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Why Are More People Not Using Xeomin?

Seems like a good alternative to Botox and the fact that it does not need to be refrigerated, seems more people would try it. Is there a downside?

Doctor Answers 13


Xeomin is Botulotoxin produced in Germany by Merz pharmaceutical. It contains no bounding albumin protein compared to other types of Botulotoxin like Botox, Dysport etc. Hence it is believed to cause less allergies. Before reconstitution it can be kept at room temperature and this is another advantage over the other products.

Studies shown that it is equivalent in efficacy and doses to Botox. It is a relatively new product in comparison with the older Botulotoxins. Some doctors prefer to use what they familiar with. Nevertheless Xeomin is becoming more and more popular and quickly catching up with Botox.

Xeomin is a great product

Xeomin IS a great product. It is safe and FDA approved and potentially has some advantages over Botox. There is an ongoing legal dispute between the makers of Xeomin and Botox that has prevented the nationwide roll out of Xeomin for cosmetic use. Importantly, this has nothing to do with safety of Xeomin.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 76 reviews

Xeomin.... A Very Good Question

Your inclination is correct.  In my experience, Xeomin is a very good product and is essentially equivalent to Botox in efficacy and duration of results.  However, Allergan, the manufacturer of Botox has filed a legal injunction against Merz (the maker of Xeomin) for issues concerning intellectual property.  This will prevent sale of Xeomin for aesthetic purposes for the better part of the next year.  Although Xeomin can be purchased by practitioners for functional purposes, Merz cannot promote the sale or use of the product until the injunction is lifted.  This has obviously affected sales of the product, but does not mean that Xeomin is inferior in quality.  Both Botox and Xeomin are forms of Botulinum Toxin type A and work about the same for the majority of patients.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

Why Are More People Not Using Xeomin?

There is a good chance that more people are not using Xeomin simply because of brand recognition.  Do you buy facial tissue or Kleenex?

Thomas McFadden, MD
Greenville Plastic Surgeon
5.0 out of 5 stars 35 reviews

Why isn't Xeomin used more often?

Xeomin, Dysport and Botox are all preparations of botulinum toxin A derived protein that works at the nerve-muscle interface to relax targeted muscles. Each preparation is slightly different, for example the protein size differs. Dysport and Xeomin have been around in Europe for a long time and more recently introduced in the USA. Note the dosage is not the same between the drugs though each works well in my experience.

I think that because Xeomin is "the new kid on the block"in the USA, is not dramatically less expensive, and physicians are more comfortable with medications they are already using with good results - it just takes time for Xeomin to gain popularity.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 63 reviews


I have patients that use both and alternate often. Both are great products and Xeomin sets in a bit faster then Botox. 

Kristin J. Tarbet, MD
Bellevue Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Possible Limitations of Xeomin?

I've asked myself the same question. I am still not ready to recommend Xeomin use to my patients for a few reasons. I should also point out that I am in the process of completing a very large study comparing Botox, Dysport and Xeomin using only the highest quality research (a meta-analysis).

Like all businesses, there is a lot of marketing. Xeomin's claims to fame are #1 you dont need to refrigerate it and #2 there is less risk of allergies. After reviewing over 20,000 patients in a number of randomized studies, there are no reports of allergies with botox. Yes, there are reports of this happening in other series but it is extremely rare thus I dont believe that Xeomin offers any advantage in this regard. At this point, there is absolutely no evidence one is better than the other. Its just marketing based on "theory." 

Also, Botox is such a popular brand now, people ask for it by name. I think many people are nervous about trying a product that has been on the market for a few years versus one that has been around over 15 years. I tend to use Botox cause I know it works, its safe and people are happy with the results. 

Also, there is evidence that Xeomin may not last as long as Botox. Now, this is controversial but hopefully the study I am doing will answer this question. At this  time, there is no reason to believe one lasts longer than the other, however....time will tell. 

Finally, one of the "benefits" of Xeomin is that it is considered a more purified version of the active component of the toxin. Basically, botulinum toxin contains an active component (that results in the key effect) and some other proteins. Xeomin removed these proteins and thus the notion that there is less of a risk of allergy as some believe the allergy risk is associated with these proteins. However, there is another side to the story. Some people suggest that these proteins are important for making the medication work better, thus some believe this is the reason why Botox may last longer, it keeps some of these "extra" proteins that may have a role in improving its effect. Who knows, maby these proteins are required for things like, finding its way into the nerve it is going to effect. 

Wheww...Long winded I know, but its a complicated topic and one I find interesting. 

I think I'll end by saying, I dont know what the right answer is, it may turn out there is no difference between products. But as a physician, my goal is to treat people with a medication that I believe is the safest and most effective available. At this point, Botox is that product. Perhaps my opinion will change once more evidence is out there, but for now, I continue to recommend Botox. 

James Bonaparte, MD, MSc, FRCSC
Ontario Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Why Are More People Not Using Xeomin?

Good question - but without a good answer.  Except that many people are not aware of it as an alternative neuromodulator (to Botox and Dysport).  It is becoming increasingly well known, however, and should be added to list of available treatment options routinely available.

I hope that this helps and good luck,

Dr. E

Most people resist change

Xeomin is a newer product, and therefore, it is harder to put forth the effort to figure out dosing, especially if, like most of us, you have been obtaining excellent results with Botox for years.  However, if you review the literature you will find that the efficacy is essentially identical for all of the neurotoxins once optimal dosing is determined.   Those people who do "take the plunge" and learn how to dose Xeomin will discover that it is every bit as good a product as any of the others, and it offers another option for neurotoxin treatment.

Xeomin versus Botox

That is a good question. I feel that the answer is that 1) Many patients are accustomed to what they are used to, namely Botox and 2) Many patients have not heard of Xeomin. However, in the past month or so, the number of patients we have who we have seen who are requesting Xeomin has increased markedly. LIkely, that number will rise as word gets out that there is another product to compete with Botox. One thing I can assure you, the days in which the annual $50 increase that Allergan tagged onto the price of Botox are over  ( withstanding economic factors such as runaway inflation). Actually, that stopped with the advent of Dysport. 

Is there a difference in effectiveness? This is hard to tell. Interestingly, no sooner than my original order of Xeomin arrived, the Allergan representative paid a call. She showed me the package insert whose data showed that Botox lasted longer. However, a few days later, when the Xeomin rep appeared, and was questioned in this regard, he pointed out technical differences in the study and that basically she was comparing apples to oranges. Two human studies I am aware of showed equal effectiveness and longevity. One mouse study showed Botox lasted longer. 

Xeomin has advantages in that it does not need to be refrigerated during transport. ( It does need refrigeration after reconstitution). It also is a naked molecule, lacking the surrounding proteins Botox employs. This may mean less chance of developing antibodies, and hence effectiveness down the road. 

The other main advantage of course is cost. In our office, we are charging between 7-8 dollars a unit which is 3-4 dollars less than our charge for Botox. On full face treatment, this difference can result in a substantial saving.

The injection technique is the same so there will not be a learning curve as there was with Dysport. 


Xeomin had been off the market for many months during a legal dispute with Allergan, but now that it is back, it will be interesting to see if usage increases. I personally see no reason why it will not.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.5 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.