Episode 77: Daxxify

 The neurotoxin for the busy businesswoman and businessman who can’t make it into the office as often as they would like is here! Daxxify, an FDA-approved neurotoxin, is the hottest new neurotoxin on the market, and we are so excited to start using it at Austin Plastic Surgeon. This neurotoxin is special because it lasts six to nine months which is longer than traditional neurotoxins such as Botox and Dysport, and has a faster onset. A good candidate for Daxxify is someone who has had neurotoxin before and knows exactly what they want and that they want it long-lasting. Listen to Dr. Franco, PA Gilbert, Nurse Sarah, and aesthetician Andrea discuss this new neurotoxin and all it has to offer!


Welcome back to Plastic Surgeon Untold, greatest podcast in the world, is voted by us, got our celebrity crew back again. And so let’s just do a little check in. Before we check in with everybody though, today we’re talking about Daxxify, which is something that I think we’ve brought up for the last two or three years in a row as coming projects are coming, new, exciting things, but this year, it’s finally here, it’s actually been FDA approved, actually rolling out over the next two or three months. And so we’re actually going to have a quick preview of it very, very shortly. So for our VIPs, you’re gonna get an early access to this. So just to give you guys a little bit of a teaser, but before we get into Daxxify, let’s see what everybody’s got going on. Gilbert, what’s new and exciting with you? You’re looking fine and damper in your green.

Thank you. Actually, I want to piggyback on what you just said about the VIPs. Like how would someone become a VIP?

Oh, that’s a great question. So most of you know that we’ve already launched our app. And maybe Andrea will tell us a little bit more about the app shortly. But you know, if you’re on our app, you actually get some exclusive invites to some of our events. If you’re a member, which you can do through the app you get there, also get some discounts. So all sorts of fun stuff. So if you haven’t checked out our APS Rewards App, very similar to the Starbucks Rewards App except better, except cooler stuff. There’s rewards a lot. Sarah, what about you?

Yeah, um, lots of new things, new things at the office, new app, like you said, new treatments. There’s… I heard you destroyed Nashville. Nashville is awesome and exciting. It was only my second or third time there, but I absolutely loved it. But yeah, we’re just excited about the new things we can offer at the office and excited to tell you all about Daxi.

So funny that you brought up Nashville because Nashville is actually the headquarters of… What a great segway. And so, it’s gonna be there this weekend. So it’ll be super fun and lots of cool stuff. So interesting that you brought that up. Nice to have. Thank you, Andrea, what’s going on? Thanks for coming all the way from San Antonio and taking time away from your busy patients to see us. So appreciate you working us into your busy schedule. Yeah, thank you. So what’s going on new with you?

Nothing much, I just started school.

How’s that going? What’s going on?

I have to learn 206 bones for my class. So I’m kind of nervous for that.

That’s exciting. Wow. Yeah. You want you want you want Nurse Sarah to teach you.

Yes, please. I don’t know if I remember them all.

And for all your longtime viewers, some DMers, Tell us what are you studying?

So I’m in my pre-nursing degree. So yeah, I think I’m three classes away from applying. So I’m super excited. Congrats! Thank you.

Nothing makes me happier than than you know, and our team just keeps going because I think all of us feel super passionate about learning, educating and growing. And so some of you know, Nurse Sarah is actually well on her way for her NP. Andrea is working on her nursing degree and and I doubt she’ll stop there. So super fun. Now Gilbert and I gotta find something to study and learn.

I’ve actually thought about going to the Kellogg School for doing this, this business degree stuff that I’ve been exploring, so hopefully find something to do on my free time, you know, get bored and so I’m not wasting too much free time, but I’ve been looking into a PhD program.

