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Xeomin vs. Botox - Which is Better?

a doctor here mentioned that a new injection would be available called "Xeomin". Not sure how you say that! What it appears to be is another form of Botox.  Can you help clairfy what's xeomin?

Doctor Answers 32

Time will tell

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). Here is a link to the study I am doing.  You can search online for A comparative assessment of three formulations of botulinum toxin A for facial rhytides: a systematic review and meta-analyses to read the project we are working on. 
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 (the part 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.

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.

I've inserted a link to my linkedin account so you can see the publication and read the protocol. The final results will be published this year. 

Ottawa Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Xeomin is an FDA-approved alternative to Botox for glabellar wrinkles

Xeomin and Botox work the same way to paralyze muscles and smooth wrinkles. They share the identical active ingredient - botulinum toxin A. The difference is that Botox has an accompanying protein, but xeomin is naked. In the skin, all of the protein detaches from Botox within 1 minute of injection so there is no reason why the effect of xeomin should differ from Botox. Xeomin has proven effective in clinical trials. It is approved in Europe and the US to diminish glabellar (between the eyebrow) wrinkles. I have had good results with it.

Botox vs Xeomin

Botulinum toxin is a naturally occurring neurotoxic protein produced by the bacterium Clostridium botulinum. It is used to treat myriad conditions ranging from muscular spasm to migraines to wrinkles. Since 2002, when the US Food and Drug Administration (FDA) approved botulinum toxin type A for the treatment of moderate to severe glabellar furrows, it has been used to restore an illusion of youth, and many dermatologists routinely use botulinum toxin "off label" for total facial rejuvenation.
Botulinum toxin has 7 distinct serologic types lettered A to G; the most common type used in the United States is type A. The botulinum toxin A currently approved by the FDA and available in the United States is Botox® (Allergan, Irvine, California). Botulinum toxin type B, which is available under the trade name Myobloc® (Solstice Neurosciences, Malvern, , is approved for treating cervical dystonia. Two additional  approved type A toxins  in US  are Dysport® (Medicis, Scottsdale, Arizona),and Xeomin® (Merz Pharmaceuticals, Greensboro, North Carolina,).
To understand the differences among these type A neurotoxins, one must understand some of the pharmacology behind botulinum toxin. Botulinum toxin type A in its innate form is a 150-kDa protein composed of both a heavy and a light chain.[2] This "naked" protein is surrounded by a hemagglutinin protein complex. The only purpose of this complex is to protect the naked protein from degradation by stomach acid (and may be irrelevant for injectable botulinum toxin). At some point during or after injection at a physiologic pH, the hemagglutinin proteins dissociate, leaving the same 150-kDa protein regardless of the product. The heavy chain then allows for attachment of the toxin to the axon terminals, and the light chain degrades synaptosome-associated protein 25 kDa, a protein that is required for signal transduction. Xeomin®  is a "naked" toxins without surrounding hemagglutinin proteins. The current thinking is that when patients develop antibodies to neurotoxins, it is to the surrounding proteins and not to the toxin itself. Pharmacologic-grade injectable neurotoxins also contain human serum albumin in the vial, and, depending on the brand, sucrose or lactulose as stabilizers.
Several botulinum toxins are approved  in  the US market. Below is a brief overview of the neurotoxins

Currently approved in over 65 countries and the US is Dysport®. It is a type A botulinum toxin that is FDA approved for the  the glabellar complex. Whereas Botox® is purified by repeated precipitation and redissolution, Dysport® is manufactured by using a column separation method. The different purification processes produce differences in the multihemagglutinin protein complex that surrounds the neurotoxin. The difference in this complex is  differences in the onset of action and duration of Dysport® compared with Botox®. Dysport® is a smaller molecule so it diffuses further and has a faster onset of action than Botox®
Xeomin®, is an uncomplexed botulinum toxin A product. and is approved for treating glabellar frown lines in  the USA. In terms of results Xeomin® is considered to be identicall almost to Botox®  with  results showing  the average duration of Xeomin® was 3.7 months, compared with 3.5 months for Botox®. In terms of potency, Xeomin® appears to exhibit a 1:1 dose ratio compared with Botox®. When compared with Botox® for therapeutic indications, safety and efficacy  they did not significantly differ between treatments. There was also no apparent difference in field of effect compared with Botox®. The manufacturer points out that the lack of complexing proteins in Xeomin® does not limit its efficacy and theoretically may reduce sensitization and antibody formation. Although this is more likely to affect therapeutic use because higher doses are used in therapeutic indications, it may be of interest to cosmetic dermatologists with patients who are treated with neurotoxin over several years. Xeomin will likely cost $400 to $600 for a standard treatment in that you only paid $300.00 I doubt you got the full dose,

