The most useful takeaway here is not which brand wins, but how much cosmetic outcomes depend on execution. When treatments in the same drug class are treated as interchangeable, the real-world variables that matter to patients can get blurred: dose, injection pattern, product handling and the skill of the injector. Those factors may shape results more than the label on the vial.
It is also worth separating a market story from a medical one. A decline in one companyโs sales does not mean the underlying treatment category has lost effectiveness or relevance; it may simply reflect price competition, changing consumer preferences and more aggressive distribution by rivals. In aesthetics, brand recognition can be powerful, but it is not the same thing as superior outcomes.
For readers considering these procedures, the practical question is less โWhich brand is famous?โ and more โWho is administering it, in what setting, and with what expectations?โ Cosmetic injectables are elective, so the trade-off is rarely about necessity versus risk, but about how much smoothing someone wants relative to cost, duration and tolerance for minor adverse effects or uneven results.
There is also a broader behavioural angle: aesthetic demand often tracks social norms, not just biology. That means consumer preferences can shift quickly, especially when newer products promise convenience, longer duration or a different feel. Those claims may be meaningful, but they should be judged on independent evidence rather than on marketing momentum alone.
The changing face of cosmetics
My story startsย two years ago, after filming a short video for Bloomberg Originals. Weโd just wrapped shootingย and our cameraman, David, showed me the tape to review. While it may sound vain, my only thought was: โOh god, I have forehead wrinkles.โ While David assured me he could smooth the lines in postproduction, my mind was set:ย At the ripe age of 26, it was time to get Botox.
Thus began my journey with AbbVieโs wrinkle-smoothing injection that millions of Americans have turned to over the years in hopes of reversing the clock. It was easy enough to book aย Botoxย appointment online at a Manhattan medical spa that was highly recommended by friends. And for the past two years, Iโve been going back every six months or so โย when the effects fade โ for a tune-up.
At an appointment this past summer, I deigned to look at the little vial of liquid the provider was about to stick into my face. โWait! Thatโs not Botox?โ I said, confused. Apparently,ย she told me, I had never actually gotten Botox, despite booking an appointment for the treatment. The whole time Iโd been getting Dysport, a rival product from the Swiss cosmetics firm Galderma thatโs cheaper at the clinic I was going to.
It turns outย my experience isnโt unique. Botoxโs name-brand recognition has made it an eponym for an entire class of wrinkle-smoothing injections made by a half dozen rivals. And in the past few years, those competitors have beenย quietly eating into Botoxโs market share.ย Thereโs Dysport โย the product Iโve beenย getting โ but also Xeomin, Daxxify, Jeuveau and Original PostIYMvMZQN_AHpzGeTCxNseHcz9N1EHQiadcgVOBQpXZ4H0RvyvkA-Jxu7T-B5ynB05Vs753CAUSbuhRcWuHVyYif41gEAy2Zj-81aC1jd7VdO8UfTp14fZ0Hae6NEj60W9T5xXvYvgWaQMmp8iQHcoXW70lHAd7FL6bgVJmUi7jO6D3cYfA__3w_lEgIZnp4sq2xB-UT8qrRke0ghNDuiSsZ3zGLnCQupkxbR9er1AzLKJJdSG160wcnz-oN8fN1p7IbRtQykbXlQ0U0SzzrNTAKyenU/owH7krGNPQWoytx_m_qRsZ_HKgoKxth9/14" target="_blank" rel="noopener noreferrer" shape="rect">Letybo. They all work pretty much the same way, with some minor differences. And the companies that make themย have been working overtime to get their products in front of consumers, doctors and medical spas โย at Botoxโs expense.
Thatโs become a challenge for AbbVie, the maker of Botox, asย chronicled in our December issue of Businessweek.ย Sales ofย Botox Cosmeticโย a $2.7 billion drugโย are expected to drop this year for the first time since AbbVie acquired it 2019.
And thatโs not the only issue the company is facing: its filler business is slumping as consumers shy away from the super plumped up lips and enhanced cheekbones that once dominated the beauty world.
While investors have so far been shielded from the sales drop, analysts say AbbVie canโt afford to let its reliable moneymaker fade.ย โBotox is a consistent cash cow,โ Evan Seigerman, an analyst at BMO Capital Markets, told me. โIf it starts slipping, thatโs a problem.โ
For its part, AbbVieย has a plan to get back on trackย that includes a beloved reality TV hostย and an innovative new product that erases wrinkles even faster than Botox. For the full story, check out the latest issue of Businessweek. โย Madison Muller
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