He’s a little one upper, but well, we’ll talk about it another day. Here I am talking about a masters and he’s talking about PhDs. But let’s jump right into Daxxify. Cause I know we’ve talked about this, you know, over and over, people are probably tired of us saying coming soon. But it’s for real here. It’s actually a thing. And so super exciting. Number one, what is it? What what class of treatment is this? What does it do? Like kick us off. Yeah,

So Daxxify is a neurotoxin, very similar to Botox, Dysport, Xeomin, Jeuveau. They’re all neurotoxins. But it’s actually a little a little bit different. It’s a little special because of the way the neuro modulator is delivered to the to the target site. It actually uses a peptide to help deliver the molecule into the receptor site. And because of that, it slows down the degradation of the product, which essentially means that the Daxxify is going to last longer than some of the traditional neurotoxins that we’re used to seeing.

That’s super cool. And then tell us a little bit about this. Because it’s been in production for a long time, you know, who’s going to be a good candidate for this?

Yeah, I’ll tell you personally, I am super excited. It’s perfect for anybody, you know, we like to say it’s going to be perfect for like the busy business woman or man, not just women, perfect for somebody who’s been doing neurotoxins, so maybe not if it’s your very first time and you’re a little anxious or nervous about it, because we’re expecting that this is going to last about twice as long. So about six, maybe more, you know, months. So if it’s your first time ever doing neurotoxin, that maybe a little bit long, you know, but if you’re used to it, you love it. Maybe if you’re not getting as much longevity out of some other products, we we love switching things up for you. Or if you just ,it’s hard to get into the office at quarterly every three four months, this is perfect for you if you can go six plus months between treatments. So all of the above.

I think it’s gonna be great because then a lot of people come in in every six or nine months for their either filler treatment, for their RF microneedling, for their other different treatments. And it’s nice that for the busy business pro professional that that you get onto a schedule that’s a little bit easier, because most people love their toxins, it’s hard to come on. Other kind of unique thing about it is the onset is going to be super exciting, not that any of us ever procrastinate. But those of you that are in school probably know what I’m talking about, burning the midnight oil, but but talk to us a little bit about the onset as well.

It’s projected to be faster than some of the traditional toxins or neuromodulators. In terms of how fast, I think that’s gonna vary from patient to patient. So I can’t say you know, any definitive timeline, but I think a good range would be anywhere between two to five days, versus the traditional onset, which I usually educate my patients is about 7 to 10, with, you know, full onset at about two weeks.

We’re still not telling people to wait to the last minute, not a great idea, you know, but definitely a little bit nicer to be able to kind of come in and get stuff done and do that stuff, because we still worry about bruising and other other things like that. Does anyone want to share some of the the history of Daxxify? And actually, why this took so long? And what their their initial thoughts are? And that’s how they developed this peptide?

Are you familiar with the history? Take it away, Gilbert. Tell us about it.

Super cool. Yeah. So Revance, the company that makes Daxxify initially had the idea to bring to market a neurotoxin that was topical, versus injectable, which I think would have been just so innovative and game changing in in the aesthetic world. Unfortunately, I think it was in the phase two trials, they found that it just was not effective, they couldn’t get the product transdermally, or to pass through the skin, as well as they originally planned. So they pivoted and started looking at it from the perspective of an injectable version of the same same product, which is how we have Daxxify now, but there were some hiccups. Back in 2020, if you remember there was a little incident that occurred called COVID. That, that pretty much shut down the world for a little while. And this was around the time that Daxxify was going to be coming to market. And so the FDA had to do a site visit of their manufacturing plant. But because of COVID, they couldn’t because everything was shut down. So it delayed things for so long. And so once the things, once things started getting rolling again, and the FDA was finally able to do their site visit, make sure that everything was in compliance, that’s how things started moving a little bit faster.

It’s super cool because if you think about it, right, so they had an alternative approach, which made them think about, you know, the toxin in in a little bit different manner than anyone had before. And so they developed a separate peptide that the goal was to, to be able to, you know, penetrate through the skins easily and seamlessly. And it works to a degree but not where they had wanted to. But, you know, they found that, that this peptide that they had created for a completely different purpose, but a very unique approach compared to, to other toxins had this really great, you know, and if you notice any parallels, we were talking about semaglutides earlier, you know, which was initially rated to be a cheetah at diabetics, you know, and then found that people had such significant weight loss stuff. This is similar, so it didn’t work as well going through the skin, though, does work a little bit, you know, with the ability for it to be able to bind to these receptors, and then to prevent the degradation because what happens with regular toxins is that your body breaks it down, the receptors get get absorbed, and then you get new receptors and your muscles starts moving again. So I think that it’s super, super cool.

