Is Xeomine a good alternative to Botox?
Doctor Answers (11)
Alternative to Botox Cosmetic
Some patients find that after many years of use, their bodies have become resistant to Botox and they look for alternatives. There several alternatives to try. Two first line alternatives are Dysport and Xeomin. Both of these products have basically equivalent results, cost and duration of action to Botox Cosmetic and both have cosmetic indications. Another alternative is Myobloc which is usually used for medical indications but can be used off label for cosmetic indications. In my office, I stock all four products so that we will have all options available for our patients.
Xeomin as alternative to Botox
No two toxins are equal!
Troubles in Paradise: Botox 2013
Botox was the wonderchild of cosmetic enhancement of the 21st century. It was the magical agent of the facial universe which seemed to be virtually goof-proof and simply a wonderful reason to have a party. The doctor’s prospered. patient’s were happy, and Allergan got rich. People seemed to have forgotten that this was originally an orphandrug approved in 1989 for uncontrollable blinking, spasms of the eye and crossed-eyes( stramismus.) But in 2003 unusual things began to happen. The chief consultants for Allergan went to work for other cosmetic companies. Not only did they speak at the FDA and get such agents as Artefill approved by the FDA, they injected across America However there was one tiny problem, they were foreign and had no green card nor a US license.In the same year they attempted to get a paper published on why dilution of Botox did not matter. Their data made no sense so they did the logical thing they changed it. This paper would not be published until 2007 accompanied by a Paper on a Myobloc in which they deemed this toxin safe and effective. They attempted to add two others doctors names to this paper but those doctors refused to be included. Why ? Because literature surrounding this agent showed it capable of causing severe side effects distant to the site of injection and Myobloc had been found in foreign studies to be more toxic than US studies had shown..Then a very troubling thing began to happen. After toxin injections people would get sick and at times die. This was more from the use of these products in neurologic conditions than in cosmetic conditions. Then in January of 2008 Sidney Wolfe and the Public Citizen Health Research Group petitioned the FDA to respond to what was happening: spread of toxin from the site of injection associated with weakness, inability to swallow, and even death. While Canadian Health(the Canadian FDA) and Allergan had already dealt with these problems one wonders why the information was not given to the US FDA Well a response came from Janet Woodcock, Director. Center for drug Evaluation at the FDA. This 19 page response really does not provide The breadth of information available on toxins.
1)Dilution:A review of all the available studies on childrem with spasticity in two medical search sources revealed the concentration and volume of the diluted toxin can affect the spread. Furthermore, injection techniques were highly variable from center to center. 2 Though the FDA preiously cautioned Allergan about dilution it cannot be found in their response to Wolfe. 3
2)Myobloc:While Dysphagia can be associated with Botulinum type A toxin it occurs with a much greater frequency with type B. Even when treating the distal legs one has seen difficulty swallowing with type B and it has been noted even when the toxin is used for excess sweating. When Skin Medica was considering aquiring this toxin a clinical trial for treatment of the glabella revealed such severe side effects the purchase was not completed.
3)Mechanism of Action: Inhibition of the release of Acetylcholine.
This was once considered its only mode of action but how could this explainthe manner in which it relieved pain in patients who had shingles or evenimprovement in migraine. Furthermore this is not the manner in which it effectsspasticity.Research has shown that botulinum toxin Type A decreases spasticityby its action primarly on muscle spindles which are bodies found in almost all muscles of the limbs.These spindles then give signals to other spindles within the area whicn accounts for the profound effect of Botox on spasticity which is greater than the normal zone of diffusion. Furthermore when correctly injected botox will effect spasticty without creating muscle weakness s. In regards pain this is most probably due to a blockade of neurotransmitters such assubstance P,glutamate and calcitonin gene-related peptide.7,8,9thus, the ihibition of acetylcholine release is only one mode of action and in no way explains its action on pain or spasticity,
4)The response article attempts to treat all toxins the same. Furthermore it attempts to use the same injection pattern for all toxins. This pattern was developed specifically for Botox based on its diffusion. In that Toxins such as Purtox,Xeomin,Myobloc,and Dysport have a lighter molecular weight and tare able to diffuse to a greater extent. Than Botox the patterns are not the same.Furthermore you cannot compare a Type B toxin to a Type A.12 Type B is known to have severe distant side-effects! Furthermore 2000U of Myobloc was used to treat the frown in a study where 20 units of Botox was used. Therefore, 80,000 Units of Myobloc would equal about 400 units of Botox but this is not the case. Myoboc is not safe and effective and can never be compared to Botox. Unfortunitly the literature says it is safe and effective and that is what doctors believe.Somehow, somewhere there should be a source of information which is independent of the drug companies, and reflects what is truly known in this field. Yet we are at a time in medicine where the truth is considered a source of great controversy. In relationship to Xeomin to Botox it does last as long. Remember the initial Botox trial was 16 not 12 weeks. Dysport also diffuses further and does not last as long. Furthermore the Dysport to Botox ratio is individualized and not always 3 to1.
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Is Xeomin a good alternative to Botox
Xeomin is a fine alternative though I would caution that most people have found it drops off much quicker and results end sooner than the 3 month period, no matter the dosage. I find Dysport to be a more true comparable product and have switched some patients over to that who were not having enough lasting effects of Botox anymore. I would say though that this is few and far between and often upping the dosage just a bit in people who have Botox wear off too quickly is often just as good a solution.
"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."
Xeomin is an alternative to Botox you may wish to consider.
If you're not getting a favorable result from Botox, Xeomin is a neurotoxin similar to Botox. In fact, Allergan just announced an increase in the cost of Botox, so I see Xeomin gaining popularity in 2014.
Hope this helps you.
Xeomin vs Botox
Best of luck.