Q: What are the pros and cons of Xeomin?

Pros Xeomin injections require no downtime. You can get the treatment done during your lunch hour and head straight back to work. Along with smoothing existing lines, it can help prevent new wrinkles from forming. It’s common for young people to get neurotoxin injections as a preventive measure, to keep lines from digging in or deepening. Xeomin can be used to shrink certain large muscles, like the masseters (chewing muscles), over time. The effect is both functional—a reduction in painful clenching and grinding—and cosmetic. It’s safe for all skin types and tones. Effects are temporary, so if you’re unhappy with the results, you’re not stuck with them—they’ll gradually disappear over about four months. The most common side effects of Xeomin—injection site bruising, swelling, soreness, and short-term headaches—are minor and transient. Cons As with similar botulinum-based muscle relaxants, results are temporary; you’ll have to get periodic touch-ups to maintain them. While Xeomin can help with lines caused by muscle movements and facial expressions, it can’t erase etched-in wrinkles that are visible when your face is at rest. In the hands of an inexperienced injector, you could temporarily end up with a crooked smile, uneven eyebrows, or droopy eyelids. RealSelf Tip: Avoid this and other neurotoxins if you are breastfeeding, are pregnant, or plan to become pregnant. The effects haven’t been studied in those instances, so the potential effects on an unborn (or new) baby are unknown.

Question 1

What is Xeomin?

Accepted Answer

Xeomin (incobotulinumtoxinA) is an injectable neurotoxin that temporarily relaxes muscles to reduce the appearance of lines and wrinkles created by dynamic facial movements, such as smiling, frowning, or raising your eyebrows.

It’s FDA-approved to treat moderate to severe frown lines between the eyebrows (glabellar lines), but it’s commonly used off-label to treat everything from gummy smiles to boxy jawlines.

Xeomin is also FDA-approved to treat neck pain caused by cervical dystonia, eye spasms known as blepharospasm, and upper limb spasticity.

Question 2

What are the pros and cons of Xeomin?

Accepted Answer

Pros

Xeomin injections require no downtime. You can get the treatment done during your lunch hour and head straight back to work.
Along with smoothing existing lines, it can help prevent new wrinkles from forming. It’s common for young people to get neurotoxin injections as a preventive measure, to keep lines from digging in or deepening.
Xeomin can be used to shrink certain large muscles, like the masseters (chewing muscles), over time. The effect is both functional—a reduction in painful clenching and grinding—and cosmetic.
It’s safe for all skin types and tones.
Effects are temporary, so if you’re unhappy with the results, you’re not stuck with them—they’ll gradually disappear over about four months.
The most common side effects of Xeomin—injection site bruising, swelling, soreness, and short-term headaches—are minor and transient.

Cons

As with similar botulinum-based muscle relaxants, results are temporary; you’ll have to get periodic touch-ups to maintain them.
While Xeomin can help with lines caused by muscle movements and facial expressions, it can’t erase etched-in wrinkles that are visible when your face is at rest.
In the hands of an inexperienced injector, you could temporarily end up with a crooked smile, uneven eyebrows, or droopy eyelids.

RealSelf Tip: Avoid this and other neurotoxins if you are breastfeeding, are pregnant, or plan to become pregnant. The effects haven’t been studied in those instances, so the potential effects on an unborn (or new) baby are unknown.

Question 3

How much does Xeomin cost?

Accepted Answer

Xeomin costs depend on how many units you get and the cost per unit, which is influenced by your provider’s credentials and location.

Cosmetic treatments like this one aren’t covered by health insurance.

See our complete guide to Xeomin costs

Question 4

Xeomin before and after pictures

Accepted Answer

The Xeomin photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Xeomin vs. Botox and other neuromodulators: How do they compare?

Accepted Answer

Xeomin is a botulinum toxin type A, so it works very similarly to Botox (onabotulinumtoxinA), Dysport (abobotulinumtoxinA), Jeuveau (prabotulinumtoxinA-xvfs), and Daxxify (daxibotulinumtoxinA-lanm): by blocking signals between nerves and muscles so the injected muscle can’t contract and wrinkle the skin.

