What Is Xeomin?
Xeomin (incobotulinumtoxinA) is an FDA-approved injectable neurotoxin manufactured by Merz Pharmaceuticals. Like Botox and Dysport, Xeomin temporarily relaxes facial muscles to smooth wrinkles. It received FDA approval in July 2010 for the treatment of glabellar lines (frown lines between the eyebrows) in adults.
What sets Xeomin apart from every other neurotoxin is its purification process. Xeomin is the only botulinum toxin product that has been purified to remove all complexing proteins — the extra bacterial proteins that surround the active toxin molecule in Botox and Dysport. This is why Xeomin is called the “naked toxin” or “naked Botox” — it delivers only the pure, active 150 kDa neurotoxin molecule with nothing extra attached.
Pronunciation: ZEE-oh-min (rhymes with “see-oh-min”).
The simple version: Xeomin is essentially Botox without the extra proteins. Same active ingredient (botulinum toxin type A), same mechanism, same 1:1 unit dosing, same results — but with a purer formulation that may reduce the risk of your immune system developing resistance over time. And it typically costs 15-25% less.
The “Naked Toxin” Explained
To understand why Xeomin's purity matters, you need to understand how neurotoxins are manufactured:
All botulinum toxin products start as a complex produced by Clostridium botulinum bacteria. This raw complex contains the active neurotoxin molecule (the part that actually relaxes muscles) surrounded by non-toxic associated proteins (NAPs) — bacterial proteins that naturally cluster around the toxin. Think of it like a pearl inside an oyster: the pearl is the active toxin, and the oyster shell is the complexing proteins.
Molecular Size Comparison
900 kDa
Botox
Active toxin + large protein complex
500 kDa
Dysport
Active toxin + smaller protein complex
150 kDa
Xeomin
Pure active toxin only — no extra proteins
kDa = kilodaltons (unit of molecular weight). Smaller = purer.
Why Does Purity Matter?
- Reduced antibody risk: Your immune system can develop antibodies to the complexing proteins in Botox and Dysport, potentially making them less effective over time. Since Xeomin has no foreign proteins beyond the active molecule, there are theoretically fewer targets for your immune system to attack.
- No refrigeration needed: Without proteins that can denature, Xeomin is stable at room temperature before opening (Botox must be refrigerated). This doesn't affect you as a patient, but it's a practical advantage for clinics.
- Cleaner formulation: For patients who prefer minimalist approaches to what goes into their body, Xeomin delivers only the essential active ingredient.
- Same efficacy: Multiple clinical studies (including the landmark NEUROTOX study) have demonstrated that Xeomin produces equivalent clinical results to Botox at the same dosing.
The antibody debate: While the theoretical advantage of Xeomin's purity is well-established, clinically significant antibody resistance to Botox remains uncommon at cosmetic doses (it's more relevant in therapeutic applications using 200+ units). However, for patients who treat frequently, use higher doses, or plan to use neurotoxins for decades, the reduced immunogenicity of Xeomin provides a meaningful long-term safety advantage.
Xeomin vs Botox: Complete Comparison
| Feature |
Xeomin |
Botox |
| Generic name | IncobotulinumtoxinA | OnabotulinumtoxinA |
| Manufacturer | Merz Pharmaceuticals | Allergan / AbbVie |
| FDA approved | 2010 | 2002 (cosmetic) |
| Complexing proteins | None (“naked”) | Yes (900 kDa complex) |
| Active molecule size | 150 kDa | 150 kDa (within 900 kDa complex) |
| Unit conversion | 1 : 1 (identical dosing) |
| Onset | 3-5 days | 5-7 days |
| Duration | 3-4 months | 3-6 months |
| Spread / diffusion | Moderate (similar to Botox) | Moderate |
| Cost per unit | $8-$12 (15-25% less) | $10-$15 |
| Refrigeration required | No (before opening) | Yes |
| Antibody resistance risk | Lower (fewer foreign proteins) | Higher (more foreign proteins) |
| Allergy concerns | None specific | Human albumin sensitivity |
| Loyalty program | Xperience+ (Merz) | Alle (Allergan) |
| Clinical efficacy | Equivalent (proven in head-to-head studies) |
The switching advantage: Because Xeomin and Botox use the
same 1:1 unit ratio, switching between them is completely straightforward — unlike switching to/from
Dysport (which requires a 2.5-3:1 conversion). If you currently get 20 units of Botox in your frown lines, you get 20 units of Xeomin. Same dose, same results, typically lower cost.
