Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Scott Webb (Host): Most of us have heard of Botox for the treatment of wrinkles and fine lines, but Daxxify is a vegan-friendly alternative to Botox that requires fewer treatments per year and is available now at Duly Health and Care. And joining me today to tell us more about Daxxify is Dr. Stephanie Gan. She's a dermatologist with Duly Health and Care.

So, Dr. Gan, thanks so much for your time today. I was mentioning to you that I've heard of Botox, I'm sure most folks have heard of Botox, but I've never heard of Daxxify. So, we're going to talk about Botox, Daxxify today, which one is right for folks. And I know that Daxxify at least is a new alternative to Botox for wrinkle and fine line treatment. So, maybe you could talk about the main differences between Botox and Daxxify.

Dr. Stephanie Gan: So, Daxxify is a longer lasting neuromodulator. And neuromodulators are the category of treatments similar to Botox that helps to relax the lines caused by muscle movement. It lasts up to generally five to six months and it also takes effect faster in about two days versus seven to 10 days, which is like with the traditional neuromodulator treatments.

Lastly, also, it's called peptide-powered. So, the active ingredient called botulinum toxin A needs to be stabilized. And so, with Daxxify, you're stabilizing with a peptide versus with Botox or some of the other brand names, they are stabilized with a human blood product or an animal blood product. So, great for those who are more vegan-friendly.

Host: Yeah. It's great to have experts on, because I was like, "What the heck is Daxxify?" And now, I sort of know, and it certainly seems like there are some benefits to Daxxify over Botox, though I'm sure Botox is still, you know, widely used. Now, do you apply Daxxify to all areas where a patient has previously received Botox? Is its approval limited to specific injection sites, or are there instances where you use it in other places? Kind of known as, I think, off-label, I'm putting that in quotes. And what considerations should patients keep in mind when it comes to that off-label usage of Daxxify?

Dr. Stephanie Gan: With the Daxxify, it is FDA approved to treat the frown lines, moderate to severe frown lines, or the 11 lines between the eyebrows. And we definitely inject it in areas that we had previously treated with Botox, such as the upper forehead lines, the crow's feet, or what are called the lateral canthal lines. And these are very safe to use, very safe injection sites. It has a similar efficacy and side effect profiles. So, it is very safe to use and definitely we use it in these off-label sites.

Host: Okay. So yeah, you're selling me big time on Daxxify. As I told you, I'm 55. So, occasionally, I look in the mirror and I go, "Hmm, interesting," right? So, what specific skin concerns or aging signs are better suited for Botox versus Daxxify, you know, when Botox, maybe is more appropriate?

Dr. Stephanie Gan: So, Botox and Daxxify, they actually treat the same skin concerns. So, specifically, this would be for the deeper lines that are caused from muscle movement. So, the patient who is a candidate for Botox would also be a candidate for Daxxify. The benefit being with Daxxify is that it lasts longer. So, patients who are only able to come into the office, let's say twice a year, I would, encourage them to treat with Daxxify versus Botox, which lasts only up to three to four months. And you will get the same overall result, the same muscle relaxation and wrinkle reduction.

Host: Are there any other notable advantages or benefits to one or the other? Are you recommending one or the other now when folks come in and they've maybe after today, they will have heard the podcast on Daxxify and say, "Hey, I heard about Daxxify, Dr. Gan. What is that?" I mean, you have recommendations? Are there benefits, advantages? Maybe you could take us through that.

Dr. Stephanie Gan: Sure. So with Daxxify, the main benefit is that it lasts up to five to six months, so conventional frown lines last three to four months. And in the clinical trials with Daxxify, at least 50% of patients in clinical studies had no or minor frown lines at six months after treatment with Daxxify. And in other safety studies, 5 to 17% still had noticeable improvement nine months after treatment. And at four-week followup, 98% of patients were very satisfied with treatment. So, I would say, these days I have been recommending Daxxify more so than Botox because let's be real, you know, everyone's busy. It's hard to come into the office three to four times per year. So, a twice a year treatment with the same results is a huge benefit.

Host: Yeah, absolutely. Are there any safety concerns at all between Botox, Daxxify, between you know, comparing the two or just in general? Are there any real notable differences when we think about safety?

