Botulinum toxin

Botulinum toxin type A · Botox Cosmetic, Dysport Aesthetic, Xeomin Cosmetic, Nuceiva and Letybo

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How it works

A toxin in the muscle, which then contracts less

MuscleNeedleNerve endingAcetylcholineMuscle fibreAt the nerve ending the toxin holds theacetylcholine back, so the fibre is signalledless and contracts less.

Botulinum toxinThe muscle contracts less

Layers, top to bottom: epidermis, dermis, subcutaneous tissue, muscle, bone.

EpidermisDermisSubcutaneous tissueMuscleBoneNeedleNerve endingAcetylcholineMuscle fibreAt the nerve ending the toxin holds theacetylcholine back, so the fibre is signalledless and contracts less.

Botulinum toxinThe muscle contracts less

Frown lines, five sites: two in each corrugator muscle, one in the procerus. Forehead lines, 4 sites along the frontalis for Botox Cosmetic, five for Xeomin Cosmetic; crow’s feet, 1 to 3 sites a side for Botox Cosmetic, three for Dysport Aesthetic, three or four for Xeomin Cosmetic, into the orbicularis oculi. Each product’s units are its own, every monograph states. 4 a site, 20 in all, for Botox Cosmetic, Xeomin Cosmetic, Nuceiva and Letybo; 10 a site, 50 in all, for Dysport Aesthetic. Illustrations are schematic.

What Botox actually does

How it relaxes the muscles behind frown lines, what a year of it costs in Canada, and the drooping-eyelid risk.

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What it costs

$10 to $12 a unit of Botox Cosmetic at five clinics, 20 units for frown lines

ProductAt the monograph’s dose
Botox Cosmetic20 units at $10 – $12 a unit$200 – $2405 clinics
Xeomin Cosmetic20 units at $10 a unit$2001 clinic
Nuceiva20 units at $10 a unit$2002 clinics
Dose-based estimates for one treatment. Five clinic pages price Botox Cosmetic per unit, two Nuceiva and one Xeomin Cosmetic. Dysport Aesthetic is omitted from the price calculation: the quoted clinic units have not been verified against its monograph units; no conversion is assumed. Its monograph specifies 50 units for frown lines and 30 a side for crow’s feet. No clinic page read prices Letybo. Each listed total uses the named product’s own monograph dose and price, not a complete course or a personal dose recommendation. Canadian dollars before tax, as the clinic pages state them.

Results & duration

Trials measured changes in frown lines

Each product’s Canadian monograph, as it reports the trials behind it. Each number is that product’s own, on its own study’s scale and endpoint — a two-point improvement for most, “none or mild” for Dysport Aesthetic and for Xeomin Cosmetic’s combined study — so the columns are not one test applied to five products.

Botox Cosmetic

Doctor-rated at maximum frown

Responded to treatment

more than80%of 203 people

The monograph states more than 80% — a floor, not a figure — for the investigators’ rating of glabellar line severity at maximum frown; the study was placebo-controlled, its placebo rate not reported.

AbbVie 2025 § 14

Person-rated

Saw an improvement

more than90%of 203 people

The monograph states more than 90% on their own global assessment of change; a floor again. By day 120, 44.1% still rated themselves at least moderately improved.

AbbVie 2025 § 14

Dysport Aesthetic

Doctor-rated at maximum frown

Lines none or mild at day 30

89.3%Dysport Aesthetic · 92 of 103 people

3.9%Placebo · 2 of 51 people

Treatment success on the study’s four-point scale: none or mild, from moderate or severe; the single-dose study.

Galderma 2023 § 14

Doctor and person agreeing

Two grades better at day 30

56.3%

Both rated at least two grades of improvement; by day 120, 24.2% were still rated none or mild by the investigators.

Galderma 2023 § 14

Xeomin Cosmetic

Doctor-rated at maximum frown

Two points better at day 30

76.6%141 of 184 people

On the four-point Facial Wrinkle Scale; study 1 of two of identical design, a single dose of 20 units.