In terms of cost and longevity, it's quite similar to Botox and its competitors. One exception to this rule is Daxxify, the latest neuromodulator to earn FDA-approval, which is proven to last for six to nine months.

Xeomin also differs in that it doesn’t contain so-called complexing proteins (which are produced by the same bacteria that makes the toxin). The way Xeomin is manufactured removes these proteins from the active ingredient, botulinum toxin type A, which Harrison, New York-based oculoplastic surgeon Dr. James Gordon considers a plus. For certain patients, “it’s reassuring when a product has fewer unnecessary ingredients,” he says.

Xeomin does, however, contain the stabilizing protein human serum albumin, which makes it less pure than Daxxify, the only neuromodulator to be formulated without this blood-derived additive. Daxxify is also free of complexing proteins.

Some doctors theorize that these purer toxin formulations may be less likely to cause drug resistance over time, though this has yet to be clinically proven.

Whether a cleaner chemical composition gives a neuromodulator an edge over the competition is a point of debate among injectors. Houston-based dermatologic surgeon Dr. Melissa Chiang says that “all the protein detaches from Botox within one minute of injection, so there’s really no reason the effect of Xeomin should differ from Botox.”

Still, other doctors have reportedly found Xeomin to work for patients who’ve become unresponsive to other toxins.

Related: What’s the Difference Between Botox, Dysport, Xeomin, and Jeuveau?

Question 6

How to prepare for a Xeomin treatment

Accepted Answer

The most important part of prepping for any injectable treatment is choosing your provider. The person administering your Xeomin should be a licensed, experienced healthcare professional working full-time in aesthetic medicine (not, say, an OB-GYN, dentist, or primary care doctor who injects on the side).

We recommend seeing a board-certified dermatologist, plastic surgeon, facial plastic surgeon, or oculoplastic surgeon, but there are plenty of registered nurses and physician associates who are also expert injectors.

Studies show that complications like ptosis (a droopy eyelid) are far less common when neuromodulators are administered by experienced injectors.

Beyond excellent credentials and years or practice, your provider should have an aesthetic that’s in line with yours. If you prefer to get light doses of injectable muscle relaxants to maintain natural expressions, you’ll want to find an injector who is on the same page and doesn’t deliver frozen foreheads to everyone who sits in their chair.

Once you’ve done your homework and picked a reputable provider, there’s really no other prep work to do prior to your Xeomin treatment. Just show up the day of your appointment with a clean face, ask any questions you might still have, and review the possible side effects of Xeomin and aftercare instructions.

Question 7

What happens during a Xeomin treatment?

Accepted Answer

Xeomin injections typically take 10 to 20 minutes, depending on the number of injections you get. This includes consultation time.

No anesthesia is required, though if you’re particularly sensitive, your provider may apply numbing cream beforehand. If so, expect this to add another 15 to 30 minutes to your treatment time.

Your provider will use a very small needle. They may ask you to smile, frown, raise your eyebrows, crinkle your nose, or make other expressions, to help identify the spots that need addressing. You’ll probably feel pinching but not pain during the injection of Xeomin.

Question 8

What can you expect afterward?

Accepted Answer

You won’t need any downtime after your injection, but your provider should recommend proper aftercare, including—most important—that you don’t rub or massage the injection sites for a few hours after your treatment. This keeps the product from spreading and inadvertently affecting other areas.

The most common side effects following an injection of Xeomin are minor tenderness, swelling, bruising, or a headache. Your physician may give you an ice pack to apply gently to the injection sites before you leave the office and advise you to ice the treated areas at home, to reduce discomfort.

It’s also important to avoid exercise for 24 hours, to reduce the risk of diffusion from the treatment area.

