Botulinum toxin comparison: long-acting or short-acting

Since July 2026, two families of botulinum toxins have been approved for aesthetic use in Europe⁹. This comparison builds on our page about what the new botulinum toxin is: it puts the two profiles side by side, based on their official product information, to help you prepare the discussion with your doctor.

Why a comparison without a winner?

It is tempting to look for "the best" toxin. The data do not allow it. There is no trial directly comparing type A toxin and the short-acting toxin: the pivotal trial of the latter has no active comparator, because no serotype E product was marketed yet¹⁰. Every comparison on this page therefore brings together product information drawn from different trials.

What can be said with certainty is that the two families do not have the same pace. The short-acting toxin gives you a choice between two profiles: one slower and longer-lasting, the other faster and shorter. Which one suits you depends on what you are looking for, the area to be treated and your medical situation.

The comparison table

What each row means

First effects

With the short-acting toxin, clinical effects begin to show 8 hours after injection¹. This is the first time point measured in the trials: the beginning of an effect, not a complete result. With type A toxins, first effects usually appear within 2 to 3 days^2,4, and one product information states that the effect usually appears within one week³. For a detailed look at these timelines, see how long botulinum toxin takes to work.

Peak effect

The effect of the short-acting toxin peaks around day 7¹. That of type A toxins is reached, depending on the product, during the second week⁵ or around day 30^2,4. This is why the table gives "between week 2 and week 4" for type A^2,5. In both cases, this is when the result can be assessed.

Usual duration

This is the clearest difference. The effect of the short-acting toxin usually lasts 2 to 3 weeks¹. That of type A toxins lasts up to 4 months for most products^2,3,4, and an effect has been shown for up to 6 months for some^6,7. A short duration means that a result, expected or not, fades sooner; a long duration means less frequent sessions. The page on how long botulinum toxin lasts explains why the effect always wears off in the end.

Approved aesthetic areas

In France, all type A toxins for aesthetic use are approved for frown lines; depending on the product, some are also approved for crow’s feet and forehead lines^3,4,7. The short-acting toxin is approved only for frown lines between the eyebrows in adults, when they have an important psychological impact¹. Other areas of the face are not included in any of these aesthetic approvals.

Track record

The first aesthetic approval of a type A toxin in France dates from 2003⁸, which means more than 20 years of use. The short-acting toxin has been approved in the European Union since 15 July 2026⁹ and in Canada since 22 June 2026¹¹. A shorter track record does not mean a less safe product: it means fewer years of observation in everyday practice, and this toxin is also subject to additional monitoring⁹.

Treatment rhythm

The product information of type A toxins requires at least 3 months between two sessions^2,4. That of the short-acting toxin provides for occasional use, because of its early onset and short duration¹. Retreatment less than 6 weeks after the previous injection has not been evaluated, nor have more than 3 consecutive injections beyond 18 weeks¹.

Long-acting or short-acting: what the table does not show

Three points do not fit in a table, but they matter in the decision.

Doses do not translate. Each product has its own unit of measurement, not interchangeable with that of the others^1,2,4. Comparing "numbers of units" between two toxins therefore makes no sense.

Side effects cannot be compared directly. For the short-acting toxin, the trials report a drooping eyelid in 0.17% of patients, a drooping eyebrow in 0.13% and an upward lift of the outer end of the eyebrow in 0.04%¹. The frequencies for type A toxins come from other trials, in other areas and at other doses: putting them side by side would be misleading.

Age is not a simple rule. Data on the short-acting toxin after 65 are limited¹: only 7% of trial patients were in this age group, with lower response rates on day 7¹. But several type A toxins are not indicated after 65 either^2,4,6, and one is indicated up to 75⁵. It is for the doctor to judge.

When the long-acting toxin remains the right choice

The short-acting toxin does not make the long-acting toxin outdated. The authors of the phase 3 trial acknowledge it themselves: its shorter duration may be a disadvantage for people seeking a longer-lasting effect, and it is not intended for long-term use¹⁰. The block below sums up what the product information and the studies say.

Switching from one family to the other

Switching from a type A toxin to the short-acting toxin, or the other way round, is a decision for the doctor, who then sets a new dose. The product information of the short-acting toxin states that a type A toxin injected less than 30 days after it has not been evaluated¹. In a phase 1 study, a type A toxin injected on day 30 had a similar effect whether the subjects had previously received this toxin or a placebo¹. The same product information states that it must not be given at the same time as another botulinum toxin, a combination that has not been studied¹.

The practical questions raised by any change of product, whatever the family, are covered in our article on switching botulinum toxin. The trials behind these figures, and the questions that remain open, are detailed on the page what the studies say about the new botulinum toxin.