Often Lasting Twice as Long as Any Other Neurotoxin on the Market, Daxxify Makes Its US Debut

Are you excited?” Ellen Marmur, MD, asks me, beaming from behind her mask, when I settle into a treatment room at her white-walled Upper East Side office on a cold winter afternoon. The Manhattan-​based dermatologist has just returned from a weekend at Revance’s headquarters in Nashville, where the pharmaceutical company hosted about 80 cosmetic dermatologists and plastic surgeons for a series of intensive seminars on Daxxify, the latest neuromodulator to receive FDA approval for the treatment of the glabella, the frequently furrowed lines between the eyebrows. In the company’s clinical trials, “Daxi,” as Marmur refers to it, had shown median outcomes lasting six months—sometimes up to nine months—more than twice as long as any other botulinum product on the market. As a member of Daxxify’s scientific advisory board since 2018, Marmur was one of the first providers to receive the injectable, which is being marketed as “the future of aesthetics” since it began its slow rollout at the end of last year. Her enthusiasm is palpable. “We’ve seen so many things come and go,” Marmur continues, prepping a syringe. “But really this broke through the noise.”

There has been a lot of noise in the injectables space over the last 30 years. “Following Viagra, Botox is the second most recognizable pharmaceutical name in the world,” says Michael Kane, MD, a Manhattan-​based plastic surgeon and self-proclaimed “injectables guy.” (After pilfering a vial of the original botulinum toxin from an ophthalmology colleague at Manhattan Eye, Ear, and Throat Hospital in 1991, Kane became the world’s largest provider of Botox from 1991 to 2002.) Now there’s also Dysport, and Xeomin, and the Seoul-born Jeuveau—all of which are designed to do the same thing: block the nerves that tell certain facial muscles to move, relaxing fine lines and wrinkles, among other benefits. Kane has consulted on all of them, and he’s been providing feedback on Daxxify—which was originally designed to transdermally deliver botulinum to the crow’s-feet through the skin, without a needle—for 17 years. “Every formulation has its own little personality,” Kane says, explaining that while each one uses different carrier and stabilizing proteins, any performance variation (faster or wider dispersion, for example) is mostly based on anecdotal evidence. “A lot of it is patient choice,” Kane concedes. “There’s a certain allure to newness, so if a patient is really happy with the new thing, I see no reason to switch them.” The flip side is also true: The “new thing” has a less-proven track record, which can steer patients toward the older formulas they know and trust. Daxxify’s defining personality just happens to be longevity, suggests Kane, the possible result of a proprietary peptide that cleaves the cell membrane and drags the large, positively ​charged peptide through the cell, then through the next cell, before it latches onto the negatively ​charged nerve terminal. According to gossip in derm circles, the FDA required Revance to test its molecule as an injectable for safety purposes, which is when they discovered that its clinical outcomes outlasted the competition, what Marmur calls its “disruptive moment.”

Because Daxxify can last twice as long, a treatment with it can be twice as expensive, Marmur cautions. (A Botox injection in the glabella can run between $375 and $500, while Daxxify will likely be priced closer to $700 to $1,000.) It can also mean living with a disappointing outcome for longer. But for plenty of people, that’s a risk worth taking for three more months, possibly more, of wrinkle-free skin. That benefit seemed well worth the price of admission for me as a first-timer. One of the things that has long kept me away from Botox and filler is the maintenance: I barely have time to grocery shop—how could I possibly commit to regular aesthetic appointments? But I began to observe Daxxify’s promised results within 48 hours, and even more so two weeks later. There was no dramatic transformation to speak of; in fact, no one close to me mentioned any noticeable change to my appearance. But the slight smoothing effect, which presented more as an easing of tension, was perceptible—and satisfying—to me.

“The initial studies were able to show more of an eyebrow lift with a slightly new injection pattern, too,” Marmur adds, administering the last of a “baby” injection above the arch of my brow. As I examine my face in a handheld mirror, waiting to see two and a half years of postpartum and pandemic stress, anxiety, and exhaustion magically disappear, Marmur gives me a tender hug. “Are you excited?” she asks again. Indeed, I reply, my smile lines growing ever deeper.