Merz 2023 § 14

Doctor and person agreeing

Two points better at day 30

60.3%Xeomin Cosmetic · 111 of 184 people

0%Placebo · 0 of 92 people

The study’s primary endpoint; nearly all had lost the response by day 120, the monograph states.

Merz 2023 § 14

Nuceiva

Doctor-rated at maximum frown

Two points better at day 30

77.5%

On a four-point severity scale; the first of two trials of identical design. The monograph states the rates alone, with no counts behind them.

Evolus 2024 § 14

Doctor and person agreeing

Two points better at day 30

67.5%Nuceiva

1.2%Placebo

The study’s primary endpoint, both rating independently.

Evolus 2024 § 14

Letybo

Doctor-rated at maximum frown

Two points better, and none or mild, at week 4

65.8%348 of 529 people

On the four-point Facial Wrinkle Scale; BLESS I, the largest of three trials of identical design.

Hugel 2024 § 14

Doctor and person agreeing

Two points better, and none or mild, at week 4

46.5%Letybo · 246 of 529 people

0%Placebo · 0 of 175 people

The study’s primary endpoint; both the investigator and the person independently met these criteria.

Hugel 2024 § 14

How soon does botulinum toxin work, and how long does it last?

It starts within days where a monograph says: as soon as 24 hours, median 3 days, for Dysport Aesthetic; 2 to 5 days for Xeomin Cosmetic, the maximum effect after 2 weeks; 2 days for Nuceiva. Botox Cosmetic and Letybo state no onset. It lasts 3 to 4 months for Botox Cosmetic, Health Canada says. The monographs: Dysport Aesthetic may last up to 4 months; Xeomin Cosmetic an average of 9 to 16 weeks; in Botox Cosmetic’s frown-line study 44.1% still rated themselves at least moderately improved at day 120, and in Dysport Aesthetic’s 24.2% were still rated none or mild by the doctors at day 120. The Nuceiva and Letybo monographs state no duration: they report trial results only at day 30 for Nuceiva and week 4 for Letybo. Every monograph sets the shortest interval between treatments at 3 months.

Health Canada · Cosmetic injections (2015) · onset: Dysport Aesthetic § 14.2, Xeomin Cosmetic § 10.2, Nuceiva § 4.2 · duration: Dysport Aesthetic § 10.3, Xeomin Cosmetic § 10.2 · trial results: § 14 · interval: § 4.1, Xeomin Cosmetic § 4.2

Recovery & risks

Headache and temporary eyelid droop were reported

Five monographs · frown lines, the placebo-controlled trials

Drooping eyelid
Botox Cosmetic 3.2% of 405 people, none of 130 on placebo; Dysport Aesthetic 2% of 2,041; Nuceiva 1.6% of 737; Letybo 0.8% of 955, counting brow droop, dry eye and blurred vision with it; Xeomin Cosmetic 0.3% of 796 over repeat treatments, and facial weakness 0.7% of 535.
Headache
Botox Cosmetic 9.3% of 405, against 15.4% of 130 on placebo; Dysport Aesthetic 5% of 2,041; Xeomin Cosmetic 5% of 535; Nuceiva 12.3% of 737, against 13.3% of 211 on placebo; Letybo 2.9% of 955, against 1.3% of 317.
How long
Most drooping-eyelid events after Dysport Aesthetic were mild to moderate and resolved over several weeks. The Nuceiva, Letybo and Xeomin Cosmetic monographs say reactions are generally temporary but can last several months. None of the trials counted days off work.

Side effects reported to Health Canada

A drooping eyelid in 3.2% of 405 people after Botox Cosmetic for frown lines, 2% of 2,041 after Dysport Aesthetic, 1.6% of 737 after Nuceiva, 0.8% of 955 after Letybo counting brow droop, dry eye and blurred vision with it. Weakness away from the injection site: no rate established; reported hours to weeks after an injection.