Arnold W. Klein, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Xeomin Vs. Botox

Xeomin is another neurotoxin - it is in the same category as Botox and Dysport.  It has been used in Europe for many years.  It has less proteins then Botox, possibly making it less stable and possibly reducing the chance of resistance.  We have been using it in our office for a while and have had results consistant of Botox so far - however the cost to the consumer is cheaper with Xeomin as it stands now.   

Dr. Grant Stevens


Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 95 reviews

Xeomin - Great For Patients

Xeomin is finally approved here in the United States and offers several major advantages.  

  • Xeomin does not have any additives, i.e. is a naked botulinium toxin, it has less risk of antibody formation.  This has the theoretic advantage of patients less likely to develop resistance to Xeomin.
  • Xeomin does not have to be refrigerated
  • Xeomin works essentially the same as Botox.  Same duration, amount of time, dosing, etc.  This familiarity makes it a much easier product for physicians and patients to adopt to.
  • Xeomin will drive the overall price of botox down.
  • Has been used in Germany for more than 3 years but product is very similar to Botox.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 101 reviews

Xeomin is similar to Botox, but not the same

Xeomin is a substance similar to Botox (r).  However it has less protecting proteins around the actual active molecule than Botox. There have been some concerns about the stability and spreading of Xeomin. It has been in use in Germany for some years.

Robert Kasten, MD
Mainz Dermatologic Surgeon

Xeomin VS Botox VS Dysport

Botox, Dysport and Xeomin are commercial formulations of Toxin type A produced by the Clostridium Botulinum bacteria. Botox is produced by Allergan.

Xeomin, produced by Merz Pharma, has been used in Europe since 2008 AND has become available in the US in Nov 2011. It IS being used in Austria, Canada, Germany, Denmark, Finland, France, Italy, UK, Luxembourg, Norway, Poland, Portugal, Spain, Sweden, Argentina and Mexico.

The company claims that 1 unit of Xeomin is equivalent to 1 unit of Botox. The SUPPOSED advantage, yet to be proven of Xeomin over Botox is that by removing complexing proteins higher doses, as are needed in spastic disorders care, can be given without resulting in antibody formation. With the doses used for facial cosmesis this is not a major concern in my opinion.

I have used ALL these toxins and so far the Xeomin proved equal to Botox at a cheaper price.

Dr. P Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 83 reviews

Xeomin versus Botox

The fact that you see a multitude of different opinions about these two products means that there isn't a clear answer or a clear winner amongst the two. You will see arguments about the purity and decreased number of proteins we can possibly react to with Xeomin, and right next to it you will see arguments for a longer duration and more proven track record with Botox. This is the battle of big industry. In time we may find that there is no difference, and if there is one it will likely be subtle. 

Cameron Chesnut, MD, FAAD, FACMS, FASDS
Spokane Dermatologic Surgeon
5.0 out of 5 stars 18 reviews

Xeomin vs Botox and Dysport - more similar than different

Dysport, Xeomin 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.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 76 reviews

Xeomin & Botox & Dysport

Xeomin is fast onset as like Dysport in my study. Onset of Botox was late. Onset of Dysport was faster than Botox significantly. Potency of Dysport was stronger than Botox. I think Onset is Xeomin > Dysport >>>>>>>>>Botox.  Duration (Potency) is Dysport >>>>>>>Xeomin > Botox. This is from my stydy. But many doctors have different opinion, so we should discuss about this onset & duration more detail in woril congress of meeting like IMCAS or AMWC. Dr Jongseo Kim, Antonio, Seoul Korea

Jong Seo Kim, MD
South Korea Plastic Surgeon
4.5 out of 5 stars 3 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.