Skip to main content

Updates on Botulinum Neurotoxins in Dermatology


Being the most popular non-surgical cosmetic procedure, botulinum neurotoxin (BoNT) injections are increasingly of interest to all cosmetic practitioners across the globe. This article serves to update readers on the new botulinum toxins that are currently in development or close to market in the USA and Canada, including daxibotulinumtoxin A, prabotulinumtoxin A, letibotulinumtoxin A, and botulinum toxin E. Despite having relatively similar characteristics and equivalent clinical efficacies, these neurotoxins manifest a multitude of unique potential advantages that will be explored in this review, including but not limited to a longer duration of action, the absence of animal-derived components or human albumin, and a rapid onset with short duration of action.

This is a preview of subscription content, access via your institution.


  1. Lamanna C. The most poisonous poison. Science. 1959;130:763–72.

    Article  CAS  Google Scholar 

  2. Scott AB, Rosenbaum A, Collins CC. Pharmacologic weakening of extraocular muscles. Invest Ophthalmol. 1973;12:924–7.

    CAS  PubMed  Google Scholar 

  3. Carruthers J, Carruthers JA. Botulinum toxin use for glabellar wrinkles. Presented at the annual meeting of the American Society for Dermatologic Surgery, Orlando, Fla., March 13–17, 1991.

  4. Huang W, Foster JA, Rogachefsky AS. Pharmacology of botulinum toxin. J Am Acad Dermatol. 2000;43(2):249–59.

    Article  CAS  Google Scholar 

  5. Jacobson MJ, Lin G, Tepp W, Dupuy J. Purification, modeling, and analysis of botulinum neurotoxin subtype A5 (BoNT/A5) from Clostridium botulinum strain A661222. Appl Environ Microbiol. 2011;77:4217–22.

    Article  CAS  Google Scholar 

  6. Won CH, Kim HK, Kim BJ, Kang H. Comparative trial of a novel botulinum neurotoxin type A versus onabotulinumtoxinA in the treatment of glabellar lines: a multicenter, randomized, double-blind, active-controlled study. Int J Dermatol. 2015;54(2):227–34.

    Article  CAS  Google Scholar 

  7. Beer KR, Shamban AT, Avelar RL, Gross JE. Efficacy and safety of prabotulinumtoxin A for the treatment of glabellar lines in adult subjects: results from 2 identical phase III studies. Dermatol Surg. 2019;45:1381–93.

    Article  CAS  Google Scholar 

  8. Rzany BJ, Ascher B, Avelar RL, Bergdahl J. A Multicenter, randomized, double-blind, placebo-controlled, single-dose, phase III, non-inferiority study comparing prabotulinumtoxin A and onabotulinumtoxin A for the treatment of moderate to severe glabellar lines in adult subjects. Aesthet Surg J. 2019.

  9. Mishra M. FDA approves cheaper Botox rival to treat frown lines [Internet]. Reuters; [cited 2019 Feb 1].

  10. Caprino M. Revance’s RT002 demonstrates unprecedented efficacy and duration in largest-ever aesthetic neuromodulator clinical program [Internet]. Revance Therapeutics, Inc. Revance Therapeutics, Inc.; [cited 2018, Dec 4].

  11. Acquire Media. Revance reports results for RT001 topical phase 3 trial for lateral canthal lines [Internet]. Revance Therapeutics, Inc. Revance Therapeutics, Inc.; [cited 2016 June 13].

  12. Solish N, Bertucci V, Humphrey S, Bhatia A. Two phase 3, randomized, double-blind, placebo-controlled, multicenter trials to evaluate the efficacy and safety of daxibotulinumtoxin A for injection to treat moderate to severe glabellar lines (SAKURA 1 and 2). J Am Acad Dermatol. 2018;79(3):AB306.

    Google Scholar 

  13. Carruthers J, et al. Injectable daxibotulinumtoxin A for the treatment of glabellar lines: a phase 2, randomized, dose-ranging, double-blind, multicenter comparison with onabotulinumtoxin A and placebo. Dermatol Surg. 2017;43:1321–31.

    Article  CAS  Google Scholar 

  14. Guillen-Fabi S, Green JB, Liu Y, Rubio RG, Gallagher CJ. SAKURA-3, a large open-label safety study of daxibotulinumtoxin A for injection in glabellar lines. Toxicon. 2018;156(S1):S42.

    Article  Google Scholar 

  15. Frevert J, Ahn KY, Park MY, Sunga O. Comparison of botulinum neurotoxin type A formulations in Asia. Clin Cosmet Investig Dermatol. 2018;5(11):327–31.

    Article  Google Scholar 

  16. [Internet]. Bethesda (MD): National Library of Medicine (US). 2000 Feb 29. Identifier NCT03408236. Randomized, double-blind, active-controlled, multicenter, phase I/III clinical trial to evaluate the safety and efficacy of Botulax® as compared to Botox® in subject with moderate to severe crow’s feet lines; 2017 Sept 11 [First posted 2018 Jan 23].

  17. Rose A. Allergan to acquire Bonti adding new neurotoxin programs to medical aesthetics pipeline [Internet]. Allergan plc. Allergan plc.; [cited 2018 Sept 14].

  18. Yoelin SG, Dhawan SS, Vitarella D, Ahmad W, Hasan F, Abushakra S. Safety and efficacy of EB-001, a novel type E botulinum toxin, in subjects with glabellar frown lines: results of a phase 2, randomized, placebo-controlled, ascending-dose study. Plast Reconstr Surg. 2018;142(6):847e–55e.

    Article  CAS  Google Scholar 

  19. Rodrigues O. Bonti announces successful completion of phase 2a scar reduction clinical study [Internet]. Bonti. Bonti; [cited 2018 Aug 2].

  20. Kim JE, Song EJ, Choi GS, Lew BL, Sim WY, Kang H. The efficacy and safety of liquid-type botulinum toxin type A for the management of moderate to severe glabellar frown lines. Plast Reconstr Surg. 2015;135(3):732–41.

    Article  CAS  Google Scholar 

  21. Monheit GD, Nestor MS, Cohen J, Goldman MP. Evaluation of QM-1114, a novel ready-to-use liquid botulinum toxin, in aesthetic treatment of glabellar lines. 24th World Congress of Dermatology; 10-15 June 2019; Milan, Italy.

  22. U.S. Food and Drug Administration. Myobloc® (rimabotulinumtoxinB) injection [Internet]. Solstice Neurosciences, Inc. Solstice Neurosciences, Inc.; [cited 2009 July 31].

  23. Spencer JM, Gordon M, Goldberg DJ. Botulinum B treatment of the glabellar and frontalis regions: a dose response analysis. J Cosmet Laser Ther. 2002;4(1):19–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Edith Hanna.

Ethics declarations


No funding was received for the preparation of this review.

Conflict of interest

Edith Hanna has no conflicts of interest to declare. Kucy Pon has received honoraria for presentations from Allergan and Galderma.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hanna, E., Pon, K. Updates on Botulinum Neurotoxins in Dermatology. Am J Clin Dermatol 21, 157–162 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: