Botox vs. Letybo Results: Which Looks More Natural?

For the treatment of glabellar lines; the “11s” between the eyebrows, current clinical evidence suggests that Letybo and Botox can produce comparable wrinkle-reducing results. A randomized Phase III trial found letibotulinumtoxinA noninferior to onabotulinumtoxinA for glabellar-line improvement at four weeks. There is not good evidence that one product universally produces a more natural-looking result. In practice, the appearance of the result depends heavily on treatment goals, facial anatomy, muscle activity, dosing and injection technique—not simply the brand of toxin.

If you’re looking beyond natural-looking results and want to compare treatment areas, FDA-approved indications, onset, duration, safety, and other key differences, see our Botox vs. Letybo: Complete Comparison.

At a Glance

The most important distinction is that FDA approval is indication-specific. Letybo’s U.S. approval is for glabellar lines, while Botox Cosmetic has FDA-approved cosmetic indications that include glabellar lines, lateral canthal lines and forehead lines.

Does Letybo Look More Natural Than Botox?

There is not enough evidence to say that it does.

This is one of the most common claims patients encounter online.

You may see descriptions such as:

• “Letybo looks softer.”
• “Letybo looks more natural.”
• “Botox looks more frozen.”
• “Letybo gives a silkier result.”
• “Botox gives more precise results.”

These statements may reflect individual clinical experiences, but they should not be presented as established scientific differences between the two products.

A direct Phase III comparison found Letybo noninferior to onabotulinumtoxinA for glabellar-line improvement. That supports comparable efficacy in the studied indication; it does not establish that Letybo produces a universally more natural aesthetic result.

What Actually Makes Botox or Letybo Look Natural?

The most important variables are usually:

1. The patient’s anatomy

Every face has different:

• Muscle strength
• Muscle size
• Brow position
• Eyelid anatomy
• Facial proportions
• Baseline asymmetry

2. The treatment goal

There is a major difference between:

“I want these lines completely gone.”

and:

“I want the lines softened but still want to move naturally.”

3. Dose

More muscle relaxation is not necessarily a better aesthetic result.

4. Injection pattern

The location and distribution of injections influence which muscles are weakened.

5. Injector judgment

An experienced injector evaluates the interaction between muscles rather than treating wrinkles as isolated lines.

Can You Still Move Your Face After Botox?

Yes.

Botox does not have to eliminate facial expression. The objective of aesthetic treatment can be to reduce excessive muscle activity while preserving an appropriate degree of movement.

The amount of movement remaining depends on:

• Dose
• Injection placement
• Muscle strength
• Treatment objective
• Individual response

A natural result is therefore not synonymous with “zero movement.”

Can You Still Move Your Face After Letybo?

Yes.

The same principle applies to Letybo.

Letybo temporarily reduces activity of the muscles into which it is injected. It does not inherently require a completely expressionless result.

A provider can adjust treatment according to whether the patient wants:

• Maximum wrinkle reduction
• Moderate softening
• Preservation of more movement
• A subtle “refreshed” appearance

What Does “Frozen” Actually Mean?

“Frozen” is a patient-friendly term rather than a precise medical diagnosis.

Patients usually use it to describe an appearance in which facial movement has been reduced more than they wanted.

This can happen when:

• Too much toxin is administered
• Too many muscles are treated
• The treatment does not account for the patient’s anatomy
• The patient’s aesthetic preference was misunderstood

It is therefore misleading to automatically associate a “frozen” appearance with one particular brand.

Can Letybo Give You a Frozen Look?

Yes.

Like other botulinum toxin products, Letybo can excessively weaken targeted muscles if treatment is too aggressive for the patient’s goals or anatomy. That does not mean Letybo inherently produces a frozen appearance.

The same applies to Botox.

Can Botox Give You a Natural Look?

Absolutely.

Botox has been used extensively for aesthetic facial treatment, and natural-looking results are possible when treatment is individualized.

The product itself does not determine whether a patient looks natural.

What Does the Research Say About Letybo vs Botox Results?

One of the most useful studies for this question is a Phase III randomized controlled trial directly comparing Letybo with onabotulinumtoxinA.

The study included 500 participants with moderate-to-severe glabellar wrinkles.

At week 4:

• 88.49% of the Letybo group achieved a glabellar severity score of 0 or 1 at maximum frown.
• 87.39% of the onabotulinumtoxinA group achieved the same outcome.

The difference was 1.10 percentage points, with a 95% confidence interval of −5.02 to 8.82, supporting noninferiority.

What does that mean in plain English?

For glabellar wrinkles, Letybo performed similarly to Botox in this controlled clinical trial.

It does not mean that every patient will have identical results.

It means that the evidence does not support the idea that Letybo is substantially inferior to Botox for the studied treatment.

How Effective Is Letybo for Frown Lines?

In another Phase III study involving 355 participants, 78.6% of Letybo-treated subjects were responders according to investigator assessment at week 4, compared with 0% in the placebo group.

