Xeomin vs Botox: Differences, Similarities, and Uses
Ask ten injectors which neurotoxin they prefer and you will hear eleven opinions. Patients care less about the brand name and more about results that look natural, move well, and last. Still, understanding how Xeomin and Botox differ helps you choose wisely, especially if you are planning a personalized botox cosmetic treatment for wrinkles or a medical indication like migraines or jaw clenching.
Both products relax targeted muscles by blocking acetylcholine at the neuromuscular junction. In the right hands, they soften lines, refine facial balance, and can relieve symptoms from conditions like TMJ or hyperhidrosis. The differences live in their formulation, handling, potential for antibody formation, and the way they settle in specific facial areas. Below, I break down how each performs in real practice, what I consider when picking one over the other, and how to calibrate expectations so your results match your goals.
What they are, in plain language
Botox Cosmetic (onabotulinumtoxinA) and Xeomin (incobotulinumtoxinA) are both type A botulinum neurotoxins. Think of the active toxin as the same core molecule. Botox includes complexing proteins around that core, while Xeomin is “naked” toxin without accessory proteins. The presence or absence of those proteins does not change the fundamental mechanism, but it can affect manufacturing stability, storage requirements, and possibly immunogenicity.
Botox is the brand most patients name when they ask about botox for forehead lines or botox for crow’s feet. Xeomin entered the market later, gained traction among practitioners who prefer a clean formulation, and has built a track record for consistent performance in cosmetic and therapeutic uses. In head-to-head practice, both work when dosed correctly and placed with precision.
How they compare in the real world
The fastest way to appreciate differences is to look at how each behaves across common concerns. Keep in mind that individual variability, injection technique, and dose matter as much as the label.
Onset and peak. Most patients feel the first softening from Botox or Xeomin within 2 to 4 days, with peak effect around day 7 to 14. Some report that Xeomin feels a touch slower to kick in during the first treatment, especially in strong muscles like the glabella, though plenty notice no difference at all. If you are preparing for an event, plan a 2 week buffer regardless of brand.
Duration. Typical duration falls in the 3 to 4 month range for both. High-movement areas, like lips for a lip flip botox or bunny lines on the nose, can wear off closer to 8 to 10 weeks. Areas with stronger muscles, like masseter botox for jawline slimming or TMJ, often hold 4 to 6 months when dosed appropriately. Repeat treatments can sometimes extend longevity as muscles decondition.
Spread and precision. Botox and Xeomin have similar diffusion profiles at equivalent units when injected at comparable volumes. The idea that one spreads more broadly than the other is overstated. Dilution, injection depth, and technique play a larger role. That said, some injectors prefer Xeomin for very precise work, like micro botox or treating tiny pullers near the lateral brow, because they find it a touch predictable in delicate areas.
Formulation purity. Xeomin lacks complexing proteins. For patients with prior exposure to multiple neurotoxins or those concerned about antibody formation, that purity is appealing. Botox’s complexing proteins have not been shown to reduce efficacy Sudbury, MA botox in typical cosmetic dosing, but theoretical differences in immunogenicity drive some clinicians to choose Xeomin in heavy users or therapeutic cases requiring high cumulative doses, like hyperhidrosis botox treatment.
Stability and storage. Both arrive as a lyophilized powder and require reconstitution. Xeomin can be stored unrefrigerated before reconstitution according to its labeling, which some clinics like from a logistics standpoint. After reconstitution, both are refrigerated and used within recommended time frames determined by the clinic’s policy and label guidance.
Where each shines for wrinkles and facial balance
Forehead lines. When patients ask for botox for forehead lines and want a natural, mobile brow, brand matters less than mapping forehead anatomy and balancing the glabella. Xeomin or Botox can deliver subtle botox results at doses ranging from about 8 to 20 units for a smaller forehead and 20 to 30 units for a larger or stronger frontalis. For baby botox forehead dosing, I often start at 6 to 10 units spread across more injection sites to keep movement while smoothing the canvas.
