It has been used overseas for years, and now Letybo has finally made its way to the United States: The neuromodulator was approved by the FDA to treat glabellar lines (a.k.a. “11s,” or the area between the brows) last year. And now it's starting to show up in more dermatologist’s offices—potentially as a competitor to Botox, Xeomin, and the rest of the neuromodulator crew.
Before Letybo was approved, there were five neuromodulators available to injectors in the US: Botox, Xeomin, Dysport, Daxxify, and Jeuveau. Each one is formulated with botulinum toxin A, which interrupts signals between muscles and nerves so the muscles can’t contract, therefore reducing wrinkles. So how does Letybo stack up?
Letybo, manufactured by Hugel, is massively popular in Korea, where it’s called Botulax, says Roy Kim, MD, a board-certified plastic surgeon in San Francisco. Doctors in Korea “have used it zillions of times,” he says, adding that it’s been around for about a decade there. Letybo (aka Botulax) is often used in Korea’s popular “combination therapy” approach, in which a patient might get neuromodulator, filler, skin boosters (shallow injections of hyaluronic acid to moisturize skin), and a facial, all in one three-hour visit.
Letybo is well-suited to these mega-aesthetics sessions because it doesn’t drive up the total cost as much as other neuromodulators might, says Dr. Kim. “Getting Letybo in Korea is less expensive than getting your hair styled,” he says. “In Korea, they have over 70 neurotoxin competitors. Botox is considered a very good product there, but the problem is it's expensive. So Letybo, or Botulax, is viewed as a great product—similar to other neuromodulators, but way less expensive.”
Letybo is rolling out in the US now, and one of the first dermatologists we’ve talked to who’s using it is Cheri Frey, MD, a board-certified dermatologist in Washington, DC, and assistant professor of dermatology at Howard University. Dr. Frey, who typically uses Botox and Dysport, says Letybo is new to her practice—she has used it on “a handful of patients” over the past week. One subset of her patients has been particularly excited to try it: Those who have found that “Botox has been a little bit inconsistent” for them recently, says Dr. Frey. She says this group has begun complaining that it takes longer for their Botox results to kick in, or they’re not seeing the same results that they used to. (Botox resistance, in which the body develops antibodies that minimize Botox’s effects, is thought to be rare—one study suggests it occurs in 0.5% of Botox users, Allure has previously reported.)
For Dr. Frey, incorporating Letybo into her practice made a lot of sense. With some of her patients looking for Botox alternatives, “I thought it was a really good opportunity for a new toxin to hit the market,” she says. Dr. Frey has been injecting it into the forehead and the 11s, and says “its properties are essentially so similar to Botox—patients have been pretty happy [with the wrinkle-smoothing results so far].” Because the mechanism of action is the same as Botox and its cohorts, she adds, “I think it could be used in all of the traditional areas”—the forehead, the area between the brows, and crow’s feet.
As Letybo makes its way into more injectors' hands, you might hear that it could work faster and last longer than its competitors. “Anecdotally, it does work faster,” says Dr. Kim, explaining that Letybo might yield results within a few days. The full results of Botox typically can be seen within a week.
Some doctors are skeptical of the “works faster” claims, though. “Maybe it has a slightly quicker onset, but the reality is, there is no instant onset of any of the neuromodulators,” says Doris Day, MD, a board-certified dermatologist in New York City. “They're all going to take hours to a couple of days. I don't think the amount of time to onset is going to be the critical factor that my patients look for.” As for whether Letybo’s results last longer than those of other neuromodulators, Dr. Day shares that from the data so far, “longevity appears to be comparable to that of Botox, generally lasting about three to four months.”
It’s not the first time that we’ve heard of a new neuromodulator promising to last longer—and doctors are wary of longevity claims as a whole. Shereene Idriss, MD, a board-certified dermatologist in New York City, previously told Allure that she’s tried Botox, Dysport, Xeomin, Daxxify, and Jeuveau on herself and finds that in terms of performance, “they are all more or less the same.” While some doctors were hopeful that Daxxify’s results would last longer when it was FDA approved in 2022, Dr. Idriss notes that, in her experience, it “does not last the six to nine months as it was originally marketed.”
As for that lower price point on Letybo, exactly how much doctors (and med spas) in the US will charge remains to be seen. But Dr. Kim guesstimates that Letybo might cost about $9 to $12 per unit in major cities, compared to the current cost of Botox, which is about $12 to $18 per unit. So if you're getting 25 units total, Letybo might run you $225 to $300, versus $300 to $450 for Botox. In her own practice, Dr. Frey charges the same for Letybo as other neuromodulators—“we charge for our skill and the result, not the product,” she says.
In general, the doctors we spoke with are happy to have another option in their toolkit. “I'm excited to inject it,” says Dr. Kim, who does not offer Letybo yet but plans to bring it into his practice, especially to cocktail it with filler for shallow skin booster injections. (A custom mix of hyaluronic acid and neuromodulator “works great for delivering dewy, glass skin” by reducing pore size and adding moisture, Dr. Kim has previously told Allure.)
“As a physician, I welcome the introduction of newer toxins with newer manufacturing processes that can deliver a highly purified product that has an excellent safety profile,” says Ava Shamban, MD, a board-certified dermatologist in Beverly Hills and Santa Monica, who was a clinical investigator on FDA trials of Letybo. She says the clinical studies have shown Letybo to have “high efficacy and a convincing safety profile” when treating glabellar lines, and adds that “time will tell” whether Letybo poses any real competition to its neuromodulator peers. “FDA trials have shown the product to be safe and efficacious, so feel free to try it out, but since the FDA approval is for four months and not six, don't expect it to last six months,” says Dr. Shamban.
Letybo isn’t the only new face in the neuromodulator game, either. The manufacturer Galderma recently gained approval for a product called Relfydess in the EU, United Kingdom, and Australia; it’s used to address frown lines and crow’s feet. Relfydess is unique in that it’s a liquid formula versus a reconstituted powder, and it’s also a totally new strain of botulinum toxin, created by Galderma solely for this product. The FDA trials for Relfydess have been completed, so the next step is approval—which could take awhile. According to Dr. Frey, Letybo should be widely available in the United States at the end of the month.
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