Xeomin vs. Botox: Which Is Right for You?

Xeomin (incobotulinumtoxinA) and Botox (onabotulinumtoxinA) are two prescription drug brands used to correct facial wrinkles temporarily. They also have value in easing symptoms of certain health problems. Both drugs behave in the same way and provide similar results.

Xeomin and Botox use botulinum toxin type A, a byproduct of the bacterium Clostridium botulinum that is safe in small, controlled doses. Though both drugs contain the same main ingredient, they are prepared differently.

This article explains how these drugs work and their uses, dosages, and side effects.

Xeomin

Xeomin injectables primarily consist of the active ingredient incobotulinumtoxinA, a preparation of botulinum toxin type A. It is called a naked injectable, meaning the solution contains no additives.

Xeomin is injected into muscles or glands. It is administered in an in-office, minimally invasive cosmetic procedure. Because the effects of Xeomin are reversible and temporary, you must have regular treatments at periodic intervals to maintain the desired effect.

Uses

Xeomin is approved by the Food and Drug Administration (FDA) to improve the look of moderate to severe glabellar lines (frown lines between the eyebrows) in adults.

Xeomin is also used to treat the following non-cosmetic health conditions related to movement disorders:

• Sialorrhea (chronic drooling) in adults and children 2 to 17 years of age
• Increased muscle stiffness in the arm because of upper limb spasticity (uncontrollable movements of the arms) in adults
• Increased muscle stiffness in the arm in children 2 to 17 years of age with upper limb spasticity, excluding spasticity caused by cerebral palsy or chronic drooling
• Abnormal head position and neck pain with cervical dystonia (involuntary, painful spastic movement of the neck) in adults aged 18 and over
• Blepharospasm (abnormal spasm of the eyelids) in adults age 18 and over with prior Botox treatment
  

Dosage

Your healthcare provider determines the appropriate dosage of Xeomin. The total recommended dosage of Xeomin varies based on the condition being treated. The following dosages are recommended:

Glabellar lines: The recommended dose for glabellar lines is 20 units per treatment session, with the total dose divided into five equal intramuscular injections of 4 units each. The injection placement includes two injections in each corrugator muscle (eyebrow muscle) and one in the procerus muscle (the muscle between the eyebrows). The minimum recommended time between treatment sessions is three months.

Chronic sialorrhea: The recommended total dose for chronic sialorrhea is 100 units per treatment session, consisting of 30 units per parotid gland (major salivary gland) and 20 units per submandibular gland (salivary gland). The minimum recommended time between treatment sessions is 16 weeks.

Upper limb spasticity, cervical dystonia, and blepharospasm: Dosage is individualized for each patient's needs. Prior treatment and severity of symptoms are used to determine the optimum dose, frequency, and the number of injection sites in the treated muscle(s) for these conditions. The recommended doses include the following:

• Upper limb spasticity in adults: The recommended total dose is 400 units with a minimum of 12 weeks between doses.
• Upper limb spasticity in pediatric patients: The maximum recommended dose is 8 units/kg divided among the affected muscles up to a maximum dose of 200 units per single upper limb. Treatment involving both upper limbs should not exceed 16 units/kilogram (kg), up to a maximum of 400 units, with a minimum of 12 weeks between doses.
• Cervical dystonia: The recommended initial total dose is 120 units per treatment session, generally no more often than every 12 weeks, with the frequency based on clinical response.
• Blepharospasm: Initial dose based on initial Botox dose. The recommended starting dose is 1.25 units to 2.5 units per injection site. The initial dose should not exceed 70 units, with a maximum of 35 units per eye. The frequency should be no more than every 12 weeks.
  

