What Botox and Xeomin are
Botox and Xeomin are both brand names for botulinum toxin type A. That is a protein made by a germ called Clostridium botulinum. In tiny, purified doses, it relaxes the small muscles that pull your skin into lines when you frown, squint, or raise your eyebrows.
Botox is made by AbbVie (the company that bought Allergan). Its medical name is onabotulinumtoxinA. Xeomin is made by Merz, a German company. Its medical name is incobotulinumtoxinA. Both are prescription drugs that must be injected by a trained provider.
The U.S. Food and Drug Administration (FDA) approved Botox for frown lines between the eyebrows in 2002. Xeomin got the same approval in 2011. Both are also approved for several medical problems, like neck muscle spasms and eye twitching.
The main difference: extra proteins
Inside a vial of Botox, the active toxin is wrapped in other proteins. These are called accessory proteins or complexing proteins. They do not do the wrinkle-smoothing work. They are just part of how the drug is made.
Xeomin is often called a "naked" toxin. Merz strips those extra proteins away, so the vial holds only the active part. Some doctors believe that fewer extra proteins might mean a lower chance that your body builds antibodies against the drug. Antibodies could make the drug work less well over time. This is a theory, and studies so far have not proven that it matters for cosmetic use.
There is one practical difference that is well established. Because it has no accessory proteins, Xeomin can be stored at room temperature before it is mixed. Botox must be kept in a refrigerator. This does not change your results, but it is one reason some clinics prefer Xeomin.
Do they work the same?
Several randomized trials have compared the two drugs head to head for frown lines. In those studies, the same number of units of Xeomin and Botox gave very similar results. The lines softened about the same amount and for about the same length of time.
Both drugs start working in about 3 to 7 days. The full effect shows up at around two weeks. Results usually last 3 to 4 months, then the muscle slowly regains movement and the lines return. Some people find one brand lasts a little longer for them, but there is no strong evidence that one wins overall.
Dosing is roughly one to one. That means a provider who uses 20 units of Botox for frown lines would likely use about 20 units of Xeomin. Still, the two are not legally interchangeable, so your provider should not swap them without telling you.
Where each one is approved for wrinkles
Botox Cosmetic is FDA-approved for three areas: frown lines between the brows, crow's feet beside the eyes, and horizontal forehead lines. Xeomin is approved for frown lines. Many providers use both in other areas as well. That is called off-label use, and it is legal and common, but it means the FDA did not review that specific use.
Both products carry the same boxed warning. In rare cases the toxin can spread beyond the injection site and cause trouble swallowing or breathing. This is very unusual with the small doses used for wrinkles, but it is why you should only get treated by a licensed, trained provider.
Side effects and who should avoid them
Common side effects for both are mild. You may get a small bruise, a headache, or a little swelling at the injection site. A droopy eyelid or uneven brow can happen if the drug drifts into a nearby muscle. That usually wears off in a few weeks.
You should skip both drugs if you are pregnant or breastfeeding, if you have a nerve or muscle disease like myasthenia gravis, or if you have had an allergic reaction to any botulinum toxin product. Tell your provider about every medicine you take, including antibiotics and blood thinners.
How to choose
For most people the choice comes down to the provider, the price, and personal experience. Both drugs are safe and effective for frown lines, and both wear off in a few months. If one brand seems to stop working for you, trying the other is reasonable.
Zen IV Spa does not offer injectable neurotoxins right now. What we do offer is prescription skin care that works on the skin itself rather than the muscle. Tretinoin, a vitamin A cream, is the best-studied topical for fine lines and sun damage. Our medical director can prescribe it after a free video visit, and it ships to your door for $99 per month. If smoother skin is your goal, that is a strong place to start.
Next steps with Zen IV Spa
If you want to keep your skin looking its best between any injectable treatments, visit our skin page at /skin/. You will see tretinoin for fine lines and dark spots, plus our acne and rosacea program for $119 per month. Every plan starts with a free video visit, and we serve clients across New York and New Jersey. Call (332) 239-2005 or book online at https://zenivspa.zenoti.com/webstoreNew/services.
Common Questions
Is Xeomin cheaper than Botox?+
Prices are set by each clinic, not by the drug maker. Xeomin is often a little less per unit, but the gap is small. Ask what you will pay per unit and how many units the provider plans to use.
Can I switch from Botox to Xeomin?+
Yes. Many people switch between brands. Wait until the last treatment has worn off, usually 3 to 4 months, and tell your new provider which brand you had before.
Does Xeomin kick in faster?+
Not in a meaningful way. Both start working in about 3 to 7 days, with the full effect at about two weeks.
Is one more natural looking?+
No. How natural the result looks depends on the dose and where it is placed, not on the brand.
Are these the same as fillers?+
No. Botox and Xeomin relax muscles. Fillers are gels that add volume under the skin. They treat different problems and are often used together.
Sources: FDA prescribing information for Botox Cosmetic (AbbVie) and Xeomin (Merz); Prager et al., head-to-head comparison of incobotulinumtoxinA and onabotulinumtoxinA for glabellar lines, Dermatologic Surgery 2010; American Academy of Dermatology patient guidance on botulinum toxin.
All treatments are medical services. Every guest is screened, and every treatment is prescribed by a licensed provider. Nothing on this page is medical advice for you personally, and the opinions summarized here belong to the doctors named, not to Zen IV Spa. Talk to a provider before starting or stopping anything.
