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Blog – What is Botox

Medical Aesthetics Explained

What is Botox, Really? A Doctor's Guide to Neuromodulators

By Dr. Sophia Ali • July 24, 2026

Hey y'all! I was talking to my Botox representative today and I thought to myself, do people know what Botox really is? And how it works? Do people know that there are different options out there now, in addition to Botox?

When I write Botox (like in the title), I really mean neuromodulators. The brand name Botox has become such a household name that it is now perceived as the general name for all neuromodulators used in aesthetics. Botox was the first neuromodulator ever used in aesthetics and it still holds the largest market share in the global neuromodulator industry.

Science of Aesthetics

So what are neuromodulators?

A neuromodulator is an injectable agent that temporarily relaxes facial muscles to help soften and smooth the appearance of dynamic fine lines and wrinkles (below I define what dynamic means). Neuromodulators fit under the broad category of neurotoxins. Over the past few years, the industry has moved away from using the word neurotoxin (which we used to use all the time to describe these treatments) to neuromodulator, probably because the word neurotoxin sounds more intimidating. It's all about the marketing, am I right? Regardless, the word neuromodulator does describe these treatments better, since it reflects what the product does versus what it is. You can think of neurotoxin as the actual ingredient in the injectable that causes the muscle to relax.

The neurotoxin used in every single neuromodulator we have on the market right now is botulinum toxin type A. This toxin, or protein, is produced by a bacterium called Clostridium botulinum. This protein is harvested and then put through a purification process, yielding a highly purified protein that is safe for medical and aesthetic use.

The Botox Connection

Botox® is simply the famous brand name for the first FDA-approved neuromodulator. Today, several other exceptional and safe FDA-approved alternatives exist—such as Dysport®, Xeomin®, and Jeuveau®—each featuring slight structural variations that allow our practitioners to customize treatments specifically to your anatomy.

SCIENCE & TREATMENT

How Does Botox Work?

All the neuromodulators (neurotoxins) on the market right now that are approved for cosmetic use have the same fundamental mechanism, although they may differ in formulation. To make a facial expression, your nerves release a chemical messenger called acetylcholine, which tells the muscle to contract. Repeated contraction of certain muscles leads to dynamic wrinkles (see below). Neuromodulators are injected into muscles causing those wrinkles, acting at the neuromuscular junction — the communication point between the nerve and the muscle. The toxin enters the nerve cell and cleaves a protein essential for releasing acetylcholine into the neuromuscular junction. No acetylcholine from the nerve means that no message goes out to the muscle to contract, leaving us with smoother skin.

TREATMENT TIMELINE & EXPECTATIONS

What types of wrinkles does Botox treat?

It's important to understand what dynamic and static wrinkles are. Dynamic wrinkles are the ones we get with repeated facial expressions, like frowning, raising your eyebrows, or squinting. These types of wrinkles respond well to neuromodulator treatment because they relax the muscles that allow us to make those repeated facial expressions. If you can't make the expressions causing the wrinkles, then the wrinkles and fine lines smooth out over time.

Static lines, on the other hand, are lines that we see on our face when our face is at rest. These fine lines and wrinkles don't respond well to neuromodulator treatment (think about wrinkles that are formed by sleeping on your side with your face pushed up against your arm or pillow, creating a pressure fold). Over time, and with repeated compression, these lines can become permanent wrinkles due to the breakdown of collagen and elastin in those areas, causing volume loss (which is why you've heard it's best to sleep on your back!)

Some common dynamic wrinkles include the horizontal lines on our foreheads when we raise them, the lines around the outside of our eyes when we smile or squint, and the “11s” that form in between our eyebrows when we frown. Hopefully this helps you understand if the wrinkles and fine lines you see on your face could be treated with a neuromodulator like Botox.

3-5

Days: Initial Action

The targeted muscles begin to relax. You will notice a subtle easing of deep expressions and fine lines.

14

Days: Peak Smoothness

Full results are realized. The skin overlaying treated areas appears deeply refreshed, smooth, and naturally radiant.

3-4

Months: Preservation

Muscle activity slowly returns to normal. This is the optimal window to arrange your next visit to preserve your look.

The Clinical Key: Maintenance & Consistency

Consistency is critical for deep wrinkle prevention. Routine scheduling prevents dynamic lines from 'setting' back into the skin. Over time, consistent treatments allow the underlying muscles to stay relaxed, requiring less frequent dosing to keep your clinical results natural, crisp, and fresh.

What different types of neuromodulators are on the market?

Currently there are six neuromodulators that are approved in the US for aesthetic treatments, all of which use botulinum toxin type A. Botox has the most fascinating history since it was the first neurotoxin approved for aesthetic use — which means we get a short history lesson, yay!

1817–22

Justinus Kerner

A German doctor named Justinus Kerner recognized that a biological toxin was the cause of “sausage poisoning” (which we now know as botulism), and even speculated there might be a therapeutic use for it. He was way ahead of his time!