Treatment Areas & Units
Xeomin uses the same unit system as Botox (1:1 conversion), making it easy to understand dosing if you're familiar with Botox. Here are the most common treatment areas:
Frown Lines (Glabella / 11s)
Units: 20 (FDA-approved dose)
Botox equivalent: 20 units
Cost: $160-$300
Duration: 3-4 months
FDA approved: Yes (primary indication)
Forehead Lines
Units: 10-30
Botox equivalent: 10-30 units
Cost: $80-$360
Duration: 3-4 months
Note: Always treat with glabella to prevent brow drop
Crow's Feet
Units: 12-24 per side
Botox equivalent: 12-24 per side
Cost: $96-$288 per side
Duration: 3-4 months
Injection points: 3-4 per side
Bunny Lines (Nose)
Units: 4-10
Botox equivalent: 4-10 units
Cost: $32-$120
Duration: 3-4 months
Injection points: 1-2 per side
Masseter / Jaw Slimming
Units: 25-50 per side
Botox equivalent: 25-50 per side
Cost: $400-$1,200
Duration: 4-6 months
Also treats: TMJ, bruxism (teeth grinding)
Lip Flip
Units: 2-6
Botox equivalent: 2-6 units
Cost: $16-$72
Duration: 2-3 months
Result: Subtle upper lip eversion
Neck Bands (Platysma)
Units: 20-50
Botox equivalent: 20-50 units
Cost: $160-$600
Duration: 3-4 months
Also called: “Nefertiti lift”
Brow Lift
Units: 2-5 per side
Botox equivalent: 2-5 per side
Cost: $32-$120
Duration: 3-4 months
Placement: Lateral brow tail
Gummy Smile
Units: 2-4
Botox equivalent: 2-4 units
Cost: $16-$48
Duration: 3-4 months
Target: Levator labii superioris
Full Upper Face: Units Summary
| Area |
Xeomin Units |
Botox Units |
Dysport Units |
Xeomin Cost |
| Frown lines | 20 | 20 | 50 | $160-$240 |
| Forehead | 10-30 | 10-30 | 30-80 | $80-$360 |
| Crow's feet (both) | 24-48 | 24-48 | 48-120 | $192-$576 |
| Full upper face | 54-98 | 54-98 | 128-250 | $432-$1,176 |
How Fast Does Xeomin Work?
Day 2-3
First signs of effect. Some patients notice subtle reduction in muscle movement. Xeomin's lack of complexing proteins may allow slightly faster binding to nerve receptors compared to the larger Botox complex.
Day 3-5
Noticeable improvement. Wrinkles are visibly softened. Most patients can see a clear difference by day 5. This is slightly faster than Botox (5-7 days) but slower than Dysport (24-48 hours).
Day 7-10
Strong results. Wrinkle reduction is significant. Muscle relaxation is well-established across the treated area.
Day 14 (2 Weeks)
Full results. Maximum wrinkle reduction is achieved. This is the ideal time for your follow-up appointment to assess symmetry and determine if a touch-up is needed.
Month 2-3
Peak period. Results are stable and you're enjoying your smoothest appearance.
Month 3-4
Gradual return of muscle movement. Schedule your next treatment before full movement returns for best cumulative results.
How Long Does Xeomin Last?
Xeomin results typically last 3-4 months, which is comparable to Botox. Studies have shown equivalent duration between the two products at the same dosing. Some patients report that with consistent retreatment over 12+ months, results may begin lasting 4-5 months as the treated muscles gradually weaken from reduced use.
| Treatment Area |
Duration |
Notes |
| Frown lines | 3-4 months | Consistent across clinical trials (NEUROTOX study) |
| Forehead | 3-4 months | May wear off slightly faster in patients with strong frontalis |
| Crow's feet | 3-4 months | Reliable and consistent |
| Masseter | 4-6 months | Higher doses in thick muscle = longer duration |
| Lip flip | 2-3 months | Shortest duration (high movement area, low dose) |
| Neck bands | 3-4 months | Variable depending on muscle thickness |
How Much Does Xeomin Cost?
Xeomin is one of the most cost-effective neurotoxins, typically priced 15-25% below Botox. Since it uses the same 1:1 unit ratio, the savings are straightforward:
| Treatment Area |
Units |
Xeomin Cost ($8-$12/unit) |
Botox Cost ($10-$15/unit) |
You Save |
| Frown lines | 20 | $160-$240 | $200-$300 | $40-$60 |
| Forehead | 20 | $160-$240 | $200-$300 | $40-$60 |
| Crow's feet (both) | 24-48 | $192-$576 | $240-$720 | $48-$144 |
| Full upper face | 64-88 | $512-$1,056 | $640-$1,320 | $128-$264 |
| Masseter (both) | 50-100 | $400-$1,200 | $500-$1,500 | $100-$300 |
Annual savings add up: If you treat your full upper face 3-4 times per year, switching from Botox to Xeomin could save
$400-$1,000+ annually — with equivalent clinical results. That's enough to add a lip flip, brow lift, or even a syringe of
lip filler to your treatment plan.
