I Have Always Used but Botox but Tried Xeomin Recently and Haven't Had Great Results. Am I Resistant?

I have always love botox but my doctor stopped offering it and said xeomin would work better. I've waited three weeks with still no results, just some twitching near my right brow. Could I be resistant? I had the same amount/units as normal, if I switch back to botox will it still work. I have heard that it isn't recommended to go back and forth. I also take olive leaf extract and read that sometimes it is a natural antitoxin( use it for acne) Thanks!

Doctor Answers 22

Differences in Xeomin activity more likely relate to dose

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It is more likely that differences in activity between the available type A botulinum neurotoxins - Xeomin, Botox, and Dysport - are due to the amount given and amount needed in the individual person to achieve a desired result.  There are individual variations in the activity of ALL of the toxins, and while many injectors use convenient "conversion factors," like 2 or 3:1 for Dysport to Botox units or 1:1 for Xeomin to Botox units, the truth is that these conversions are only guidelines and won't work 100 % of the time for all people.  Rather than totally discard Xeomin or any of the toxins, if you wish to convert, my advice is to keep working with your physician to determine YOUR optimal dose of your chosen neurotoxin based on your desired result.

San Diego Plastic Surgeon

I Have Always Used but Botox but Tried Xeomin Recently and Haven't Had Great Results. Am I Resistant?

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You may need more units applied to the area to see full correction, seek a reputable physician who can provide you with the result you wish to achieve 

I Have Always Used but Botox but Tried Xeomin Recently and Haven't Had Great Results. Am I Resistant?

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I have had excellent results with Xeomin and I now routinely offer it as a neuromodulator (along with Botox and Dysport).  It is perfectly reasonable to go back and try the Botox to see if that gives you a better result but it is equally important to make sure that you are receiving the same number of units (1 of Xeomin = 1 of Botox) and that the solution is fresh (there is some question as to exactly how long each lasts once it is made up but I try to make it fresh for each patient, or at least within just a few hours).  Within those parameters you should be as happy with your Xeomin treatments as you have been with Botox.

I hope that this helps and good luck,

Dr. E

Xeomin vs Botox

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Xeomin is the newest neuromodulator available in the U.S. and thus far, only experienced injectors are being given access to it for patient use.  Therefore, each physician who answers here has excellent credibility.  I have been using it in patients who have previously had Botox, as well as some who have never been treated, and I am diluting it exactly the same as Botox.  My results thus far have been equivalent between the two products for cosmetic purposes.  I am able to offer Xeomin at a slightly lower cost to the patient, which is attractive to many.

I have one long term patient who gets injections for essential blepharospasm (uncontrolled eyelid twitching), and when she switched to Xeomin she did not get nearly as good a result as with Botox.  Her spasms went away only for three weeks instead of the three months she gets with Botox.  In her case, we have gone back to Botox.

Provided that everything else is the same (injector, dilution, location of injections), I think that you are similar to my one patient in that, for unexplained reasons, Botox works better for you than Xeomin.  There should be no problem with going back to Botox and you should get the same good result you did before.

James Bartels, MD
Manchester Facial Plastic Surgeon

Xeomin vs Botox

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Unfortunately,  the study cited below did not compare the same dosage of Xeomin to the same dosage of Botox which makes consumers and physicians assume you need more Xeomin to be equivalent to Botox. It is quite possible that the study would have found the EXACT same results (equivalence with a trend toward Botox) using 20 units of Botox and 20 units of Xeomin. It is unclear why they did this and it does make me suspect of their motives.  I love Botox and have been using Xeomin 1:1 and have been pleased in most but not all patients.  As many other reviewers said, there may be individual differences, but otherwise they are all good products. 

Jacqueline Calkin, MD
Sacramento Dermatologic Surgeon

Comparing Xeomin to Botox

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I have been offering Xeomin to all my patients since it became available in the United States on Nov.1, 2011. I also have used Botox and Dysport for many years. Thus far I have not been able to see any difference between Xeomin and the others. The three available neurotoxins for injection in the United States are all type A produced from the same wild-strain of Clostridium botulinum. Botox is OnabotulinumtoxinA, Dysport is AbobotulinumtoxinA, and Xeomin is IncobotulinumtoxinA. Only Xeomin differs from the others as the manufacturing process involves a series of purification steps that yields exclusively active neurotoxin, free from inactive complexing proteins that are present in the other preparations. You are not likely to be resistant to Xeomin. I recommend that you return to your injecting physician and switch back to Botox.

Xeomin vs botox

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It sounds as if you may need more product, and shoud discuss this with your injecting physician. There three available neurotoxins in the States are Botox, Xeomin and Dysport. They all act with the same mechanism of actiion, and are all effective products. If you feel that the Xeomin did not work for you, then switch back to Botox, it is safe to be re-injected with the doses that you found effective.

Here's a study of BOTOX® vs XEOMIN® for forehead lines

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Marion Moers-Carpi, MD et al recently presented the results of an experiment comparing 20 units of BOTOX®  to 30 units of XEOMIN® for forehead lines. It was a large, double blind study, with 112 patients in each treatment group.

Multicentre, Randomised, Double-Blind Study to Evaluate the Efficacy of OnabotulinumtoxinA (20 units -- BOTOX®) in the Treatment of Glabellar Lines, When Compared to IncobotulinumtoxinA (30 units XEOMIN®)

Bottom line: This clinical study found that 20 units of onabotulinumtoxinA [BOTOX®] are as effective as 30 units of incobotulinumtoxinA [XEOMIN®] in reducing the severity of glabellar lines 28 days post injection, and demonstrated a trend in favour of onabotulinumtoxinA at days 84, 98 and 112. These results were obtained despite a 50% higher dose of incobotulinumtoxinA than onabotulinumtoxinA.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon


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Xeomin works as well as botox in my opinion. You may be needing additional units as you continue to age. 

Botox vs Xeomin for eye twitching

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Xeomin is an FDA approved botulinum toxin similar to Botox. Its dilutions are the same as Botox and it lasts as long as Botox, but is much less expensive.

We have replaced Botox for Xeomin for cosmetic injections. The results have been the same.

However, we have not gotten the same results for hyperhidrosis (sweating) as we do with Botox. I do not know the reason.

It sounds like you are receiving the drug for eye twitching. Maybe it is not as effective as Botox for muscle twitching.

Go back to Botox. It should work as well now as it did in the past.

Good luck.

Harry Goldin, MD
Skokie Dermatologist

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.