Botox vs. Xeomin: Choosing the Right Neurotoxin for You

While Botox has been a trusted mainstay in the cosmetic world for decades, other neurotoxins such as Xeomin have emerged as alternatives for men and women seeking to refine their appearance. These injectable treatments can safely smooth out facial wrinkles, addressing common concerns like crow’s feet and frown lines. 

Although both Botox and Xeomin are derived from botulinum toxin type A, they each have unique characteristics that cater to different needs and preferences. Whether you’re looking to rejuvenate your facial appearance or seeking a solution for a specific medical condition, understanding the nuances of these popular treatments can guide you in making an informed decision.

How Do Botox and Xeomin Work?

Botox and Xeomin are two formulations of clostridium botulinum, a neurotoxin used in both cosmetic and medical applications. The primary function of both Botox and Xeomin is to act as muscle relaxants. When injected into specific facial muscles, they temporarily block the nerve signals that cause muscle contractions, causing those muscles to relax.

This relaxation of muscles leads to a reduction in the appearance of fine lines and wrinkles that are formed due to repeated facial expressions. It also improves conditions related to involuntary muscle contractions, such as teeth grinding and muscle spasms in the eyes and neck. 

One neurotoxin, two formulations

Botox, the more well-known brand name manufactured by Allergan, contains onabotulinumtoxinA along with several accessory proteins–additives which serve to stabilize the toxin.

Xeomin, on the other hand, was developed by Merz Pharma and is often referred to as a ‘naked’ neurotoxin, consisting solely of incobotulinumtoxinA without any accessory proteins. This fundamental difference in formulation can influence how your body responds to the treatment.

Botox’s formulation, with its additional proteins, may lead to the development of antibodies in some cases, potentially reducing its effectiveness over time. Xeomin’s purer form minimizes this risk, as it lacks these extra proteins. This distinction is particularly noteworthy for patients who receive regular neurotoxin treatments and might be concerned about developing resistance.

Benefits and Uses of Botox

When you hear about Botox, it’s often in the context of its cosmetic uses, but its benefits extend far beyond. As an FDA-approved treatment, Botox injections have a broad range of applications. Cosmetically, it’s most commonly used to address glabellar lines (vertical frown lines between your eyebrows), forehead lines and crow’s feet around the eyes. 

However, Botox’s utility isn’t limited to smoothing out facial wrinkles. It’s also used to treat several medical conditions. For instance, it has proven effective in managing chronic migraines, offering relief to those who suffer regularly from these debilitating headaches. Additionally, Botox is used to treat excessive sweating, known as hyperhidrosis, by blocking the nerve signals responsible for sweat gland activation. It also is FDA-approved to treat cervical dystonia, a painful condition causing involuntary contractions in the neck muscles.

The effects of Botox are temporary and localized to the area of injection. This targeted approach ensures that while the treated muscles are relaxed to reduce wrinkles or manage medical symptoms, the rest of your facial muscles continue to function normally, allowing you to express a full range of emotions.

Benefits and Uses of Xeomin

Xeomin distinguishes itself in the realm of neurotoxin-based treatments with its distinctively pure formulation. Unlike Botox, Xeomin contains incobotulinumtoxinA, a form of botulinum toxin type A, without any accessory proteins. 

The absence of these proteins means that there’s a reduced risk of your body developing antibodies against the treatment. Antibodies can sometimes diminish the effectiveness of neurotoxin treatments over time, especially in cases of frequent use. Therefore, Xeomin might be a preferable option if you’re considering long-term, repeated treatments.

Another practical advantage of Xeomin’s formulation is its stability. Xeomin doesn’t require refrigeration before use, unlike other neurotoxins. This stability can be particularly beneficial in terms of storage and handling, ensuring the treatment retains its efficacy from manufacture to injection.

Comparing Botox and Xeomin

While Botox and Xeomin share many similarities, there are key differences to consider when choosing the right treatment for your needs.

Number of units needed

The number of units needed for effective treatment can vary between Botox and Xeomin. You’ll usually need fewer units of Botox compared to Xeomin for the same treatment area. This is partly due to the molecular structure of each formula. Botox contains accessory proteins that may enhance its ability to bind to nerve receptors, potentially making it more potent per unit. 

Onset time

The time it takes to see the effects of each treatment also differs slightly between Botox and Xeomin injections. Botox generally starts to show results within 3-5 days of injection, with full effects visible after about two weeks. 

Xeomin, on the other hand, may have a slightly quicker onset time, with some patients noticing effects as early as 1-3 days after treatment. However, like Botox, the full effects of Xeomin are typically seen after two weeks.


