects you on purpose. But we also have varying levels of experience and varying degrees of how much continuing education we pursue. Long story short, don’t coupon your face. Duh!

Of course, this isn’t meant to answer ALL your curious questions, but heck…we have to start somewhere! You can check out the Prescribers Digital Reference or the Food and Drug Administration on any ol’ pharmaceutical product you want all the details for.

Whether you know me already or are just checking out my services (and attitude) you need to know I’m a local girl with an aesthetic eye toward natural beauty. My favorite thing to do is enhance features my patients already have, maybe just make them look more rested, or shave a few years off. I’m decidedly against pillow face!

Often my peeps come to see me for a little wrinkle relaxation to start, then they return and they have one or two curious questions like: “what would you do for this?” (while pointing at their cheeks, or jowls, or nasolabial folds, or marionette lines, or simply pulling back their entire face). I’m happy to help guide decision making, but I’ll never over sell something I don’t think jives with your look, your anatomy, or your goals. I don’t know about every product or device out there, but I do hear stories and am happy to give you my thoughts on even things I don’t offer myself. When I add something to my line up it’s after careful research, but sometimes I bring on a service too that I end up feeling isn’t all it was cracked up to be, and I’ll admit that too!

All that being said—one of my go to recommendations (and a solid “hell yes!” product) continues to be poly-L-lactic acid which is sold under the brand name Sculptra in the United States. Sculptra has been around for 20 years and comes from a very interesting beginning (you should ask me about it). Why do I like this treatment? #1 It’s a filler that’s not a filler, it triggers your OWN collagen growth. #2 It provides what I call global enhancement—where a syringe of filler is good for a specific target area (like lips). That means your whole face looks fresher, younger…but not overdone. #3 Even when injected deep, it helps give the skin a lovely glow. #4 It’s one of the few treatments that can help give your peripheral face a little pull (think temple area, and the crepey skin you start noticing in front of the ears, or even smile lines in your lower cheeks). Much of aging is from chronic UV exposure and from collagen loss which starts at about age 30, and doesn’t come back without a gentle nudge. Sculptra is a great nudge!

Poly-L-Lactic-Acid comes as a powder which is then reconstituted with sterile water and usually a little lidocaine by the provider. It is then injected based on what is seen during our assessment. There are on label indications, and different ways (off label) of getting there, but for me commonly areas treated includes the temple, the cheeks, near the nose, the hollow by the chin and near the corner of the jaw. After injections you’re numb for about 15-30 minutes. You’ll feel a little puffy due to the water, but that is resorbed over the next several days. One of the most important parts of after care for you includes massaging—5 minutes, 5 times a day, for the first 5 days. Why? Massage encourages the little particles to float uniformly in the tissue until the water is all resorbed, and reduces the risk of developing a nodule (which is just collagen, and no big deal). When the water is absorbed you might initially think “what was that for? I don’t see anything!”—but that’s precisely when the magic is happening. Your body then sees the teensy-weensy particulate, it goes to work to extract it while replacing it with your own collagen! That improves the “fluff” in your skin, and once you’re corrected appropriately, you will notice improvement for up to two years.

On average I recommend 2 vials x 2 sessions spaced 2 months apart (give or take). Another vial or two might be suggested but I usually wait for about 4-6 months before I make that decision because your collagen growth takes time to be seen and appreciated. So, for the money you invest in Sculptra as a solid foundation to revitalizing your face, you’ll have a reduced need for hyaluronic acid fillers (translation, eventual savings) that can still be used to add contour, or fluff the lippies, or what have you.

Like most injectables it is not advised to be used in pregnancy, lactation or if you have a tendency to keloid or hypertrophic scarring. Also, not a first choice for those with a flair or compromised immune systems— (funny strange though, it was developed to bolster confidence and quality of life for patients suffering significant immunocompromise in the 1990’s). It takes special training to inject this product well –so be sure you know who you’re going to when you take the leap!

Most common side effects are swelling, tenderness, redness which last for a few days. Bruising, bleeding, itching and bumps can also occur. It is not used around the eye or in the lips due to the constant motion of those muscle groups.

I’m on my own Sculptra journey—I practice what I preach. I had my first session in October, and my second in December of 2022. I’m now in chill mode waiting to see if there is more in my future but I can tell you I’m not pillow face, and my jowls don’t distract me the way they used to. I’m happy with what I see so far, and I do it for me not for anyone else. That makes it a total win in my book.

So, if you ask me a curious question and I think it’s the right answer and appropriate for your precious face, don’t be surprised if I hand you a Sculptra brochure and ask you to do a little research (full product details can be found on I want you to stay you for as long as possible!

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