Side Effects

Xeomin side effects vary by individual and the condition being targeted. Problems can range from mild to severe. The most common side effects include the following:

Glabellar lines:

• Headache

Chronic Sialorrhea:

• Tooth extraction
• Dry mouth
• Diarrhea
• High blood pressure (hypertension)

Upper Limb Spasticity:

• Seizure
• Nasopharyngitis (inflammation of the nasal passages, throat, and pharynx—the cavity behind the nose and mouth)
• Dry mouth
• Upper respiratory tract infection

Cervical Dystonia:

• Dysphagia (difficulty swallowing)
• Neck pain
• Muscle weakness
• Injection site pain
• Musculoskeletal pain

Blepharospasm:

• Eyelid ptosis (eyelid drooping)
• Dry eye
• Dry mouth
• Diarrhea
• Headache
• Visual impairment
• Dyspnea (shortness of breath)
• Nasopharyngitis
• Respiratory tract infection

Cost

The cost of Xeomin varies significantly, though its cost is comparable to Botox. Xeomin is measured and priced in units. According to the American Society of Plastic Surgeons, a typical cost is about $10 to $15 per unit.

The amount of Xeomin used, and the location of the treatment determines the price you pay. Other considerations like the expertise of the healthcare provider administering the treatment and the time and level of complexity involved can affect your cost. Prices can also vary by geographic location.

Generally, the cost of Xeomin is not covered by insurance for cosmetic treatments. The cost of Xeomin for medical conditions may be covered by insurance, depending on your plan.

Botox

Botox treats medical conditions ranging from blepharospasm (eye spasm) to migraine headaches. Another form of the product, Botox Cosmetic, is FDA-approved for cosmetic use, such as wrinkle reduction.

The drug sold under the brand name Botox is a time-tested medication that has been extensively studied. However, due to its longevity, the term "Botox" is often used to describe all brands of botulinum toxin type A injections.

Uses

Botox is FDA-approved to treat the following conditions:

• Urinary incontinence (unintentional loss of bladder control) due to overactivity of the detrusor (bladder muscle) associated with a neurologic condition (e.g., spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an anticholinergic medication
  
• Upper limb spasticity in adult patients
• Cervical dystonia in adult patients, to reduce the severity of abnormal head position and neck pain
• Severe axillary hyperhidrosis (excessive sweating) that topical agents inadequately manage in adult patients
• Blepharospasm associated with dystonia in patients who are 12 years or older
• Strabismus (misalignment of the eyes) in patients 12 years of age or older
• Prevention of headaches in adult patients with chronic migraines that occur on 15 or more days per month with headaches lasting four hours a day or longer

Botox Cosmetic is FDA-approved to treat the following cosmetic issues in adults:

• Moderate to severe glabellar lines
• Moderate to severe lateral canthal lines (lines along the sides of the eyes also known as crow's feet)
• Moderate to severe forehead lines

Dosage

Dosages for Botox are specific to the condition being treated. Adults treated for one or more conditions with Botox Cosmetic should not exceed 400 units in intervals of three months.

The recommended dosage of Botox Cosmetic includes the following:

Glabellar lines: The recommended dose for glabellar lines is 4 units per 0.1 mL injection for each of the five sites, for a total dose of 20 units.

Lateral canthal lines: The recommended dose is 4 units per 0.1 mL injection into each of three sites per side (six total injection points), for 24 total units.

Forehead lines; The recommended dose for forehead lines is 4 units per 0.1 mL injection in each of five forehead line sites (20 units) with 4 units per 0.1 mL injection in each of five glabellar line sites (20 units), for a recommended total of 40 units.

Adults who are being treated for one or more conditions with Botox should not exceed 360 units in intervals of three months. The recommended dosage for specific conditions includes the following:

Urinary incontinence: The recommended dose for urinary incontinence due to detrusor (bladder muscle) overactivity is 200 units, as 1 mL (about 6.7-unit) injections across 30 sites into the detrusor.

Chronic migraine: The recommended total dose for chronic migraine is 155 units, as 5 units per 0.1 mL injection per site divided across seven head/neck muscles.

Upper limb spasticity: The recommended dose for upper limb spasticity is based on the muscles affected, the severity of muscle activity, the initial response to treatment, and adverse event history.