Frown lines. The glabella complex is powerful and can cause a chronic scowl that reads as tired or upset. Typical dosing ranges from 15 to 30 units. Both Xeomin and Botox soften the “11s” effectively. If a patient metabolizes quickly or clenches habitually, we might edge up to the higher end. A brow-lift effect is possible with careful dosing at the tail and mid-brow elevators, often called an eyebrow lift botox or non surgical brow lift botox.
Crow’s feet and smile lines. Lateral canthus lines respond well to both products. Most need 8 to 12 units per side. For botox for smile lines around the nose and perioral area, micro dosing with shallow placement is key to avoid smile asymmetry. Xeomin’s precision can be helpful here, but again, the injector’s technique is the main determinant.
Bunny lines, chin dimpling, and neck bands. These small pattern concerns benefit from light, targeted placement. Xeomin’s protein-free profile sometimes appeals to patients who are sensitive or those who report heaviness after prior treatments. For neck botox treating platysmal bands, both brands work, with units ranging widely based on the number of bands and their strength.
Facial slimming and masseter contouring. For jawline botox using the masseter, I care most about consistency and dose. Botox or Xeomin can both create a softer, more tapered lower face and reduce grinding. Typical dosing begins around 20 to 30 units per side, then titrates up based on bulk. For TMJ botox treatment or botox for teeth grinding, a medical diagnosis guides dosing and frequency, and many patients appreciate the dual benefit of pain relief and slimmer contours.
Lip flip and gummy smile. A subtle lip flip botox uses 2 to 6 units total in the orbicularis oris to roll the upper lip slightly outward. For gummy smile botox, a couple of units placed into levator muscles can reduce excessive gum show when smiling. These are finesse treatments with a short duration compared to larger muscle groups. Expect 6 to 8 weeks for the lip flip, sometimes a bit longer for gummy smile correction.
Medical and therapeutic uses beyond fine lines
Migraines. Botox is FDA approved for chronic migraine prevention at specific dosing patterns while Xeomin has evidence in the literature but lacks the same FDA indication in many regions. For migraines botox treatment, the standardized protocol includes 31 injections totaling 155 units across the head and neck. Patients see benefit after 2 to 3 cycles, spaced about 12 weeks apart. If a patient has tried and failed multiple medications, the predictability of the approved protocol is valuable.
Hyperhidrosis. Botox has an FDA indication for severe primary axillary hyperhidrosis, and Xeomin is used off label with comparable outcomes in experienced hands. For botox for excessive sweating under the arms, dosing commonly ranges from 50 to 100 units per axilla. Palmar and plantar hyperhidrosis can also be treated, though injections can be uncomfortable and may require nerve blocks. Many patients appreciate the life change from dry shirts and fewer antiperspirant layers.
Blepharospasm and eyelid twitching. Both brands work for medically indicated eyelid spasms. Here, the choice may follow the prescriber’s familiarity and insurance coverage.
Bruxism and TMJ. Therapeutic botox for jaw clenching is among the most gratifying treatments when done carefully. Patients who grind at night report less morning jaw fatigue and fewer headaches. Dosing depends on masseter volume, symptomatic severity, and whether temporalis treatment is needed.
Choosing between Xeomin and Botox for a personalized plan
For cosmetic goals, the best predictor of success is not the logo on the vial but the injector’s eye. What I consider during a botox consultation:
Your specific animation patterns. Do your brows pull upward strongly? Does your left eyebrow arch higher? How deep are etched lines at rest? I map injection sites to your movement, not a cookie-cutter diagram. Your tolerance for downtime and risk. If you cannot afford even a day of brow heaviness, we stage doses or start with baby botox and bring you for a botox touch up at 2 weeks. Your history with neurotoxins. If you have had frequent treatments or therapeutic doses elsewhere and worry about antibodies, Xeomin’s lack of complexing proteins is a reasonable choice. Your event timeline. If you need results focused on a wedding or broadcast, we schedule the botox appointment 2 to 3 weeks ahead and keep photos to guide future dosing. Your budget and maintenance plan. Some clinics offer botox membership or botox package deals that reduce cost over time. Price per unit matters, but so does how many units you truly need for natural looking botox.
