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Botox is a name that everyone has come to know and love. As the first neurotoxin on the market, Botox quickly became branded as a “liquid wrinkle eraser.” Other companies have since joined Allergan, the producer of Botox, in creating FDA approved cosmetic injectables that are derived from botulinum toxin to treat the appearance of frown lines and other facial wrinkles. Xeomin® is a product similar to Botox®, both of which are cosmetic injectable treatments that work through the same chemical pathways to block the signals from nerves to muscles. This allows for the muscles to relax and results in the disappearance of unwanted wrinkles and fine lines. The biggest difference between Botox and Xeomin is that Xeomin is produced without any additives or accessory proteins, essentially making it a pure form of the toxin. For this reason, Xeomin is commonly referred to as “naked Botox”. The purity of Xeomin makes it a great choice for patients who have stopped responding to Botox injections, and also means that Xeomin is less likely to cause one to develop an allergic reaction to the toxin.

Xeomin offers all of the same cosmetic benefits as Botox injectables, including smoothing out any fine lines on the forehead, around the eyes (the crow’s feet), and the glabella (the eleven lines). Xeomin, like Botox, is botulinum toxin A. Whether Xeomin or Botox is used, they both attach to the same receptor in the muscle to essentially “freeze” the area and soften wrinkles. When you have your treatment with an experienced injector, such as Dr. Michele Green, the results appear natural, beautiful, and “unfrozen.” Dr. Green has expertly performed countless Botox injections, and has over 25 years of experience providing the best in Botox treatments from her dermatology office in New York City. Dr. Green’s “less is more” philosophy and phenomenal cosmetic results have lead to her being consistently voted as one of the best cosmetic injectors in New York.

Xeomin and Botox alike can, and often are, combined with other non-invasive cosmetic procedures such as dermal filler injections (like Juvederm and Restylane), laser skin resurfacing treatments, skin tightening lasers, chemical peels, and microneedling. An individualized treatment approach guarantees that each patient achieves total facial rejuvenation, leading to them looking and feeling their absolute best. To date, injections of neurotoxin are the number one cosmetic procedure currently performed in the United States. Neurotoxin injections are so loved because they are painless, quick, and highly effective. Botox and other cosmetic injections of Xeomin, Dysport, Juvederm®, and Restylane® are some of the most popular procedures at Dr. Michele Green’s private boutique New York office. If you are considering non-invasive cosmetic treatment for your fine lines and wrinkles, Xeomin may be the best option for you.

B​​​​otox injections vs. Xeomin

The popularity of cosmetic Botox injections has grown exponentially since its approval for use by the FDA in 2002. Botox, produced by the company Allergan, is not only used to smooth out the appearance of fine lines and wrinkles, but also to treat chronic migraines, overactive bladder, and excessive sweating. Everyone knows the name Botox, but what exactly is it? Botox is the brand name for the onaboutlinumtoxinA, a derivative of the botulinum toxin A. This neurotoxin is created by a species of bacteria called Clostridium botulinum and has become one of the most well-known (and loved) neurotoxins on the market.

When it comes to younger looking, rejuvenated skin, there are a variety of skincare options available, but injectable treatments have quickly become a go-to cosmetic procedure for a youthful glow that lasts. Whether you’re considering consistent use of injectables for anti-aging maintenance, or you’re interested in trying injectable cosmetic treatments for the first time, Botox alternatives, such as Xeomin treatment, may be the perfect option for you.

Xeomin is an injectable cosmetic treatment similar to Botox, Dysport, Jeuveau®, and Revance®, that encourages the muscles around an injection site to relax, ultimately reducing the appearance of fine lines and wrinkles. Like all neuromodulators, Xeomin works on treating “dynamic wrinkles,” wrinkles which are caused by muscle contractions that happen during repeated facial expressions. “Static wrinkles” are wrinkles which do not move, and they are generally caused by aging, sun damage, and volume loss. The most common areas of dynamic which may be treated by all neurotoxins are:

  • Frown lines between the eyebrows
  • Laugh lines
  • Crow’s feet
  • Forehead lines
  • Neck lines
  • Dao’s or oral commissure

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What is Xeomin?