The median onset of effect was approximately 3 days.

This provides strong evidence that Letybo is effective for its FDA-approved glabellar indication.

Do Patients Actually Notice a Difference?

They can.

But patient perception is not necessarily the same thing as a difference in pharmacologic efficacy.

A pooled analysis of the Letybo Phase III studies found significant improvements in patient-reported measures of the psychological burden associated with glabellar lines, perceived age and satisfaction with treatment compared with placebo.

That tells us something important:

Patients don’t simply care whether a wrinkle score changes. They care whether the change makes them feel and look better.

Is Letybo Better Than Botox for the “11s”?

There is no evidence establishing a universal winner.

For glabellar lines, both products have demonstrated efficacy.

The direct comparison found Letybo noninferior to onabotulinumtoxinA.

Therefore, a more accurate answer than “Letybo is better” or “Botox is better” is:

Both can work very well for glabellar lines, and the best choice depends on the individual patient and treatment plan.

Is Botox Better Than Letybo for Forehead Lines?

This question requires an important distinction.

Botox Cosmetic has an FDA-approved indication for forehead lines in combination with glabellar lines. Letybo’s FDA-approved cosmetic indication is currently moderate-to-severe glabellar lines.

Therefore, it would be inappropriate to imply that Letybo and Botox have identical FDA-approved cosmetic indications.

A provider may have clinical experience using different botulinum toxin products in areas beyond their labeled indications, but that is not the same as FDA approval.

Is Botox Better Than Letybo for Crow’s Feet?

Again, the FDA indication matters.

Botox Cosmetic has an FDA-approved indication for lateral canthal lines, commonly called crow’s feet.

Letybo’s U.S. FDA approval is for glabellar lines.

Therefore, for a patient specifically seeking an FDA-approved botulinum toxin treatment for crow’s feet, Botox has an important regulatory distinction.

That does not mean Botox necessarily produces a better aesthetic result in every individual.

It means the products do not currently have identical FDA-approved cosmetic indications.

Can Letybo Be Used on the Forehead?

This question should be answered carefully.

Letybo’s FDA-approved U.S. indication is for moderate-to-severe glabellar lines.

Treatment of other facial areas is not included in that indication.

A provider may discuss other treatment approaches based on clinical judgment, but patients should understand the distinction between:

FDA-approved use and use outside the FDA-approved indication.

Why Is Treating the Forehead More Complicated Than Treating the “11s”?

The forehead contains important muscles that elevate the eyebrows. The glabella contains muscles that contribute to brow depression.

These muscles work together to determine:

• Brow height
• Brow shape
• Upper-eyelid appearance
• Facial expression

Over-relaxing the wrong muscles can therefore change the appearance of the entire upper face. This is one reason forehead treatment should not simply be approached as:

“How many units should I put into these lines?”

The provider needs to understand the entire brow–forehead system.

Why Can Two People Get Different Results From the Same Number of Units?

Because units are only one part of the treatment.

Two patients may have:

• Different muscle strength
• Different anatomy
• Different line depth
• Different brow positions
• Different treatment goals
• Different previous toxin exposure

Consequently, identical dosing does not guarantee identical results.

This is another reason that online “exact unit” calculators are not a substitute for facial assessment.

Does Letybo Work Better on Deep Wrinkles?

Not necessarily.

Botulinum toxin primarily treats dynamic wrinkles—lines that are created or worsened by muscle movement.

A deeply etched line that remains visible when the face is completely relaxed may have an additional structural component.

That can include:

• Repeated skin folding
• Loss of collagen
• Reduced skin elasticity
• Photoaging

Relaxing the underlying muscle can reduce the dynamic component, but it does not necessarily erase every static line.

Can Botox or Letybo Prevent Wrinkles From Getting Worse?

There is a reasonable biological rationale that reducing repeated muscle contraction can reduce repetitive folding of the skin. However, patients should not interpret either product as a guarantee against future wrinkles.

Skin aging continues because of multiple factors, including:

• Chronologic aging
• Sun exposure
• Genetics
• Collagen loss
• Environmental factors

Botulinum toxin is one component of an overall aesthetic strategy.

Does Letybo Work Faster Than Botox?

This question overlaps with our earlier supporting article, so I would keep the discussion brief here.

Clinical evidence demonstrates that Letybo can begin producing visible effects within several days. In the Phase III study, the median onset was 3 days, with some subjects noticing improvement as early as day 2.

The important point for this article is:

A faster onset does not automatically mean a better final aesthetic result.

Onset and appearance are separate questions.

Does Faster Onset Mean Letybo Is Stronger?

No.

The speed at which a patient notices an effect should not be interpreted as a simple measure of potency.

Different botulinum toxin products have different formulations, assays and clinical characteristics.

A product that becomes noticeable sooner is not necessarily “stronger,” and a slower onset does not mean a product is weaker. 

A faster onset does not necessarily mean a better or more natural-looking result. If you’re interested in the timing of Letybo’s effects specifically, see How quickly does Letybo work?

Does Letybo Last Longer Than Botox?

There is individual variation, and this is covered more extensively in the earlier duration article.

For this article, the important point is:

Duration should not be confused with quality of result.

A toxin lasting longer is not automatically better if the patient prefers more movement or wants a different aesthetic effect.

Which Is Better for Someone Who Wants a Very Natural Look?

Both can be used to create a natural-looking result. The provider should understand exactly what the patient means by “natural.”

For example:

“I want my wrinkles softened but still want to move.”

That is different from:

“I want as little movement as possible.”

A good consultation translates those preferences into an appropriate treatment plan.

Natural-looking results are only one consideration when choosing a neuromodulator. Safety, potential side effects, treatment planning, and injector technique also matter. For a deeper look at these considerations, read our guide to Letybo vs. Botox side effects and safety.

Which Is Better for Someone Who Wants Maximum Wrinkle Reduction?

Again, there is no universal brand winner.

Maximum wrinkle reduction requires an assessment of:

• Muscle activity
• Baseline wrinkle depth
• Skin quality
• Treatment area
• Desired degree of movement

The goal should be appropriate correction, not simply maximal paralysis.

Does the Injector Matter More Than the Product?

For the final appearance, injector expertise can be extremely important.

A skilled injector understands that the face is a dynamic system.

The provider needs to assess:

• Which muscles are producing the unwanted movement
• Which muscles provide desirable movement
• Which muscles compensate for other muscles
• How the brow is positioned before treatment
• How the patient’s facial expressions change with treatment

This is why the same toxin can look excellent in one patient and less satisfactory in another.

Dr. Monica Gavin’s Perspective

“When patients ask me whether Botox or Letybo gives the more natural result, I don’t consider the brand in isolation. I first look at how the patient’s facial muscles move, where the lines are coming from, the position of the brows and what the patient means by a ‘natural’ result. Two patients can receive the same product and have very different outcomes because their anatomy and treatment goals are different.”

— Monica Gavin, MD
Azani Medical Spa, Bethlehem, Pennsylvania

Why “Natural-Looking” Does Not Mean “No Wrinkles”

A natural result does not necessarily mean eliminating every line. Facial expressions are part of how people communicate. A patient may look younger and refreshed while still having some movement.

This is particularly relevant for patients who are concerned about appearing:

• Frozen
• Over-treated
• Unexpressive
• Artificial

A conservative, individualized approach can sometimes be more aesthetically appropriate than attempting to erase every dynamic line.

Botox vs Letybo: Results by Treatment Goal

What We Know vs. What We Don’t Know

What the evidence supports

• Letybo works for moderate-to-severe glabellar lines.
• Letybo has demonstrated comparable glabellar-line efficacy to onabotulinumtoxinA in a randomized Phase III trial.
• Both products can produce natural-looking results when appropriately administered.
• Treatment technique and patient anatomy influence the final appearance.

What the evidence does not establish

• Letybo is not proven to look more natural than Botox.
• Botox is not proven to look more natural than Letybo.
• One product is not universally better for every patient.
• A faster onset does not mean a superior aesthetic result.

The Bottom Line

For glabellar lines, Letybo and Botox can produce highly effective and comparable wrinkle-reducing results.

The best available direct comparison found Letybo noninferior to onabotulinumtoxinA at four weeks. The evidence does not support the marketing claim that one product universally produces a more natural result.

Instead, the final appearance depends on:

The product + the patient’s anatomy + muscle activity + dose + injection pattern + treatment goals + injector expertise.

For patients considering treatment at Azani Medical Spa in Bethlehem, Pennsylvania, Dr. Monica Gavin, MD evaluates these factors rather than assuming that one neurotoxin is automatically the best choice for everyone.

MEDICAL REFERENCES

1. U.S. Food and Drug Administration — Letybo

FDA Drug Trials Snapshot: Letybo. Approval February 29, 2024; indication, clinical trials and study population.

2. FDA Approval Package

FDA Center for Drug Evaluation and Research approval package for Letybo (letibotulinumtoxinA-wlbg).

3. Mueller DS, et al.

Efficacy and Safety of Letibotulinumtoxin A in the Treatment of Glabellar Lines: A Randomized, Double-Blind, Multicenter, Placebo-Controlled Phase 3 Study. Aesthetic Surgery Journal.

4. Phase III Direct Comparison

• A Phase-III Noninferiority, Randomized Controlled Trial of Letibotulinum Toxin A for the Improvement of Moderate-to-Severe Glabellar Wrinkles in China.* This trial directly compared letibotulinumtoxinA with onabotulinumtoxinA.

5. Cox SE, et al.

LetibotulinumtoxinA Attenuates the Psychological Burden of Glabellar Lines and Is Associated With High Subject Satisfaction in Phase 3 Clinical Trials. Dermatologic Surgery. 2024.

6. FDA Novel Drug Approvals

FDA 2024 Novel Drug Approvals listing Letybo and its approved indication.