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 40

Time will tell

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UPDATE: The research discussed below is now completed. Feel free to check out the link I posted. This will discuss the final results. 

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 21 reviews

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

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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.

Xeomin - Great For Patients

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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
4.8 out of 5 stars 177 reviews

Xeomin & Botox & Dysport

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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

Xeomin is similar to Botox and possibly cheaper to the patient.

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Xeomin is another Botulinum toxin A like Botox and Dysport with a very similar safety profile and effectiveness. I have used all three and find that each works very effectively when used to reduce wrinkles and shape your brow position. Hope this helps..Laurie A. Casas,MD

Laurie A. Casas, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 110 reviews

Xeomin vs. Botox - How do they differ?

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Xeomin is a botulinum toxin A type that is FDA approved for the minimization of wrinkles between the eyebrows.  The FDA approval came in fall of 2011 however the Xeomin has been used since 2008 in Europe under the brand name Bocouture.    

The major difference between these two medications is that Botox is a molecule that has a carrier protein attached to it and Xeomin is a "naked" toxin.  Basically when Botox is injected the protein disconnects within a minute of injection and the Botox becomes active.  Xeomin is active as soon as it is injected.  Some physicians believe that in patients who become tolerant to Botox after multiple injections that this protein complex may be part of the cause.  Thus, Xeomin may have an advantage in this regard according to this theory.

The truth is nobody really knows which will last longer in individual patients.  As it is used more and more in the United States time will tell.  Some physicians in the United States started treating with Xeomin a few months ago but it is too soon to see if it lasts the same amount of time, longer, or shorter.  In a year or two American physicians will be able to tell you about their personal experience with the various products.  

This is an exciting time as neurotoxins are the most popular "procedure" performed in the United States.  The avialability of Botox, Dysport, and now Xeomin broadens the available products for physicians and patients to choose amongst.  If you have further question you should contact a local plastic surgeon or dermatologist experienced in facial rejuvenation to learn more!

Evan Sorokin, MD
Cherry Hill Plastic Surgeon
4.8 out of 5 stars 77 reviews

Xeomin VS Botox VS Dysport

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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

My experience with Botox and Xeomin - Portland Oregon

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I've used Botox since 1997 and I have had VERY reliable and predictable results with it, it works more than 99% of the time.

Xeomin came out about 4 years ago, and the rep said the studies were done and it was equally effective.  Great! I thought, it's less expensive!   So, I treated about 100 patients who had all had Botox at least twice before with the Xeomin using the 1:1 ratio.  At least 5 people called to say it didn't work, we brought them in at the 2 week peak point to visualize their response, and they were right, it was like they had not received any treatment.  No result.   
Many felt it was about the same.  This was not a double blinded study or a meta-analysis. Overall, of the 100 that tried it about 75% went back to Botox, and 25% said they preferred the Xeomin.  

Bottomline to how I practice is that I don't like to start a new patient out with Xeomin, because of that failure rate I had experienced.  I like to know that my standard dosing with Botox and therefore the patient's expectations will be met.  I don't want that new patient to lose faith in me because their first treatment with Xeomin had no effect at all.  I offer both because the informed patient can choose, and the price difference can be significant.

Marla M. Klein, MD
Lake Oswego Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

Xeomin versus Botox

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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
Spokane Dermatologic Surgeon
4.9 out of 5 stars 121 reviews

Xeomin is similar to Botox, but not the same

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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

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.