Pharmacology of Neurotoxins: Onabotulinum ToxinA (Botox®), Abobotulinum ToxinA (Dysport®), Incobotulinum ToxinA (Xeomin®), DaxibotulinumtoxinA-Lanm (Daxxify ®), and PrabotulinumtoxinA-Xvfs (Jeuveau™)

Neurotoxins, or botulinum neurotoxins type A (BoNT/A), are commonly known as Botox®, Dysport®, Xeomin®, and Jeuveau™ for cosmetic use and are the most commonly performed nonsurgical aesthetic procedure in the world. A new FDA-approved BoNT/A called Daxxify® (daxibotulinumtoxin-lanm) was released to the US market mid-June 2022. BoNT/A treatment in the facial muscles causes relaxation of the muscle fibers by cleaving SNAP-25 and subsequently reducing the formation of SNARE complexes and acetylcholine release from the peripheral nerve cells into the neuromuscular junction. This results in relaxation of the targeted muscle or muscle group and leads to smoother overlying skin because the muscle is no longer able to fully contract and cause a line. The smoothing result of the neurotoxin is temporary and lasts approximately 3–4 months, although the medication package inserts state up to 6 months. This chapter will review the pharmacology of the most commonly used neurotoxins for cosmetic use.