If you’re wondering but what is a Xeomin injection?, you’re not alone. Xeomin, created by Merz Pharmaceuticals, is a new, cutting-edge product available for both cosmetic and medical use. Xeomin is inspired by the innovations in cosmetic dermatology from throughout the last several decades, like Botox cosmetics. Unlike Botox, however, Xeomin is free of additives. The accessory proteins are removed from Xeomin during the manufacturing process, making it a pure form of the toxin. The active ingredient in Xeomin is botulinum toxin type A and the inactive ingredients are human albumin and sucrose.

Xeomin (IncobotulinumtoxinA) actually uses the same key ingredient as Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA): botulinum toxin type A. This is a neurotoxin created by the same bacterial species that creates botulism. The success of these products related to reducing the appearance of dynamic wrinkles and fine lines has made them even more popular than traditional cosmetic plastic surgery procedures. Neurotoxin injections are now the number one cosmetic procedure in the United States.

Botulinum toxin products–including Myobloc (rimabotulinumtoxinB)–use this neurotoxin in order to block neuromuscular signals, which in turn relaxes targeted muscles at or near the planned injection site. The relaxation of these muscles can reduce the appearance of wrinkles or fine lines caused by commonly used muscles, known as dynamic wrinkles. The result? A refreshed, relaxed, younger looking you!

Though botulinum toxin products, or neuromodulators, rely on a shared active ingredient, the formulation for these different injectables is distinct. Xeomin is unique in that it uses a “naked” version of botulinum toxin, meaning that it is not combined with accessory proteins or protein additives. Due to the purity of Xeomin, which contains only pure 150kD neurotoxin, having these injections will not result in the production of neutralizing antibodies or affect the immune system. Xeomin is a leading treatment for those who have developed antibody resistance with other products such as Botox, which unfortunately can occur with continued use over time.

What is Xeomin used for?

Xeomin is a treatment that can be used both for cosmetic purposes as well as for medical purposes. Cosmetically, Xeomin is best used to eliminate frown lines or other dynamic wrinkles on the face. Dynamic wrinkles are fine lines or wrinkles that occur as a result of muscle movement . For example, when you smile, lines appear around your mouth and along the corner of your eyes. Repeated movement in this way over the course of a lifetime mean that these wrinkles become more pronounced over time. Xeomin treatment relaxes the muscles that are responsible for forming the wrinkles without eliminating the expressive capabilities of your face, thus eliminating the dynamic fine lines.

Xeomin has also been FDA approved to treat certain medical conditions. As the treatment works to relax the muscle at the injection site, Xeomin is ideal for treating a variety of muscle spasm conditions. Specifically, Xeomin has been FDA approved to treat several forms of upper limb spasticity, including blepharospasm, which causes involuntary spasms in the eyelid, cervical dystonia, which involves spasms in the neck muscles and abnormal neck positioning, and upper lip spasticity. Botox has also been FDA approved to treat these conditions of upper limb spasticity. Xeomin, however, is uniquely approved to treat sialorrhea, which is chronic drooling, for both children and adults.

What is Botox used for?

Botox and Xeomin have been FDA approved to treat similar conditions but each treatment option has specific conditions it is best suited to address. Cosmetically, both Botox and Xeomin have been approved to treat frown lines, also known as glabellar lines, that appear between the eyebrows. Additionally, Botox has been FDA approved for the cosmetic purposes of treating forehead lines and crows feet that appear in the corner of the eyes. Both are extremely effective at eliminating the dynamic wrinkles that appear on the face as a result of muscle activity.

Xeomin and Botox have both been approved to treat conditions of upper limb spasticity, including blepharospasm, cervical dystonia, and upper lip spasticity, but Botox has also been uniquely approved to treat a number of other medical conditions. Botox is specially suited to treat the following conditions: chronic migraines, strabismus, which is when the muscle in the eye is abnormally aligned, overactive bladder, and hyperhidrosis, which is a condition characterized by excessive sweating.

What is the process for Xeomin treatment?

Patients begin the treatment process by scheduling a consultation appointment with Dr. Green at her Upper East Side dermatology office. There, Dr. Green will assess the treatment area to determine the scope of the treatment necessary. You will discuss your unique physical and aesthetic goals and together determine the treatment plan that best suits your needs.