Cervical dystonia: The recommended dose is based on the patient’s head and neck position, localization of pain, muscle hypertrophy, patient response, and adverse event history. A lower initial dose is advised for people without prior botulinum toxin treatment.

Axillary hyperhidrosis: The recommended dose for axillary hyperhidrosis is 50 units per axilla (armpit).

Blepharospasm: The recommended dose for blepharospasm is 1.25 units to 2.5 units into each of three sites per affected eye.

Strabismus: The recommended dose for strabismus is 1.25 units to 2.5 units initially in any muscle.

Side Effects

Botox side effects vary by individual and condition treated. The most common side effects of Botox Cosmetic include the following:

Glabellar lines:

• Eyelid ptosis (sagging)

Lateral canthal lines:

• Eyelid edema (eyelid swelling)

Forehead lines:

• Headache
• Brow ptosis (brow sagging)

The most common side effects of Botox for medical conditions include the following:

Urinary incontinence associated with a neurologic condition:

• Urinary tract infection (UTI)
• Urinary retention (not being able to empty your bladder fully)

Chronic migraine:

• Neck pain
• Headache

Spasticity:

• Pain in extremity

Cervical dystonia:

• Dysphagia
• Upper respiratory infection
• Neck pain
• Headache
• Increased cough
• Flu syndrome
• Back pain
• Rhinitis (inflammation and swelling of the nose's mucous membranes)

Axillary hyperhidrosis:

• Injection site pain and hemorrhage
• Non-axillary sweating (sweating that occurs in areas other than the armpits)
• Pharyngitis
• Flu syndrome 
  

Cost

The cost of Botox varies significantly based on a wide range of factors that include the expertise and qualifications of the person performing the treatment, the time and effort involved in administering the treatment, and your geographic location. Other factors such as the location of the treatment and your desired results, which can affect the amount of Botox used, can also affect cost.

Like Xeomin, Botox is measured in units, with a typical cost of about $10 to $15 per unit. Other costs may also be involved in the procedure.

Generally, the cost of Botox Cosmetic is not covered by insurance when it's intended to approve your appearance. The cost of Botox for medical conditions may be covered by insurance, depending on your plan.

How They Work

Xeomin and Botox work by causing temporary muscle weakness in the muscles treated with the drug. They do this by blocking chemical signals that cause muscles to contract. Without a signal, the muscle does not contract. The effect allows the treated muscle to remain relaxed.

In cosmetic applications, the skin above the treated muscle remains smooth and wrinkle-free. The effect can also relieve symptoms caused by uncontrolled muscle activity. These drugs are considered first-line treatment for symptoms that involve muscle spasms in certain medical conditions.

While Xeomin and Botox are similar, they should not be used together or interchangeably with other botulinum products.

Is Xeomin as Good as Botox?

Research shows that Xeomin and Botox have comparable efficacy and healing effects, with similar mechanisms of action. Botox and Xeomin are dosed similarly so that they have a clinical conversion of 1-to-1, meaning that 20 units of Xeomin are equivalent to the strength of 20 units of Botox.

The primary difference between Xeomin and Botox is in their formulation. The contents of Botox differ from those of Xeomin.

While Botox is purified with extra proteins, Xeomin only contains the active neurotoxin. It does not contain the complexing proteins that are contained in conventional botulinum neurotoxin type A drugs like Botox. The purity of Xeomin may mean that its formulation may reduce the risk of antibody-induced therapy failure in individuals where this is an issue.

Both drugs last about 12 weeks depending on the individual's needs. Your healthcare provider can help you determine which drug is most appropriate for your condition and treatment goals.

Summary

Xeomin and Botox are two drugs that use the same main ingredient, botulinum toxin type A. These drugs work by blocking the nerve messages that tell muscles to contract.

The effects of Xeomin and Botox are temporary and need retreatment to continue to work. Effects of both drugs last about 12 weeks, depending on personal response and the type of problem being treated.

While both drugs are safe, side effects can occur. Some side effects can be serious for some people. A healthcare provider can help you choose the right brand for your needs.