In terms of this, it’ll be easy to see how Andrea sees people over the next 6 to 9 months because because it was made with this special peptide, a lot of people have started to see some skin changes and improve glow, some improved texture to their skin because of that, that special peptide stuff. So Andrea, it’ll be interesting for you to give us an update six or nine months as people are on this for for a long period of time and see how it improves people’s skin.

Yeah, and for a lot of my patients who are scared to get Botox, that’s like my number one thing I tell them, like you’re gonna have like an amazing glow, just try it. It’s so easy. So yeah, it’ll be very interesting.

Because a lot of people have some of these fine wrinkles and and creases and wrinkles that they have that they can’t get rid of and and there’s only so much that you can do with things, so I mean definitely skincare should be a great portion, but the more you can be on this at the beginning, it’s really hard to treat these deep wrinkles once once they kind of set in. Yeah, I couldn’t agree more. I always tell people it’s like folding a piece of paper, the more you fold it, the longer, the harder it is and and so we can get them out, but sometimes takes a while.

Yeah, it’ll be interesting to see with Daxxify though because I tell him if we are working on deep wrinkles, they need to come back like right as they’re starting to get movement back because if we start wrinkling or folding that paper again, they’re going to set back in so, you know, just thinking through if this is going to last twice as long hopefully we can start to fade those a little bit quicker.

That’s super interesting because for most people, it’s really, really hard to come back right at three months. And so I wonder if some of these people who have deeper lines, this is going to be more effective just from a compliance standpoint. Exactly. I hadn’t thought about that. Great point, nurse. Let’s talk about and we were talking a little bit before this, about kind of areas that that I think we’re super excited about, and maybe areas that that we would stick with either a Botox, Dysport, or Xeomin stuff, because there’s some really unique kind of things here. And we’ll also talk about whether you can combine these and if you can switch from one to the other. So maybe if you guys can hit a few of those four questions I just threw out.

I do think that you know, we mentioned this earlier, if maybe you’ve been having, you know, less longevity with your current product. I currently switch people back and forth between Botox, Dysport, Xeomin. Just depending on the patient, right, we I always talk with you about your goals, how it’s been working for you, the feeling you’re going for, because I do think that some feel slightly firmer, some feel, you know, less firm. So I don’t see any problem switching people over to Daxxify from something else. And I do think that if, obviously, you’re going to get more longevity because it lasts twice as long. But if you’ve been having some issues with that, I think you’re the perfect candidate. And if for whatever reason you don’t like it, no problem, we can always switch you back to your tried and true Botox, Dysport or whatever it was.

And what about areas Gilbert? Is there certain areas that you’re super excited to try this? Maybe an area that you would would stay with a traditional Botox, Dysport, Xeomin?

Yeah, so I’ll tell you the, the product itself is indicated for the glabella, which is in between the brows and as right as of right now, that’s the only indication it has, but as you well know, in medicine, it’s an art not a science. So we do kind of emphasize. An art and a science? It could be an art and a science. We blurred the lines a little bit. That’s what I was gonna get out. And so there’s areas that can be treated that are not indicated, that I think we will do. Do you do it for other toxins too? Yeah, almost everything we do. Yeah, that I think would would benefit quite a bit like the forehead around the eyes. But I’ll tell you, I think we mentioned this in a previous episode, I really am excited to see how this would work on like platysmal bands. Because those are those are little difficult to treat sometimes, and you know, they they do tend to come back a little bit faster. So if you can, if you can knock them out for a longer period of time and give the patient a nicer smoother neck, I think that’ll make a big, big difference. I think you mentioned masseter muscles, I think that’s a great area too because for those patients that want a slimmer look to their face, or they have issues with jaw pain, I think it’s just gonna give them that benefit for a longer period of time as well. And probably a better result because the longer you can keep that muscle from doing stuff, the better you’re going to be in terms of this.