Drooping eyelid or brow

Weakness away from the injection site

Health Canada’s cosmetic-injections page, and every monograph’s boxed warning on the toxin spreading from the muscle injected · Illustrations are schematic.

Read from the five product monographs. The adverse-event tables of each product’s placebo-controlled trials, any cause counted where the monograph counts it so. Downtime is not measured in them. The monographs describe different populations and follow-up periods; their rates cannot establish which product is safer. The harms on the cards are those Health Canada names for botulinum toxin.

Frequently asked questions

Yes, as prescription drugs, product by product: Health Canada lists Botox Cosmetic on DIN 02243721 and DIN 02531445, Dysport Aesthetic on DIN 02387735, Xeomin Cosmetic on DIN 02383489, Nuceiva on DIN 02480158 and Letybo on DIN 02528134 and DIN 02528142, each a Schedule D biologic sold on prescription. The indication differs by product: frown lines alone for Nuceiva and Letybo, frown lines and crow’s feet for Dysport Aesthetic, each in adults under sixty-five; frown, forehead and crow’s-feet lines for Xeomin Cosmetic, and those with the platysma bands of the neck for Botox Cosmetic. Nuceiva’s maker, Evolus, sells prabotulinumtoxinA in the United States as Jeuveau. Boey (trenibotulinumtoxinE, DIN 02569086) was authorized in June 2026 for frown lines in adults but is not marketed, so this page’s figures cover the other five. Daxxify, approved in the United States, has no Drug Product Database record. A drug identification number records Health Canada’s review of the product for the use filed; it does not establish every benefit, area or duration a clinic advertises.Health Canada · DPD · each product monograph § 1 · FDA-reviewed US labels, Jeuveau and Daxxify

GST or HST applies to taxable cosmetic treatments: 13% in Ontario, 5% where only GST is charged. The clinic prices here are before tax. A treatment for a medical or reconstructive purpose may be exempt when it meets the applicable health-care exemption’s conditions, including who supplies or performs the service; its purpose alone does not establish an exemption.Excise Tax Act · s. 165, Sch. V Pt. II ss. 1, 1.1, 1.2 and 5 to 7, Sch. VIII

A physician, a nurse practitioner, or a nurse working under one — and the drug itself is prescription-only, so someone with prescribing authority orders it for the person treated. The College of Nurses of Ontario’s guideline on aesthetic services (2026) states that injecting neuromodulators and dermal fillers involves two controlled acts, so an RN or RPN needs an order or directive from a nurse practitioner or physician, while nurse practitioners are autonomous. Other provinces set their own rules.CNO · Aesthetic services, practice guideline (2026) · Health Canada · DPD

Not in the figures above. Every number is read from the product’s Canadian monograph: the registration trials the maker ran for its authorization and, for Botox Cosmetic’s forehead and crow’s feet, published investigator studies the monograph summarises without naming their sponsor. Every frown-line trial had a placebo arm and blind raters, but the maker chose the scale, ran the trial and wrote it up, and the monographs report the trials at the depth each maker chose — Botox Cosmetic’s as floors, Nuceiva’s as rates without counts. This page cites no trial run by anyone else.Each product monograph § 14

No. Every monograph states that its units are specific to its own product and not interchangeable with another’s, and all but Xeomin Cosmetic’s add that they cannot be compared to or converted into another’s: the frown-line dose is 20 units of Botox Cosmetic, Xeomin Cosmetic, Nuceiva or Letybo and 50 units of Dysport Aesthetic, and a per-unit price compares clinics within one product only.Each product monograph § 4.2

Sources

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Visage Atlas

Aesthetic procedures in Canada and the products they use, source by source

A reference publication, not medical advice. Decisions about any treatment belong to an authorized practitioner. Visage Atlas is a publication of VIVAVAN CONSULTING INC., not a clinic. No maker, seller or clinic pays for or reviews Visage Atlas's editorial content; our own paid placements are labelled Sponsored.

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