Xeomin vs Botox​: How do they compare?

Key Points

• Xeomin (incobotulinumtoxinA) and Botox (onabotulinumtoxinA) are injectable drugs that contain botulinum toxin type A as their active ingredient.
• Xeomin is available under one brand name, while Botox comes in two: Botox and Botox Cosmetic.
• Both medications work by temporarily blocking nerve signals to the muscles into which they are injected, causing muscles to relax.
• The formulation of Xeomin and Botox differs. Botox contains accessory proteins, while Xeomin offers a purified version without them.
• Xeomin may cost less than Botox.

Both Xeomin and Botox have become household names in the world of cosmetic and therapeutic treatments, offering solutions for those seeking to reduce facial wrinkles and address certain medical conditions. While these injectables share the same active component—botulinum toxin type A—they differ in formulation, cost, and potentially in their effects and longevity. Understanding these differences can help patients and clinicians make informed decisions about which product might be most suitable for specific needs and circumstances.

What Are Xeomin and Botox Used For?

While both Xeomin and Botox are well-known for their cosmetic applications in reducing facial wrinkles, their therapeutic uses extend far beyond aesthetics. Both products have received FDA approval for various medical applications, demonstrating their versatility as therapeutic agents. However, Botox is approved for more conditions compared to Xeomin.

Botox gained initial FDA approval for medical use in 1989, preceding its cosmetic approval in 2002. Its medical applications include:

• Treatment of overactive bladder
• Treatment of urinary incontinence due to a neurologic condition
• Treatment of neurogenic detrusor overactivity
• Prevention of migraine headaches
• Treatment of spasticity
• Treatment of cervical dystonia
• Treatment of excessive underarm sweating
• Treatment of blepharospasm
• Treatment of strabismus (crossed eyes)

Similarly, Xeomin has established itself as an effective option for many of the same medical conditions. It is FDA approved to treat:

• Chronic sialorrhea (excessive drooling)
• Upper limb spasticity
• Cervical dystonia
• Blepharospasm

Botox Cosmetic is FDA approved to temporarily improve the appearance of:

• Moderate to severe glabellar lines (frown lines)
• Moderate to severe lateral canthal lines (crow’s feet)
• Moderate to severe forehead lines
• Moderate to severe platysma bands (neck bands)

Cosmetic uses that Xeomin is FDA approved for include:

• Moderate to severe glabellar lines (frown lines)
• Moderate to severe forehead lines
• Moderate to severe lateral canthal lines (crow’s feet)

For patients suffering from chronic migraines, muscle spasticity, or other conditions requiring repeat treatments, the choice between these products may be influenced by factors beyond those typically considered for cosmetic use. Long-term efficacy, reduced immunogenicity, and consistent results across multiple treatment sessions may hold greater importance in the medical context than in purely cosmetic applications.

Composition and Formulation Differences

Xeomin and Botox both contain botulinum toxin type A as their active ingredient, but their formulations differ significantly in purity and structure. Xeomin (incobotulinumtoxinA) is distinguished by its "naked" formulation, containing only the pure 150 kDa neurotoxin without any accessory proteins. This makes Xeomin the first botulinum toxin of its kind to be free of complexing proteins. In contrast, Botox (onabotulinumtoxinA) contains the neurotoxin along with several complexing proteins that form a larger molecular complex.

Both products are derived from the same wild-type strain of Clostridium botulinum type A, giving them similar biological activity. The most significant difference between the two is that Xeomin's formulation as pure botulinum type A potentially reduces the chances of allergic reactions and antibody formation that can lead to treatment resistance.

Protein Load and Immunogenicity

A critical difference between these products relates to their protein content and potential for triggering immune responses. In some patients, antibodies form that block the pharmacological effects of the botulinum neurotoxin. This can cause these treatments to work less well.

Xeomin contains significantly less clostridial protein (approximately 0.6 ng per 100 units) compared to Botox (approximately 5 ng per 100 units). This reduced "protein load" with Xeomin may decrease the risk of neutralizing antibody development. In clinical studies of Xeomin that included 2649 patients, 0.3% of patients were positive for neutralizing antibodies after treatment.

The risk of developing antibodies appears to correlate with several factors, including the total protein concentration injected per treatment session. For patients requiring long-term treatment, this difference in immunogenic potential between the products could have significant implications for sustained efficacy. However, long-term comparative trials in treatment-naïve patients are still needed to definitively confirm Xeomin's purported lower immunogenicity.

How Fast Do Xeomin and Botox Work?