I was gonna say the area I’m super excited to use it is in like a lip flip. Because when we’re used, doing toxin around the mouth, typically it wears off quickly, because we’re always moving our mouth, chewing, talking. So you don’t get as much longevity in general there. I feel like, to be honest, typically, it’s like six weeks, maybe, if you’re lucky. So we’ll see how long Daxxify lasts in that area. But we know it’s going to be longer. So that’s super exciting.

Definitely longer and I think this is where the art of it’s going to be because you know, definitely someone who’s had a lip flip, love it. I think it’d be great. I think someone who’s never had some toxins injected around the mouth. I don’t I don’t think I would do it for their first few because some people absolutely love it. Some some people don’t love it as much and so, definitely want to make sure you’re at a good spot with with some of that. I thought somebody had mentioned hyperhidrosis because that’s a great one people do for like weddings, events stuff, it just the amount of product you need for the short duration, you know, sometimes it’s a little bit inhibitory. So, you know, this may be opening up a lot of doors for people. So that’s kind of exciting. Yeah, absolutely. Because imagine because I feel like you’ve had hyperhidrosis, you got more than the three or four months that you get for some of the muscles stuff. So we don’t know yet. But it’ll be interesting to see how long those areas can be treated with something, especially with its unique kind of skin properties and special peptide stuff. So that’ll be something over the next two or three years for us to kind of see how long longevity that it gets, you know, people always wonder, you know, the problem with checking out these longevities in some of these is it takes time to follow people for that long and make sure that they’re in a great spot. But I think there’s a lot of exciting spots with with some of that.

Yeah, so stay tuned. That’s exciting.

What about in terms of treatments themselves? Does the treatment change very much for for people like is is, when they come into the office, is it gonna be a different experience with Daxxify than it would be with Botox, Dysport, Xeomin for the patient, you know?

For the patient? No, you know, it’s still the same procedural based, you know, treatment. I think what what we will see on our end, on the back end, is the unit conversion, I think is going to be a little different. I’m not familiar with it 100% but I do know that the unit conversion is just a little varied from what we’re used to with with Botox, Dysport, Xeomin.

It’s funny because when they talk about it, and you guys will see this when you come to our office, you know, that there’s kind of the Daxxify units. And then they’ve even, they come in initially because it’s going to be to make some… patients. They also have like a… five equivalent to Botox unit stuff. So they have like the Botox conversion already, which is a table they’ve already made. And we’ll share that with you guys when you come to the office. So you’ll see kind of the Daxxify and then the equivalent, like Botox units of it. So we’ve already simplified it for you guys, we’ll have it that way. It’s super easy. So you know, this is what I typically get for Botox, this is what I need for this, but I’m gonna get twice as long out of it. So I think that’ll be super cool. You know, I think people have had some worry about pricing. I actually am pretty pleasantly surprised, you know, may spend a little bit more at that time when we think about it, you know, being basically equivalent to almost two treatments. You’re actually… ahead… a little bit stuff. So I think that that was definitely a pleasant surprise for a lot of people.

Yea, yeah, I agree. I was worried about the price. But once we got some more knowledge on that, not quite twice, you know, we’re gonna get twice longevity but not quite twice the price. So I think I think you’re gonna win, like you said.

And then even from a time standpoint, if you think about you know, productivity loss, you know, coming in, even though we’re super efficient, try to not make you guys wait, you know, it still happens. Since we got Andrea here. And just a question I get all the time. So if somebody’s coming in, because you are trying to make the most of your day, and you’re getting either Skin Pan, you’re getting RF Microneedling, you’re getting a HydraFacial, what order would you do stuff in terms of you know, would you do your HydraFacial first? Would you do your your Daxxify? Like what order goes best? You know, if I’m seeing Gilbert and Andrea, Sarah, stuff. What do you guys tend to recommend? Yeah,

So typically, see me first because… *laughing* I’m number one. We don’t want the patient to lay down. As you know, our injectors always tell us after Botox, so see me first because obviously, they will be relaxing for a little bit and then they’ll come and see their provider.