Botox tends to have a more localized effect. This means it spreads less from the injection site, allowing for precise targeting of specific muscles or areas. This characteristic of Botox can be particularly advantageous when treating smaller areas where precise muscle relaxation is needed, such as around the eyes or between the eyebrows.

Xeomin, on the other hand, tends to spread more under the skin. While this might be beneficial for treating larger areas or for achieving a more subtle, natural-looking relaxation of facial muscles, it requires a skilled hand to ensure the product is placed accurately, especially in smaller or more sensitive areas.

Side effects

Botox and Xeomin share similar side effects due to their common active ingredient. Although neither requires any actual downtime, common side effects include temporary bruising, swelling at the injection site, dry eyes and sometimes a mild headache. Rarely, there can be a slight drooping of the eyelid, asymmetry or muscle weakness, especially if the injection is not placed correctly. 

However, as Xeomin doesn’t contain the additional proteins found in Botox, it may carry a lower risk of allergic reaction, although such cases are rare in both treatments.

Duration of results

This is another area where Botox and Xeomin are quite similar. The effects of both treatments typically last about 3-4 months. However, individual experiences can vary, with some patients reporting longer-lasting results. Factors influencing the duration include the individual’s metabolism, area treated and number of units used. Over time and with repeated treatments, the muscles can become conditioned to relax, potentially extending the time between sessions.

Long-term effects

Both Botox and Xeomin are considered safe with a long history of use. They have both been extensively studied, showing no significant long-term side effects when used for cosmetic purposes. 

However, over time, some patients may develop antibodies to Botox due to its additional proteins, potentially making it less effective. This is less likely with Xeomin, due to its ‘naked’ formulation without these extra proteins. It’s important to note that developing resistance is still uncommon with both treatments. Regular, but not excessive, use of either treatment can lead to sustained results and high patient satisfaction.

FDA-approved uses

Botox and Xeomin are both FDA-approved for a range of applications. Botox is approved for medical conditions such as migraines and excessive sweating along with glabellar lines, forehead lines and crow’s feet. 

Xeomin, on the other hand, is approved for medical issues like cervical dystonia and blepharospasm, in addition to its cosmetic application for glabellar lines.

Both Botox and Xeomin are used off-label–a widely accepted practice in the medical community–for other applications including an overactive bladder and teeth grinding.

Cost Considerations

Typically, Botox costs range from $10 to $20 per unit, but this can vary based on location and provider. Xeomin tends to be more budget-friendly, generally priced between $8 and $15 per unit.

The higher cost of a Botox treatment is often linked to its well-established brand and longer presence in the market. Its strong reputation can justify higher prices. Xeomin, although equally effective, is newer and still building its market presence, often reflected in its slightly lower pricing.

When considering the overall cost of a treatment, these per-unit prices can lead to a notable difference. For instance, a treatment requiring 20 units might see a cost saving of $40 to $100 with Xeomin, based on these average price variations. 

However, price should not be the only factor in your decision. Both Botox and Xeomin offer unique benefits, and the choice should be made to your individual needs.

Alternatives to Botox and Xeomin

Botox and Xeomin aren’t the only FDA-approved neuromodulators available. 

Dysport tends to diffuse more than other neurotoxins like Botox and Xeomin, making it a suitable option for treating larger areas but requiring skilled application for precision work.

Jeuveau, often branded as ‘Newtox’, is similar to Botox in its molecular structure and effect, but is typically marketed as a more affordable alternative with a potentially quicker onset of action.

Daxxify differentiates itself from other neurotoxins by offering a quick onset of 1–2 days and a longer-lasting effect, potentially extending up to 6 months, compared to the 3-4 months duration commonly seen with products like Botox and Xeomin.

A consultation with an experienced injector will help you determine which of these treatments is most appropriate for you.

Choosing the Right Injector

Selecting an experienced injector is crucial for both Botox and Xeomin treatments. The skill and expertise of your injector can significantly impact the outcome of your treatment. Moreover, a professional will be able to determine which neuromodulator is more appropriate for you.

Consult with a board-certified dermatologist or plastic surgeon who understands the intricacies of facial anatomy. These professionals can provide personalized advice, taking into account your specific facial structure, skin condition and aesthetic goals.


Both Botox and Xeomin offer effective solutions for reducing facial wrinkles and treating certain muscle-related medical conditions. While their core active ingredient is the same, the differences in formulation, potential for antibody development and allergic reactions are important factors to consider. The choice between Botox and Xeomin should be made in consultation with a professional, considering your personal skincare needs, treatment goals and cost considerations.

Remember, the guidance of a board-certified dermatologist or plastic surgeon is invaluable in navigating these options. With their expertise, you can choose the treatment that aligns best with your aesthetic aspirations and enjoy the rejuvenating benefits of these cosmetic treatments.

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