Before arriving for your Xeomin appointment, Dr. Green recommends that you do not take anti-inflammatory medication, such as Advil or Aleve. Taking these medications before the procedure can lead to a higher risk of bruising following the treatment. Additionally, it is best if you arrive to the appointment with a clean face that is free from make up.

The procedure itself is very quick and involves minimal discomfort. Most patients report that the injections do not cause them any pain. The complete process for most cosmetic injection treatments takes only 10 minutes – though the amount of time that the treatment takes is dependent upon the size of the treatment area and the condition that is being treated. The number of injections is also variable based on the size and scope of the treatment area. Dr. Green will make the determination as to how many units of Xeomin are necessary during your initial consultation.

Xeomin is a treatment that requires no downtime or recovery time. As such, following the treatment you can resume your regularly scheduled daily activities as planned. In fact, you can wash your face and apply make up again immediately following the treatment if you so choose. Dr. Green likes to see her patients two weeks after their initial injection treatments to ensure that treatment is satisfactory and at that time any touch up required can be performed.

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How does Xeomin treatment work?

Xeomin and Botox work the same way to treat dynamic fine lines and wrinkles as well as a variety of medical conditions. Both Xeomin and Botox are neurotoxins derived from Botulinum toxin type A, which, when injected into the muscle, work to essentially “freeze” the muscle so that it no longer contracts. Botulinum toxin type A does this by blocking the neurotransmitters present at the injection site. As a result, the muscle is not receiving the signal from the brain to contract, which causes the muscle to relax. When used for cosmetic purposes, the muscle relaxation reduces the appearance of wrinkles, smoothing out the skin.

When treating medical conditions, blocking neurotransmitters and/or causing the muscle to relax is useful in a variety of ways depending on the condition. Muscle spasm conditions, such as blepharospasm, cervical dystonia, or upper lip spasticity, involve abnormal, and unpredictable contractions of the muscle. These spasms can lead to distressing and uncomfortable twitching or limb positioning. When Xeomin is injected into the treatment site, the treatment freezes the muscles responsible for the spasm, thereby eliminating the abnormal muscle activity. For conditions such as hyperhidrosis, which is a condition characterized by excessive sweating, Botox is used to block the neurotransmitters in the area of the body where severe sweating occurs, including underarms, hands, and feet. As a result, the sweat glands are disabled, preventing excessive sweating from occurring.

Xeomin vs Dysport vs Botox vs Revance Daxi

Botox, Xeomin, Dysport and Daxi all consist of the same ingredient, Botulinum toxin type A. This toxin is produced by the Clostridium botulinum bacteria. This neurotoxin works by blocking the neuromuscular signals to relax targeted muscles at the injection site. Since all of these neurotoxins act in the same fashion, they each effect similar cosmetic results. There are many different treatment options now available, besides Botox, for cosmetic injection. Some physicians or patients may prefer one type over the other. They have similar duration of treatments with Revance Daxi lasting a bit longer, and similar side effect profile.

What is the cost of Xeomin?

The cost of Xeomin varies based on the amount of neurotoxin injected and the experience of the cosmetic injector. The size and scope of the treatment area determines the number of units of injector are necessary to treat area or condition. The more units necessary for treatment or the more treatment areas there are, the more expensive the procedure will be. The institution at which you are receiving treatment is also a factor in determining the price of treatment. A board certified cosmetic dermatologist may be more expensive than a nurse injector in a clinic or spa. In order to have the best cosmetic results with the least amount of potential side effects, it is always best to consult an expert cosmetic injector, like Dr. Michele Green.

When you have your initial consultation with Dr. Green, you will determine which areas are to be treated with Xeomin injections for best cosmetic results related to your goals. After that assessment has been made, Dr. Green’s office will be able to provide you with a nearer estimate of the cost of your treatment.

How long does it take for Xeomin to work?

In NYC, we understand that our patients are constantly on the go, and seek cosmetic treatments that work quickly and effectively to give them their desired look. So, how much time or how long is required for Xeomin to take effect? Results are typically apparent in just a few days, and a standard Xeomin treatment can have lasting results for up to six months.

The process for Xeomin injectable treatment is easy and painless. On average, a Xeomin treatment appointment takes around 10 minutes, and most patients experience little to no discomfort as the Xeomin is injected into the planned injection site. Patients can immediately return to normal activity after treatment, though some patients may experience slight bruising, as is a risk with any injectable treatment. Nevertheless, the majority of patients have virtually no downtime and are able to enjoy long-lasting results.