Dosing logic, units, and expectations
Patients often ask how many units of botox for forehead or how many units for crow’s feet. The honest answer is, it depends on your muscle strength and your aesthetic goal. Typical ranges, not prescriptions:
Glabella (frown lines): 15 to 30 units.
Forehead (frontalis): 8 to 30 units depending on brow position and forehead height.
Crow’s feet: 8 to 12 units per side.
Bunny lines: 2 to 6 units total.
Lip flip: 2 to 6 units total.
Gummy smile: 2 to 6 units total.
Chin dimpling: 6 to 12 units.
Masseter: 20 to 40 units per side, sometimes more for hypertrophy.
Neck bands: highly variable, often 20 to 50 units spread across bands.
Units are not interchangeable between brands and products like Dysport. In most clinical practice, Xeomin vs Botox units are considered roughly 1 to 1 for cosmetic areas, but injector protocols can vary. If you have seen dysport vs botox comparisons, you will know Dysport units are not equivalent, which complicates price shopping.
Safety, side effects, and the art of avoiding problems
Is botox safe? For the right candidate, in expert hands, both Botox and Xeomin have a long safety profile. Common, short-lived issues include small bruises, dull headaches, and transient injection site tenderness. Less commonly, you can see asymmetry or unwanted heaviness, which is why mapping brow elevators and depressors matters. Very rare side effects include eyelid ptosis from product migration, especially when glabellar injections are too low or diffuse.
I have a few practical rules to keep complications rare. Patients remain upright for several hours after treatment, avoid heavy workouts the same day, and do not rub the areas. I discourage facials, saunas, or hot yoga for 24 hours. Alcohol can increase bruising, so if you ask can you drink after botox, I recommend waiting a day. If a tiny bruise appears, a dab of arnica or careful concealer solves it. For what not to do after botox, skip pressure-based treatments on the face, and avoid sleeping facedown that first night.
If a minor asymmetry shows up, a small botox touch up is usually the fix. The best clinics plan a quick check around 10 to 14 days. I photograph before treatment, again at two weeks, and sometimes at six weeks to document botox results and guide a personalized botox plan next time.
Recovery and the timeline of results
How soon does botox work? Expect subtle changes by day two or three, with smoothing building to a peak at two weeks. When does botox start working is not the same as when you see it most. For first time botox, I recommend a follow-up to review outcomes and fine-tune.
When does botox wear off? Softening gradually recedes around the three to four month mark for most cosmetic areas. Some patients like preventative botox, repeating treatments before full return of movement to discourage etching of lines. How often to get botox depends on your goals and budget. A typical rhythm is every 3 to 4 months for upper face lines, every 4 to 6 months for masseters, and every 6 to 12 months for hyperhidrosis treatments.

As for botox downtime, it is minimal. You can return to most work immediately, barring high-intensity exercise the same day. Makeup after 30 minutes is fine if applied gently. For botox aftercare instructions, the priority is avoiding pressure and heat for 24 hours and staying upright for several hours.
Cost, units, and finding the right clinic
How much does botox cost varies widely by geography, injector experience, and whether pricing is per unit or per area. In many metropolitan areas, botox pricing per unit ranges from roughly 10 to 25 dollars. Botox cost per area packages are common for the glabella or crow’s feet. Xeomin pricing often mirrors Botox closely. Beware of deals that seem too good to be true. Authentic product from a reputable distributor, proper dilution, and adequate time with an experienced injector carry costs. Affordable botox is not the same as cheap botox.

Finding the best botox clinic or the best botox doctor is less about marketing and more about results and safety. Review botox patient reviews, look at unfiltered botox before and after photos from the clinic, ask about units of botox needed for your face rather than a one-size-fits-all plan, and confirm medical oversight. Same day botox is fine once you have a clear consultation and no contraindications. For botox near me for wrinkles, give preference to clinics that offer a proper assessment rather than rushing to the chair.