Xperience+ Rewards: Merz Aesthetics offers the Xperience+ loyalty program for Xeomin, Radiesse, and Belotero patients. Earn points on every treatment redeemable for discounts. Additionally, many providers offer first-time Xeomin discounts or Botox-to-Xeomin switching specials.
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All 5 Neurotoxins: Where Xeomin Fits
Here's how Xeomin compares to all five FDA-approved neurotoxins, with Xeomin's advantages highlighted:
| Feature |
Xeomin |
Botox |
Dysport |
Jeuveau |
Daxxify |
| Manufacturer | Merz | Allergan | Galderma | Evolus | Revance |
| FDA year | 2010 | 2002 | 2009 | 2019 | 2022 |
| Complexing proteins | None | Yes | Yes | Yes | Yes (peptide) |
| Molecular weight | 150 kDa | 900 kDa | 300-500 kDa | 900 kDa | 150 kDa + peptide |
| Unit ratio to Botox | 1 : 1 | 1 : 1 | 2.5-3 : 1 | 1 : 1 | ~0.5 : 1 |
| Onset | 3-5 days | 5-7 days | 24-48 hours | 2-3 days | 24-48 hours |
| Duration | 3-4 months | 3-6 months | 3-4 months | 3-4 months | 6-9 months |
| Cost per unit | $8-$12 | $10-$15 | $3-$5 | $8-$12 | $12-$20 |
| Refrigeration | Not required | Required | Required | Required | Required |
| Antibody risk | Lowest | Moderate | Moderate | Moderate | Lower |
| Allergy concerns | None specific | Human albumin | Cow's milk | Human albumin | None specific |
| Loyalty program | Xperience+ | Alle | ASPIRE | Evolus Rewards | RHA Rewards |
| Best for | Long-term users, cost savings, purity | Versatility, established brand | Fast onset, large areas | Budget option, younger patients | Longest lasting |
Xeomin's unique position: Among the five neurotoxins, Xeomin occupies a distinct niche as the purest formulation with the lowest antibody risk, no specific allergy concerns, and a price point below Botox. It's particularly compelling for long-term patients (10+ years of treatments), patients who notice Botox becoming less effective, and cost-conscious patients who don't want to compromise on results.
Side Effects & Risks
Xeomin's side effect profile is virtually identical to Botox, since the active molecule is the same. The key difference is that Xeomin's purified formulation may produce fewer allergic or immune-mediated reactions.
Common Side Effects (Mild, Temporary)
- Injection site pain: Brief stinging during injection, mild tenderness for hours afterward
- Headache: Most commonly reported side effect in clinical trials (~5%); usually mild, resolving within 24-48 hours
- Bruising: Occurs in 10-20% of treatments, lasting 3-7 days
- Swelling: Mild swelling at injection points, resolving within 24 hours
- Redness: Temporary redness at injection sites
Less Common Side Effects
- Eyelid drooping (ptosis): 1-3% of patients; resolves in 2-4 weeks
- Brow asymmetry: One brow may respond differently; correctable with touch-up
- Dry eyes: Temporary, especially when treating crow's feet area
- Flu-like symptoms: Occasionally reported in the first 24-48 hours
Serious risks (rare): As with all botulinum toxin products, there is a remote risk of toxin spreading beyond the injection site. Symptoms may include difficulty swallowing, breathing problems, generalized muscle weakness, and vision changes. These are extremely rare at cosmetic doses and require immediate medical attention. Xeomin is contraindicated in patients with known hypersensitivity to botulinum toxin type A. Unlike Dysport, Xeomin has no cow's milk protein allergy contraindication.
Aftercare Instructions
DO (First 24-48 Hours)
- Gently exercise treated muscles for 1-2 hours to promote uptake
- Stay upright for at least 4 hours after treatment
- Apply a cold compress to reduce swelling or bruising
- Resume normal gentle daily activities
- Use sunscreen and sun protection daily
- Take acetaminophen (Tylenol) for any mild discomfort
DON'T (First 24-48 Hours)
- Rub, press, or massage the treated areas
- Lie down flat for 4 hours post-treatment
- Exercise strenuously for 24-48 hours
- Drink alcohol for 24 hours
- Take NSAIDs (ibuprofen, aspirin) — increases bruising
- Wear tight headwear that presses on treated areas
- Get facials, peels, or laser treatments for 2 weeks
Am I a Good Candidate for Xeomin?