After treatment, the only recommendations are simply not to lie down on the injection site for approximately 4 hours following treatment, and to avoid deep massage of the treatment area for two days. After Xeomin treatment, washing your face and applying make-up are a-ok, unlike some other cosmetic treatments.

Xeomin treatments, quite similarly to Botox and other neuromodulators, should not be administered more frequently than every three months. For optimal results, additional treatments can take place every 3-6 months, though Dr. Green will recommend a tailored skincare plan depending on your individual needs.

How long does Xeomin last?

Following the Xeomin injection procedure, the effects of the treatment can be seen starting as soon as five days following the injections. The onset of the effects of Xeomin occurs faster than the onset of the effects of Botox, which can take 7 to 14 days to show full effect, as a result of the lack of preservative proteins in Xeomin. The pure form of the Botulinum toxin present in Xeomin allows Xeomin to interact with the muscles immediately. With Botox, on the other hand, the body needs to break down the preservative protein before the treatment can take effect.

Clinical trials have also demonstrated that Xeomin has the ability to last longer than Botox. While the effects of Botox last for three to four months, Xeomin has been shown to be effective for nearly twice that amount of time – up to six months. While Xeomin has been shown to last longer, the Journal of Dermatology Surgery published a study that demonstrated that for the length of time during which both treatments were active, they showed similar effectiveness.

Both Xeomin and Botox can be repeated when the effects begin to wear off, which is approximately every 3 to 6 months. While Botox can be repeated, however, some patients find that their bodies build an immunity to the preservative proteins found in the treatment. As a result, over time, Botox becomes less and less effective. The same has not been true for Xeomin treatment. As Xeomin does not contain any preservative proteins, the body does not build immunity to the treatment. Thus, Xeomin is a great option for patients who have started to build an immunity to Botox treatment. Not only are the effects of Xeomin longer lasting, the treatment itself can be repeated for longer than Botox.

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How many units of Xeomin do I need?

Before diving in to the question of how many units of Xeomin do I need?, it’s important to remember that Xeomin treatments are unique depending on the facial structure of each patient, as well as any aesthetic goals. Plus, the dosage amounts will be adjusted depending on the muscle mass and gender of the patient, as men typically require a higher dosage due to naturally larger muscle size. An experienced healthcare provider like Dr. Michele Green is your best resource to figure out how many units of Xeomin will be best for your needs.

However, there are certain unit ranges that are common when it comes to different areas or muscle groups in the face. If you’re wondering how many units of Xeomin for the forehead or other areas should be used, you can refer to this list of standard units of Botox as a comparative guide, and here is an additional Xeomin-specific guide below:

  • Forehead: 10- 30 units
  • Canthal Lines (“Crow’s feet”): 5-15 units
  • Glabellar Lines (“11” lines): 10-20 units; Typically, 20 units is recommended for glabellar lines in a session, which is then divided into five intramuscular injections of 4 units each.

Again, when determining how many units of Xeomin is best for you, it is critical to consult with an experienced healthcare provider, like Dr. Green in NYC.

What is the difference between Botox and Xeomin?

Xeomin and Botox are similar in that they share botulinum toxin as their active ingredient, but they differ in their formula and in some of their uses. Botox, made by Allergan, has been FDA approved since 2002 and relies on accessory proteins, which are unnecessary for the function of the active ingredient. This leads to some variation in use, and a distinction in the effectiveness overall.

While Xeomin and Botox both are commonly used to treat fine lines and wrinkles, including forehead lines, “crow’s feet”, and severe frown lines, Botox can unfortunately lose effectiveness with some patients over the course of multiple applications, due to antibody resistance that can be amplified by accessory proteins. Further, Xeomin typically shows results sooner and is longer lasting than Botox, though sometimes this variation in longevity is only by a few weeks.

Xeomin is uniquely FDA approved to treat excessive drooling or salivation. Additionally, Botox can be used to prevent migraines, limit sweating, or help to treat an overactive bladder. As these injectables have some potential side effects or can cause allergic reaction in rare cases, it is imperative that both be provided by an expert, board certified cosmetic dermatologist, like Dr. Michele Green in New York.