Dr. Stephanie Gan: Yeah. So with Botox and Daxxify, they're both extremely safe procedures. In the clinical trials with Daxxify, which included more than 2,800 patients, there were no serious treatment-related side effects. And the active ingredient in Daxxify has been proven to be effective and used for the past 20 years. Same thing with Botox. So with Botox, it has excellent safety profile. There have been no long term or life-threatening events. And it is the most common cosmetic procedure that we actually do in the office.

Host: Yeah, doctor, maybe this is a little bit off script but, you know, I've heard, I've talked to some neurologists that have been using Botox for migraines. And I don't know if you can speak to that or not, but I'm wondering if you can, you know, if they're using Botox to treat migraines in some cases, could they also be using Daxxify?

Dr. Stephanie Gan: So, Botox, its original use was actually to treat what's called like spastic neck or cervical dystonia, but it also is, FDA approved to treat migraines as well as bladder spasticity. So, right now, Daxxify is FDA approved to treat the 11 lines. It doesn't have other FDA indications, but I'm sure they're doing studies to treat other sites. Could Daxxify also be used to treat the migraines? Sure. But right now, there are no recommendations for how many units to use. But yes, you could definitely use it off-label.

Host: I see what you mean. And obviously, as you say, probably in Daxxify's best interest, you know, to keep up with Botox, so I'm sure they're working on that, testing, that kind of thing. You know, maybe seeking FDA approval. So, I knew that I could ask an expert and you'd have the answer. So, that's why it's great to have you on. What are the typical recovery periods for Botox, Daxxify? You know, you said that folks tend to notice results sooner with Daxxify, but how about the recovery period?

Dr. Stephanie Gan: So, both Botox and Daxxify have very minimal downtime. After the treatment, there may be some swelling, the skin may turn a little bit pink or red. There may be temporary pain or tenderness from the injection sites, and that swelling goes down within 20 minutes. I consider it a lunchtime procedure, so you're in and out within about 15 minutes, you can go back to work if you need to. Possible side effects are bruising. So, I recommend to try to avoid any ibuprofen, Motrin, aspirin, fish oil, maybe don't have a glass of wine the day before, and avoid exercise the day of to minimize bruising. But it's very well-tolerated, minimal down time.

Host: That's great to hear. And this has been really educational today. As I prefaced today, I was like, "I want to know what Daxxify is." So now, I know. Botox, Daxxify, got it. And as a dermatologist, how do you assess and determine which treatment option is best suited for each, know, unique skin type and concerns? They may come in and say, "I want Botox," or "I heard about Daxxify and I want that." But as the expert, as the dermatologist in the room, how do you assess and determine and then make those recommendations?

Dr. Stephanie Gan: Generally, I would say during the initial consultation, I would get a sense of what the patient's goals are, what their schedule is like. If they feel like a twice-a-year treatment would be better suited for their work schedule or their life, then I would definitely steer them towards Daxxify, because Daxxify is right now the longest lasting neuromodulator on the market, which is its main benefit. It also kicks in a little bit faster. So, it works within two days versus Botox takes about seven to ten days to start working. I like to see patients back two weeks after to see if there's any adjustment that needs to be made. And they both have the same final results, so that muscle relaxation, the wrinkle reduction.

And ideally, patients who do this type of treatment, we do want to maintain the effect. So if you're thinking that you're only going to do this once and not going to maintain it, then I would say maybe this is not a treatment that's right for you. There are other options available. So, that's all important during the initial consultation visit. But basically, Botox and Daxxify give the same final result. It's really a matter of the duration effect and that it works a little bit faster in about two to three days versus seven to 10 days with Botox. And lastly is that Daxxify is peptide-powered. So there's no human or animal byproducts used to stabilize the active ingredient.

Host: Yeah, I love it. It lasts longer. You notice it sooner. It's vegan-friendly. So, a lot of advantages to Daxxify, not putting down Botox. Still, I'm sure for many patients and dermatologists, probably still the gold standard. So, great to have you on today. Great to learn more about the two and compare and contrast and all that. So, thanks so much and you stay well.

Dr. Stephanie Gan: Thank you so much.

Host: That's dermatologist, Stephanie Gan. And for more information, go to dulyhealthandcare.com. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health and Care.