“Headaches post neuromodulator injections are a normal side effect,” says Louisville, Kentucky, plastic surgeon Dr. Marc Salzman. “They should last only a couple of days. They’re more prevalent in first-time users. You may use an NSAID [nonsteroidal anti-inflammatory drug], like aspirin or ibuprofen or Tylenol [acetaminophen], to help combat the pain.” If you tend to bruise, stick with acetaminophen, as blood-thinning aspirin and ibuprofen can exacerbate black-and-blues.

Related: Injectable Bruises? Been There. Here’s How to Handle Them Without Hiding Out.

Question 9

How long does Xeomin take to work?

Accepted Answer

According to Xeomin’s manufacturer, Merz, you could start to see smoothing three to four days post-injection. Sometimes it’ll take closer to a week for your results to appear, and you can expect your results to have reached their maximum effect after 30 days.

Most providers start patients off slowly, to preserve a more natural look, and have them come back after two weeks in order to see if any touch-up is needed.

Question 10

How long do Xeomin results last?

Accepted Answer

Typically, Xeomin results last between three and four months, though some RealSelf members say they still see results for up to six months post-injection.

All neuromodulators reduce muscle movement for about the same length of time, with the exception of the newly FDA-approved Daxxify, which is shown in clinical studies to last between six and nine months.

Related: The Treatments and Ingredients Actually Proven to Reduce Wrinkles

Question 11

What are the risks and side effects of Xeomin?

Accepted Answer

Xeomin is generally considered a safe procedure. Complications are uncommon and usually the result of poor injections or incorrect dosage. Possible side effects include:

Bruising, swelling, and tenderness at injection sites.
Drooping eyelids, a crooked smile, uneven eyebrows, or the appearance of muscle atrophy—lasting until the drug’s effects wear off.
Very rarely, muscle weakness, loss of strength, vision problems (double vision, blurred vision, or dry eyes), drooping eyelids, loss of bladder control, dry mouth, and trouble breathing. These serious side effects can happen days or even weeks after your treatment.
Allergic reactions. Signs include itching, redness, rash, swelling, breathing problems (wheezing or asthma symptoms), trouble swallowing, and dizziness or feeling faint.

Seek medical help immediately if you experience any unusual symptoms.

RealSelf Tip: Avoid Xeomin and talk to your doctor about alternative wrinkle treatment options if you’ve had an allergic reaction to other botulinum toxin products in the past, or if you already have trouble breathing or difficulty swallowing.

Question 12

Sources & studies

Accepted Answer

Evidente, Virgilio Gerald H., et al. “A Randomized, Double-Blind Study of Repeated IncobotulinumtoxinA (Xeomin®) in Cervical Dystonia.” Journal of Neural Transmission, vol. 120, no. 12, June 2013.

Field, Malgorzata, et al. “AbobotulinumtoxinA (Dysport®), OnabotulinumtoxinA (Botox®), and IncobotulinumtoxinA (Xeomin®) Neurotoxin Content and Potential Implications for Duration of Response in Patients.” Toxins, vol. 10, no. 12, Dec. 2018.

Harrison, Andrew, and Juwan Park. “Profile of Xeomin (IncobotulinumtoxinA) for the Treatment of Blepharospasm.” Clinical Ophthalmology, June 2011.

Lorenc, Z. Paul, et al. “IncobotulinumtoxinA (Xeomin): Background, Mechanism of Action, and Manufacturing” Aesthetic Surgery Journal, vol. 33, no. 1 Supplement, Mar. 2013.

Merz Pharmaceuticals. Xeomin Prescribing Information, FDA, 2018.

XEOMIN

James R. Gordon, MD, FACS, FAAO

Jolene Edgar

James R. Gordon, MD, FACS, FAAO

Jolene Edgar

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James R. Gordon, MD, FACS, FAAO

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Jolene Edgar

XEOMIN REVIEWS

Looking Great.

Thrilled with the natural results

Outstanding Service!!

XEOMIN QUESTIONS

Can crow’s-feet injections affect blink strength or tear-film distribution enough to cause significant dryness?

Resistant to all neurotoxins - can Xeomin eventually become more effective?

Forehead muscles temporarily contract 6+wks after Xeomin

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