Does Xeomin last as long as Botox?

Though the dermatology world was once thrilled by the long-lasting results of Botox — about 3-4 months — some studies have shown that Xeomin can last up to twice as long as a standard Botox treatment, giving you up to six months of relaxed, younger looking skin.

If you’re considering either Xeomin or Botox treatments, it’s important to commit to trying one treatment at a time, as botulinum neurotoxin products are not intended to be combined without ample recovery time between sessions. Dr. Green will be able to work with you to determine which treatment is best for you, and to create a treatment schedule that safely and effectively meets your needs.

Is Xeomin as good as Botox?

When patients ask, is Xeomin better than Botox, the answer is not straightforward. Xeomin and Botox are both extremely effective treatments cosmetically to reduce the appearance of dynamic wrinkles on the face and medically to treat a variety of conditions such as muscle spasticity across the body. Neither treatment is inherently “better” than the other but depending on the medical condition or particular cosmetic need, one may work better than the other to treat your specific needs.

When it comes to treating fine lines and wrinkles on the face, both Xeomin and Botox are FDA approved to treat frown lines that appear between the eyes as well as other dynamic facial wrinkles. Botox has also been specifically FDA approved to treat forehead lines and crows feet, though Xeomin can be used as an off-label treatment for these wrinkles as well. While both Xeomin and Botox are extremely effective in their results, Xeomin has been shown to be faster acting and to last longer than Botox. Additionally, patients may develop an immunity to the preservative proteins found in Botox, rendering the treatment ineffective over time. For those patients, Xeomin is the better option for longterm treatment.

Medically, both Xeomin and Botox are approved to treat muscle spasms in the neck, eyelids, and upper lip, however, there are medical conditions for which each is uniquely approved to treat. Xeomin is FDA approved to treat excessive drooling in both adults and children but Botox is not. For patients struggling with that condition, Xeomin is the better treatment option. Botox, on the other hand, is uniquely FDA approved to treat overactive bladder, chronic migraines, and excessive sweating. For that reason, Botox is the better treatment option for those treatments.

When you have your initial consultation with Dr. Green, she will be able to determine which treatment option is best for you. After examining the treatment area and discussing your medical history, Dr. Green will be able to recommend either Botox or Xeomin depending on your unique treatment needs.

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Side effects of Xeomin in cosmetic procedures

Due to the nature of neurotoxins, there are some common possible side effects which can occur. Common side effects of Xeomin are temporary and include:

  • Redness from injection
  • Bruising at the site of injection
  • Swelling
  • Temporary eyelid ptosis (drooping eyelids) or asymmetry

More uncommon side effects of Xeomin treatment that occur in 2-7% of patients include:

  • Dry Eyes
  • Dry mouth
  • Headache
  • Muscle Weakness
  • Respiratory Tract Infection
  • Trouble swallowing
  • Vision impairment

More serious side effects that can occur include blurred vision, drooping eyelids, double vision, and allergic reactions. When it comes to cosmetic injectable treatments such as Xeomin, it’s crucial to have up-to-date medical history information given to your treatment provider. If you experience any breathing problems, wheezing, hoarseness, change of or loss of voice, loss of muscle strength, loss of bladder control, or a severe rash, you should seek medical advice as soon as possible. Trouble breathing is often the first sign of an allergic reaction and medical help should be sought immediately. For complete prescribing information refer to Xeomin aesthetics.

Furthermore, you should alert your doctor if your medical history includes any of the following:

  • Bleeding problems
  • Breathing problems, such as asthma, emphysema, or a history of pneumonia
  • Diabetes
  • Dysphagia or difficulty swallowing
  • Eye problems (such as glaucoma) or recent eye surgery
  • Inability to urinate
  • Muscle or nerve disorders, such as Lambert-eaton syndrome, amyotrophic lateral sclerosis (known as Lou Gehrig’s disease or ALS) or myasthenia gravis
  • Treatment with any other neuromodulator products within the last 4 months

Side effects in medical indications for Xeomin

Certain side effects are dependent on what treatment is for; generally, cosmetic Xeomin treatment typically has far fewer potential side effects than medical treatment, and side effects are usually related to the injection site:

  • For those who are dealing with chronic sialorrhea (excessive drooling), there is a risk of necessary dental extraction, diarrhea, and high blood pressure.
  • For those treating upper limp spasticity, there is a risk of nasal congestion, upper respiratory infection, and seizure.
  • For those facing cervical dystonia, treatment may have side effects such as difficulty swallowing, injection site pain, muscle weakness, muscle pain, and neck pain
  • For those treating blepharospasm, common side effects include drooping of the eyelid, dry eye, and vision problems.

