Is there an alternative to Botox/Dysport? Xeomin?

I have used them for years but became allergic to all of them about 2 years ago. When injecting any of these 3, I get blotchy and itchy and no results. Would a good dose of Prednisone, taken a few days before and after help in suppressing this allergy?

Doctor Answers 5

Alternative options for wrinkles with Botox / Dysport / Xeomin allergy

Dear Lisdont:

Currently, there is no other neuromodulator injectible drug FDA approved in the USA for wrinkle reduction with a muscle relaxer such as Botox, Dysport or Xeomin. BUT, there are other options. 

The art of selectively weakening muscles to rebalance their contraction or pull is being explored with topical medications and/or freezing the muscle / nerve junction. Endoscopic advancements have diminished muscle thickness by excising the muscle mass of the corrugator years ago and are still performed today.

  1. Considering that the muscles that Botox, Dysport and / or Xeomin are used on cosmetically are to reduce wrinkling of the skin, there are other options at the level of the skin to:
  2. redrape surgically lax skin
  3. tighten with peels and laser
  4. firm with Sculptra, and / or
  5. shrink with retinoids. 

If it is the furrows and wrinkles of the forehead and crow's feet you speak of, I have found Restylane Silk filler to work very well in this off-labeled area. 

It is most interesting that you have a "allergic" reaction to all 3 drugs particularly when Xeomin is considered to be pure and with the least amount of preservative in it. You may wish to consult an Allergist to identify this cause. 

Seek consultation with a well versed, Board Certified Plastic Surgeon or ENT Facial Surgeon to examine you and review your other options.  Good luck!


Baltimore Plastic Surgeon
4.8 out of 5 stars 70 reviews

Allergy to Botox products

Botox is a great facial injection and allergies are rare.  However if you are allergic and not having any results then I would concur that there is currently nothing that you can substitute for it.  You can consider doing Thermage or other facial procedures which cause new collagen and decrease wrinkles.

Botox alternative?

Thank you for your question. Speak to your injector regarding prednisone. Botox, Dysport and Xeomin are the only products currently available.


Have a wonderful day,

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Allergic to BTX-A?

Dear Lisdont:

This is, indeed, an unusual response. Botox, Xeomin, and Dysport are all forms of botulinum toxin A. Myobloc is botulinum toxin B but is very rarely used.

You are probably correct in assuming that Prednisone, taken until all the product has attached, been taken into the cells, or dissipated, would prevent an allergic reaction, but if you had no effect I don't think it would work for you anyway.

Other ways to smooth wrinkles include Pellevé, Ultherapy, some lasers, topical retinoids with glycolic acid and growth factors as well as other topical creams, chemical peels, and dermal fillers.

So sorry this did not work out for you, but I feel confident other approaches are worth discussing.

All the best,

Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Alternatives to Botox

Sorry to hear about your allergies to Botox, Xeomin and Dysport. That is very unusual. At this point, those are the only neuromodulators available. I'm sure new medications will be available in the future. 

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.