Subtlety, men’s treatments, and aging well
Natural looking botox matters to men and women equally. For botox for men, sometimes branded as brotox for men, the goal often includes preserving strength in the frontalis to keep a masculine brow while softening etched lines. Men generally have stronger muscles and may require more units. Women seeking subtle botox results often prefer baby botox or micro botox techniques, which spread smaller amounts across more points for a diffused, airbrushed effect.
For those considering botox anti aging treatment early, preventative botox can reduce the formation of static lines, especially in the glabella and crow’s feet. The best age to start botox is when dynamic lines persist at rest, commonly in the late 20s or early 30s, though individual variation is wide. The point is not to freeze your face, but to stay ahead of deep creases without losing expression.
Botox versus fillers, and when to combine
Patients often ask about botox versus fillers. They do different jobs. Botox and Xeomin relax muscles to reduce motion-driven lines. Fillers restore volume, contour, and support. If etched forehead lines remain at rest after neurotoxin, ultra-soft filler or skin treatments augment the result. For facial rejuvenation botox plus carefully placed hyaluronic acid in the midface or temples can lift subtly. Use caution with fillers in high-risk areas like the glabella and nose. The best outcomes come from a customized botox treatment paired with selective filler, medical-grade skincare, and lifestyle factors like sleep and sun protection.
Edge cases, trade-offs, and my candid advice
Not every face is a good candidate for heavy toxin. If your brow sits low and your eyelids feel heavy by day’s end, aggressive forehead dosing can weigh you down. In these cases, I under-treat the frontalis, focus more on the glabella to release downward pull, and consider a non surgical brow lift botox approach that shifts the balance without bulk paralysis. Patients with very thin skin and etched lines may need multiple cycles plus adjuncts like resurfacing or biostimulators to erase static creases.
For oily skin or enlarged pores, some clinics offer botox for pore reduction or botox for oily skin using micro doses superficially. Results are modest and short-lived but can help before a big event. Set expectations accordingly.
If you metabolize neurotoxins quickly, a few strategies help. We can shorten intervals modestly, increase units slightly in resistant areas, or trial the alternate brand. In very rare cases with suspected neutralizing antibodies from high-dose therapeutic use, results diminish across brands. Here, switching to a protein-free option like Xeomin earlier in the course may have benefits, although solid clinical data are mixed.
What a great appointment looks like
A thoughtful botox consultation starts with goals and ends with a plan. Bring a list of botox consultation questions. Tell your injector about past treatments, what you liked, what felt heavy, and any medical conditions. We will discuss where you can get botox safely and which areas make the biggest difference for your face.
During the botox appointment, I mark injection sites according to your unique movement, not a template. I use fine needles, ice or vibration for comfort, and low-volume injections to limit spread. Photographs document baseline and guide your future dosing. We review botox aftercare instructions before you leave. Total chair time is often under 30 minutes, with the injections themselves taking only a few minutes.
At two weeks, we assess symmetry and function. If needed, a tiny touch up perfects the result. Botox maintenance typically settles into an every 3 to 4 month rhythm for the upper face. Over time, we may reduce units as the muscles decondition or increase spacing between visits. Keep communication open, especially if life changes shift your goals, from a wedding to a media appearance to a sports season.
Bottom line: choosing between Xeomin and Botox
If you walk into my clinic with etched frown lines and a tight timeline before a reunion, I might pick Botox for familiarity and a track record of on-label dosing patterns. If you have a long history of neurotoxin use or therapeutic doses and want the cleanest formulation, Xeomin is a smart choice. If you are new and nervous, both brands can deliver baby botox that looks subtle and natural, with room to adjust at the follow-up.
Neither product is a magic wand. The best results come from precise technique, honest dosing, and follow-up. Ask for photos. Ask how many units you are getting and why. Ask about risks in your specific anatomy, like brow heaviness or smile changes. Protect your investment with sunscreen, a retinoid if tolerated, and healthy habits. Whether you choose Xeomin or Botox, a personalized botox plan that respects your features and your lifestyle will always beat a one-size-fits-all approach.