In rare cases, botulinum toxin can have adverse effects if it spreads from the injection area, including but not limited to paralysis, respiratory failure, and even death. Because of these risks, a medical professional should always be relied upon for proper injection and accurate dosage.

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Is Xeomin safe?

Xeomin is a safe and effective treatment for eliminating glabellar lines and improving symptoms for a variety of medical conditions characterized by muscle spasms and abnormalities. Xeomin can offer much needed relief from these medical conditions and provide you with the youthful, smooth skin you desire. The treatment is safe for patients to undertake and usually only results in mild side effects that go away quickly on their own, such as bruising, redness, and swelling at the injection site.

The risk of developing more serious side effects can arise when you receive treatment from a less experienced practitioner. The Xeomin treatment is quick and easy to perform but does require exact precision to eliminate the risk of the Botulinum toxin spreading to other areas of the body. Severe side effects can include vision impairment, difficulty breathing, loss of bladder control, and difficulty swallowing. For that reason, it is imperative that you receive Xeomin treatment from an expert, experienced, board-certified dermatologist such as Dr. Michele Green. The risk of developing serious side effects is greatly reduced when you seek treatment from an expert.

Is it Safe to Use Xeomin while Pregnant?

If you are pregnant or breastfeeding, it is best to avoid use of Xeomin or any other botulinum neurotoxin product, as it is unknown whether Xeomin passes on either through the placenta or through breast milk. If you are pregnant or nursing but seeking treatment for fine lines and wrinkles or a medical condition, be sure to disclose that information to Dr. Green during your initial consultation.

Drug Interactions with Xeomin

Xeomin does have some unfortunate interactions with certain medications, including but not limited to:

  • Aminoglycosides, which are a variety of antibiotic
  • Anticholinergics, which inhibits abnormal nerve impulses
  • Anticoagulants, which prevents blood clots
  • Alzheimer’s disease drugs
  • Muscle relaxants
  • Myasthenia gravis drugs
  • Quinidine, which is used to prevent irregular heartbeats

If you are currently taking any of the above medication, or are experiencing a skin infection on the planned injection site, it is best to hold off on any Xeomin treatments.

How many units of Xeomin for forehead?

Typically, patients require between 10 and 30 units of Xeomin to treat dynamic wrinkles in the forehead. The exact number of units necessary depends on several factors, including the size of the patient’s forehead and muscles, as well as the severity of the wrinkles. During your initial consultation, Dr. Green will assess the treatment area and be able to make a clearer estimate on the number of units necessary for the treatment.

How much is Xeomin per unit?

The cost of Xeomin per unit is dependent on several factors including geographic location and the type of institution at which you are receiving treatment. While the number of units necessary for treatment is necessary for calculating the total cost of the treatment, there are many other variables that contribute to the overall price. When you go into Dr. Green’s office for your consultation, her office will be able to make a better estimate of the price based off of Dr. Green’s assessment of your treatment area.

How to pronounce Xeomin?

It can be difficult to discern the way in which Xeomin should be pronounced by looking at the spelling. In this case, the “X” in “Xeomin” is pronounced as if the word started with a “Z” and you pronounce all of the vowels in the word. As such, the word is pronounced “Zee-OH-min.”

How do I get started with Xeomin treatments?

Dr. Michele Green is an expert when it comes to Xeomin® and other cosmetic injectables and dermal filler treatments. With over 25 years of cosmetic experience with Botox, Xeomin, Juvederm, Restylane, Sculptra, skin care, and laser treatments, Dr. Green will provide you with a customized treatment plan to fully rejuvenate your skin and give you the best cosmetic results. To schedule a consultation with Dr. Green in her NYC private boutique office and to learn more about smoothing out unwanted fine lines and wrinkles call the office at 212-535-3088 or contact us online to learn more about whether Xeomin may be right for you.

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