Xeomin Is Ideal For
- Long-term neurotoxin users who want to minimize antibody resistance over years/decades of treatment
- Patients switching from Botox who notice diminishing results (possible antibody formation)
- Cost-conscious patients who want Botox-equivalent results at 15-25% lower cost
- Patients with sensitivities to additives, preservatives, or complexing proteins
- Anyone with cow's milk allergy who cannot use Dysport
- Patients who prefer a minimalist, purest-form approach to injectables
- Anyone who wants a neurotoxin with no specific allergy contraindications
- Adults 18+ with moderate to severe dynamic wrinkles
Who Should NOT Get Xeomin
- Patients with known allergy to botulinum toxin type A
- Pregnant or breastfeeding women
- Those with neuromuscular disorders (myasthenia gravis, Lambert-Eaton, ALS)
- Patients with active skin infections at injection sites
- Those taking aminoglycoside antibiotics or other neuromuscular blocking agents
Frequently Asked Questions
What is Xeomin?
Xeomin (incobotulinumtoxinA) is an FDA-approved injectable neurotoxin by Merz Pharmaceuticals. It's the only botulinum toxin product purified to remove all complexing proteins — known as the "naked toxin." It works the same as Botox (blocking nerve signals to relax muscles), uses the same 1:1 unit dosing, and produces equivalent results. FDA-approved in 2010 for frown lines.
What is the difference between Xeomin and Botox?
The main difference is purity: Xeomin has no complexing proteins (150 kDa molecule), while Botox contains a 900 kDa protein complex. Both use the same active ingredient at a 1:1 unit ratio with comparable results and duration (3-4 months). Xeomin is 15-25% cheaper, doesn't require refrigeration, has a slightly faster onset (3-5 days vs 5-7 days), and carries a lower risk of antibody-mediated resistance over time.
How much does Xeomin cost?
Xeomin costs $8-$12 per unit, typically 15-25% less than Botox ($10-$15/unit). Treatment costs: frown lines $160-$240 (20 units), forehead $80-$360, crow's feet $192-$576 (both sides), full upper face $432-$1,176. Over a year of quarterly treatments, switching from Botox to Xeomin can save $400-$1,000+. The Xperience+ loyalty program offers additional rewards.
How long does Xeomin last?
Xeomin lasts 3-4 months, comparable to Botox. Duration varies by area: frown lines and forehead 3-4 months, crow's feet 3-4 months, masseter 4-6 months, lip flip 2-3 months. With consistent retreatment over 12+ months, some patients find results lasting longer as muscles gradually weaken. Factors affecting duration include metabolism, muscle strength, dosage, and lifestyle.
How fast does Xeomin work?
Xeomin begins working within 3-5 days, which is slightly faster than Botox (5-7 days) but slower than Dysport (24-48 hours). Some patients notice initial effects at day 2-3. Full results are visible at 2 weeks. The slightly faster onset may be related to Xeomin's smaller molecular size allowing faster nerve receptor binding.
Is Xeomin better than Botox?
Xeomin is better in specific scenarios: lower cost (15-25% savings), reduced antibody resistance risk (no complexing proteins), no specific allergy contraindications, and no refrigeration needed. Botox may be preferred for its longer track record, broader FDA-approved indications, and the Alle rewards program. Clinical results are equivalent — multiple head-to-head studies confirm identical efficacy at the same dosing.
What does "naked toxin" mean?
It refers to Xeomin's purification that removes all complexing proteins (non-toxic associated proteins) from the botulinum toxin molecule. Botox contains a 900 kDa complex; Xeomin delivers only the 150 kDa active molecule — "naked" of extra proteins. Benefit: fewer foreign proteins means less immune response and lower risk of your body developing antibodies that reduce treatment effectiveness over time.
What are the side effects of Xeomin?
Side effects are nearly identical to Botox: injection site pain, headache (~5%), bruising (10-20%), mild swelling, and redness — all temporary. Less common: eyelid drooping (1-3%), brow asymmetry, dry eyes. A potential advantage: Xeomin's pure formulation may cause fewer allergic/immune reactions. It has no cow's milk allergy contraindication (unlike Dysport) and no specific allergy concerns.
How many units of Xeomin do I need?
Xeomin uses the same units as Botox (1:1). Typical dosing: frown lines 20 units, forehead 10-30 units, crow's feet 12-24 per side, bunny lines 4-10, lip flip 2-6, masseter 25-50 per side, neck bands 20-50. Full upper face: 54-98 units total. If you know your Botox dose, your Xeomin dose is the same number.
Can I switch from Botox to Xeomin?
Yes — switching is straightforward because Xeomin and Botox use the same 1:1 unit ratio. Wait until your current treatment has worn off (3-4 months), then get the same number of units in Xeomin. Common reasons to switch: cost savings (15-25% less), declining Botox effectiveness (possible antibodies), preference for a purer formulation, or your provider recommends rotating products to prevent resistance.
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