Xeomin vs Botox: the “clean tox” question, answered by what’s in the vial

Read side by side, the two labels differ on one key line. Xeomin is made “without accessory proteins,” per its prescribing information, while Botox carries them. Both are botulinum toxin type A, both were dosed 1 to 1 in the head-to-head trial, and both settle by day 14 and hold about 3 to 4 months. In practice, the results look the same.

What’s in each vial

Botox Cosmetic is onabotulinumtoxinA, made by Allergan. Xeomin is incobotulinumtoxinA, made by Merz. Both are prescription drugs that block acetylcholine at the nerve-muscle junction, so the injected muscle relaxes and the skin over it stops creasing. Both carry the FDA’s boxed warning that the effect “may spread from the area of injection,” per the Botox Cosmetic label and the Xeomin label.

The difference is packaging at the molecular level. In Botox the 150 kDa toxin travels with a group of accessory proteins. Xeomin strips those away and ships the bare toxin. Merz’s label also states “Refrigeration of unopened vials is not required,” which is a real logistics difference and where much of the “purer” marketing comes from.

In summary: the same molecule, no accessory proteins, and no refrigeration needed before opening. Our approach with either, described on the Botox and neuromodulator page, is the same: we map the forehead, glabella, and crow’s feet, write the units down, and see you again at two weeks.

Does “clean” make a clinical difference?

A common claim is that accessory proteins raise the chance your immune system learns to block the toxin, so Xeomin is the safer long-term bet. The evidence for that is still thin. A 2018 review in Dermatologic Surgery found antibody-related loss of response is rare and that the relationship “is complex,” per Dover and colleagues. So far, the clinical meaning of the protein difference is unproven.

The same review also addressed spread. The idea that one brand “diffuses more” than another doesn’t hold up. Dover’s group concluded that diffusion “appears predominately, perhaps exclusively, dose dependent,” and that protein complexes “do not influence movement from injection site.” Where the toxin goes is decided by how much is injected and where, not by the brand name on the box.

Xeomin and Botox side by side

Feature	Botox	Xeomin
Drug	onabotulinumtoxinA	incobotulinumtoxinA
Accessory proteins	Yes	No
Refrigeration before mixing	Required	Not required for unopened vials
Dose in the head-to-head trial	1	1
Onset	A few days (about 5 in one trial)	A few days (about 3 in one trial)
Full effect	Day 14	Day 14
Lasts	About 3 to 4 months	About 3 to 4 months
Approved for	Frown lines, forehead lines, crow's feet, neck bands	Frown lines, forehead lines, crow's feet
Spread	Depends on dose	Depends on dose

Onset and how long each lasts

Both take a few days to start working. The American Academy of Dermatology puts onset “within 3 to 7 days,” per its botulinum toxin FAQ. A randomized trial by Rappl and colleagues found Xeomin starting at about 3 days versus about 5 for Botox in women, slower in men, and its authors concluded Xeomin was faster and lasted longer. Other trials haven’t confirmed that difference, so for both, expect onset within a few days and full effect at two weeks.

Duration is similar. The AAD says “about 3 to 4 months, and sometimes longer.” Botox’s own trial data show responder rates falling to 25 percent by day 120. Xeomin’s label doesn’t claim more. If you’d like a longer-acting product, the conversation to have is about Daxxify, which held a none-or-mild glabella result for a median of 24 weeks in its pooled trials, though as a median, that means half of patients got less.

What each label covers

This difference can affect your treatment plan. Botox Cosmetic is approved for glabellar lines, forehead lines, crow’s feet, and, since October 2024, platysma bands in the neck. Xeomin is approved for the three upper-face areas and not the neck. Everything else you’ll see on a menu (lip flip, masseter, gummy smile, chin, brow lift, under-eye) is off-label for both.

Off-label use is common in aesthetic practice. It means the injector is working from training rather than a trial protocol, and we’ll tell you before treating those areas.

Units, and why cost comes down to your plan

The Rappl trial dosed Xeomin and Botox 1 to 1 and Dysport at 3 to 1. In practice, most injectors treat a Xeomin unit like a Botox unit. Merz’s label is stricter: Xeomin units “cannot be converted into Units of any other botulinum toxin.” Both statements are true. The trial ratio is a helpful starting point, and your muscle pattern guides the rest.

That’s why “is Xeomin cheaper” doesn’t have a simple answer. We don’t quote by the unit for either brand. We price a plan on the areas and the dose your muscles need, not on which vial was opened. What affects the number is the same for both: number of areas, muscle strength (men and masseters need more), and whether a two-week touch-up is included. The Botox cost post goes through the per-unit math, and why a very low unit price is a good reason to ask about dilution.

What neither one can do

Toxin softens lines made by movement. It doesn’t fill a line that’s carved in at rest, lift, or change skin texture. If you have etched lip lines or a deep glabella fold at rest, that calls for a filler conversation, sometimes alongside toxin. Neither product works as well past 65: in Botox’s trials, day-30 responder rates were 39 percent in patients 65 and older versus 83 percent under 65.

Which one should you ask for?

Unless you have a reason to prefer one, go with the product your injector uses most. Good reasons include a previous good result with one brand, a labeled indication (neck bands mean Botox), or a personal preference for fewer proteins that you understand isn’t backed by outcome data. The same advice applies to men following the first-year Botox timeline.

If you’ve had Botox elsewhere and would like Xeomin here, bring your previous unit count if you have it. We’ll dose from your record and see you at day 14 either way.

Book your Botox or Xeomin consult

The appointment takes about fifteen minutes, and any small bumps at the injection sites fade shortly afterward. We’re near the Diversey Brown Line stop. Directions on getting to Lincoln Avenue are on the location page.

Your questions, answered

Is Xeomin cheaper than Botox?

Not in a way that changes your plan. The head-to-head trial dosed the two 1 to 1, so a treatment needs about the same amount of either. We price by the plan (areas treated and the dose your muscles need), not by the unit, and the plan costs the same whichever vial is opened. When you compare clinics, it helps to look at what the plan includes, such as a two-week touch-up, rather than a per-unit figure.

Does Xeomin kick in faster than Botox?

One randomized trial found Xeomin started at about 3 days and Botox at about 5 in women, with both slower in men. Other trials haven’t confirmed a difference. The American Academy of Dermatology gives 3 to 7 days for onset with either product, and the full effect is judged at day 14 for both.

Can I switch from Botox to Xeomin at my next visit?

Yes. They’re the same class of drug and the dose ratio in the head-to-head trial was 1 to 1. If you have your previous unit count, bring it along so your injector can start from a record. It’s best to wait until the previous treatment has worn off, usually 3 to 4 months, since dosing more often than every 3 months hasn’t been evaluated for Botox Cosmetic.

Does Xeomin spread more than Botox?

No. A 2018 evidence review concluded that diffusion depends on dose, not on brand or on the protein complex. If a treatment spreads into a nearby muscle, the cause is the amount injected and the placement, which is why your injector maps your muscles before drawing up either product.