Okay. Is that true for just HydraFacial, Skin Pan and kind of any treatment of the face? You would do that first before the toxin, but you can do the toxin right after?

I would agree with that. Yeah, absolutely. Yeah.

Do it same day, kill two birds with one stone.

Peter, I’m sorry, we’re not, no birds were hurt in the filming of this podcast, I promise. But I do think it’s kind of nice. Because a lot of people do ask that question about timing and doing some other stuff. How about, you know, Daxxify in combination? Because we talked about some areas. Let’s say we’re, somebody’s really super excited. They’ve been doing their forehead brow for a long time, but they want to just sample a little bit of perioral toxin stuff. Can they do Daxxify? For the glabella, eyebrows, crow’s feet and then Botox or Dysport for their perioral lines? Is that okay?

Yeah, absolutely, we’ll still carry all the brands. So we can definitely mix and match your injector, we’ll keep track of all that for you, we keep detailed notes, I don’t see any reason why we couldn’t do Daxxify in your upper face, try something a little that will last a little bit less time, like just for Botox in the lower face.

If you’re experimenting with a new area that you haven’t treated before, you know, these products, they pretty much stay in the area that they’re injected. So you know, you’re not getting any kind of just movement or dispersion of the of the product into other muscle groups that you’re targeting.

I think there’s just so many things that that we’re going to be able to explore and do I think the art of the toxin is going to just even evolve more now that we have so many different options, so many different tools. So kind of depending on what you want to do, I think, you know, being able to combine this with our estheticians and kind of really working together. I think the, if you look at all the new stuff rolling out this year, the you know, the the semaglutides, you know, the changes in some of the RF Microneedling stuff that has just gotten better in terms of comfort. There are some some Micro-Coring stuff that that’s in the horizon that we’ll talk about another time, you know, and then obviously, the Daxxify, but trying to figure out a good order. And this is where I think when you do your initial consultation, really being kind of clear about your goals, because if we need to set you up to see our esthetician, then you know, first if we need to have you see one of the injectors first, you know, making sure we have a good game plan in terms of all of those those things.

Yeah, absolutely. I tell everybody, it’s a journey, we can come up with a plan for the next year. We don’t have to do it all today. And I love incorporating the estheticians, the surgeons, our internal medicine doctor, you know, we love to kind of take care of you as a whole. So we will come up with a plan, lay out the treatment plan for you, you’ll know exactly when to come in and what we recommend first and next and all of the above.

Any other Daxxify nuggets that you guys would like to leave for your longtime viewers, sometime DMers?

I just honestly think it’s going to be a game changer in the world of aesthetics. And I know we’ve said that already but I just can’t emphasize that point enough that it’s it’s going to, it’s going to change the way we do things quite a bit.

I agree. One thing, I said this earlier and I wanted to make sure to mention it, so we talk about it for like the busy business person, but also I have a ton of patients that are moms and stay at home moms. And I feel like same for them. It’s so hard to get away from the kids or just like get a babysitter for you to come in. So I think for y’all too, this is going to be a game changer. I’ll be sad that I won’t see you as often and hopefully we can come up with some other ways that I can see you but just anybody who’s looking to be more efficient with their time, which I think is all of us, this is going to be perfect for you,

Andrea, any last notes for all your fans?

You can see me every month.

She’s like, come see me.

Well, I appreciate you guys joining today and talking about Daxxify, I know we’ve kind of held people in suspense for years. So I’m glad that it’s finally here. We are gonna have a VIP event, we’ll send you guys some more information about that. So check on our website, check on our Instagram, we’ll let you know how to become a Rewards App member so you can come to our special event and Early Access, since you’ve already waited years for it, but Plastic Surgeon Untold, wherever you get your favorite podcasts, iTunes, Spotify, iHeart and Pandora, and more. But those are some and if you want to see our pretty faces all nice and smooth with our… feel free to check us out on YouTube. Alright, we’ll see you guys, bye. Bye.