1895

Emile van Ermengem

Microbiologist Emile Pierre van Ermengem figured out that the bacterium Clostridium botulinum was the source of the toxin.

1946

Dr. Edward Schantz

Botulinum toxin type A was first purified from the bacterium by Dr. Edward Schantz and studied for its therapeutic uses.

1970s

Dr. Alan B. Scott

Dr. Alan Scott purified the toxin in injection form to treat strabismus (eye misalignment). Its efficacy led to treating more conditions like blepharospasm and muscle spasticity. He named the product Oculinum and formed a company of the same name in 1978.

1980s

Drs. Jean & Alastair Carruthers

Dr. Jean Carruthers, an ophthalmologist trained by Dr. Scott, noticed patients' frown lines and skin quality improved. She and her dermatologist husband began studying the toxin for cosmetic use.

1989

FDA Approval

The FDA approved botulinum toxin type A for medical use in eye disorders.

1991

Allergan — then primarily an eye-care company — bought Dr. Scott's company Oculinum and rebranded it as Botox.

1992

Drs. Jean and Alastair Carruthers published a landmark paper showing the toxin could safely and effectively reduce facial wrinkles.

2002

The FDA approved Botox for the treatment of frown lines.

I find this history fascinating for so many reasons, especially because it embodies the essence of both medicine and science in action. Discovering that a bacterium caused outbreaks of botulism, figuring out that we could extract the toxin responsible and use it therapeutically for eyelid twitching, and then accidentally discovering through observation that it could reduce wrinkles — that transformed both medicine and aesthetics forever.

Ok, to get back to the original question, I'll outline below some of the different neuromodulators on the market right now for aesthetic use in the US. Remember that each one uses botulinum toxin type A, just formulated a little differently.

Botox

onabotulinumtoxinA

APPROVED 2002

• Formulation: Uses accessory proteins to form a larger complex that stabilizes the toxin.

• Onset: 3–7 days

• Duration: 3–4 months

Dysport

abobotulinumtoxinA

APPROVED 2009

• Formulation: Uses accessory proteins to form a larger complex that stabilizes the toxin.

• Diffusion: Larger diffusion area — a good option for large areas (forehead, masseter, neck, underarms, trapezius).

• Onset: 2–5 days

• Duration: 3–4 months

Xeomin

incobotulinumtoxinA

APPROVED 2011

• Formulation: Does not use accessory proteins, is known as a “naked” neurotoxin which means there may be a lower theoretical risk of forming antibodies against the toxin

• Onset: 3–7 days

• Duration: 3–4 months

Jeuveau

prabotulinumtoxinA

APPROVED 2019

• Formulation: Uses accessory proteins to stabilize the toxin, designed to closely mimic the clinical performance of Botox.

• Onset: 3–7 days

• Duration: 3–4 months

Daxxify

daxibotulinumtoxinA

APPROVED 2022

• Formulation: Does not use accessory proteins, instead it uses a peptide that binds to the toxin, enhancing stabilization

This peptide improves adherence of the toxin to nerve surfaces in the neuromuscular junction (check out the section “How does Botox work”), which increases its likelihood to enter the nerve cell. This allows for a longer duration of action, as long as it is dosed appropriately.

• Onset: 2–5 days

• Duration: 6 months

The neuromodulator Daxxify is distinctly different from the others because it uses a peptide to stabilize the toxin. The proteins in the other neuromodulators don't have any real biological activity — they mostly form a protective complex around the toxin that keeps it from degrading.

Daxxify, on the other hand, uses a peptide that is biologically active. Not only does it physically stabilize the toxin, it helps the toxin bind to the nerve, which may increase the likelihood that the toxin will enter the nerve cell and block the release of acetylcholine. This is probably the mechanism that contributes to its extended duration.

I have one last thought to share. Isn't it interesting that only one year after Allergan bought Oculinum, a groundbreaking paper was released showcasing the role of botulinum toxin type A in cosmetics? I don't know if it was pure luck for Allergan or a very strategic move, but what an extraordinary thing to happen for them — leading them to become the global leader in medical aesthetics. This part of the story fascinates me because it shows that a combination of things must align to make a product this successful: strategy (or maybe just luck), a great product, and amazing branding.

Find Your Match

Which one is right for me?

My honest answer is that the most important thing is to find an injector that you trust. All of these neuromodulators can be used by a skilled injector to give you the result you want. Because some of them require different dosing, it's important that your injector is well versed on the injectables they keep in their clinic and how to properly dose each.

Some things to consider: some people truly do have preferences for different neuromodulators — and that preference was founded by trying different ones. So if your injector carries more than one type, I recommend trying them all out to see which one is best for you. Different neuromodulators have different price points as well, which may factor in. Otherwise, I say you need to try it out to figure out which one is right for you.

Hopefully this article has helped you understand what neuromodulators like Botox are and how they can help you.

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