Patient experiences vary considerably when it comes to onset of action. In general, botulinum toxin treatment for medical conditions takes about 1-2 weeks to work.

• According to the manufacturer of Xeomin, the average time it takes to start working is within 2-7 days after injection.
• For cosmetic use, Botox Cosmetic starts working 1-2 days after injection to improve the appearance of forehead lines, frown lines, and crow’s feet. It can take 30 days to see the full results.
• In one study that included 180 patients, Xeomin worked faster and lasted longer compared to Botox Cosmetic for glabellar lines.

Related questions

• Does Masseter Botox work for TMJ and jaw slimming?
• How many units of Botox do I need and what will it cost?
• Daxxify vs Botox​: Which should you use?

How Long Do Xeomin and Botox Last?

Duration of effect is another important consideration for patients. Both treatments generally last between three to four months before requiring repeat injections. Each treatment should be spaced at least 3-4 months from each other, depending on the condition.

How Effective are Xeomin and Botox?

According to multiple studies, both products demonstrate comparable efficacy when used in equivalent doses, with Xeomin being exchangeable with Botox using a simple 1:1 conversion ratio. This means that 100 units of Xeomin generally produces effects similar to 100 units of Botox.

• One study found that at 1 month after treatment with either Xeomin or Botox Cosmetic, the two treatments were equivalent for glabellar frown lines. The effects were similar through 4 months after the injections were given, and patient satisfaction ratings were greater than 90% in both groups.
• Another study found Xeomin and Botox Cosmetic to be similarly effective for crow’s feet.
• A 2014 study showed Botox and Xeomin are equally effective for the treatment of blepharospasm.
• A 2005 study showed comparable efficacy and safety of Xeomin and Botox for the treatment of cervical dystonia.

How Does the Cost of Xeomin and Botox Compare?

Price is often a significant factor for patients choosing between treatment options. The American Society of Plastic Surgeons reports that an average botulinum toxin treatment is $435. According to recent pricing data, Xeomin generally costs less than Botox, providing a more economical option for those seeking neurotoxin treatments.

• Xeomin typically costs around $542 for 100 units
• Botox costs approximately $683 for 100 units
• Botox Cosmetic costs approximately $694 for 100 units

These prices are based on the Drugs.com Price Guide for Botox, Botox Cosmetic, and Xeomin.

Botox and Xeomin both offer a patient savings program, where eligible patients may pay as little as $0 for treatments.

Total treatment cost depends on several factors, including:

• Geographical location
• Provider cost
• Areas treated

Different facial regions require different amounts of product—treatments typically use 20 units for frown lines and 20-40 units for forehead wrinkles. These differences in recommended dosing can impact the final cost of a full facial treatment. According to the manufacturer of Botox Cosmetic, the average cost of treatment for forehead lines, frown lines, and crow’s feet is $400-$600.

When calculating the long-term financial impact, patients should also consider treatment frequency, as individual variation in duration of effect can influence the annual cost of maintaining results.

How Do the Side Effects of Xeomin and Botox Compare?

Xeomin and Botox cause similar side effects. Both medications have a Boxed Warning for the spread of toxin effect. This means that the medication can spread to areas outside of the injection area. Within hours to weeks after injection you may experience swallowing or breathing difficulties.

Injection site reactions from both medications are possible, and may include:

• Bruising
• Pain, tenderness, or stinging
• Swelling
• Redness
• Itching

Other side effects of Xeomin and Botox are mostly specific to where you get the injection. For example, facial treatments can cause short-term drooping eyelids and facial pain as side effects. Injections for excessive drooling can cause temporary dry mouth. Your healthcare provider can review all possible side effects and those most likely from your specific treatment.

Conclusion

Xeomin and Botox both contain botulinum toxin type A, but each has distinctive characteristics that may benefit different patient populations. Xeomin's pure formulation without complexing proteins potentially offers advantages for long-term treatment and for patients concerned about developing resistance. Its generally lower cost also provides a more accessible option for many patients seeking neurotoxin treatments.

Botox, with its longer market presence and widespread recognition, continues to serve as the standard against which other neurotoxin products are measured. Both products demonstrate comparable efficacy when administered at equivalent dosages, with individual variations in onset and duration that appear more related to patient factors than to fundamental differences between the products.

The choice between Xeomin and Botox should be individualized based on patient history, treatment goals, cost considerations, and provider expertise. As with any medical or cosmetic treatment, the decision should involve careful consideration of both benefits and potential risks, informed by scientific evidence and clinical expertise.