Xeomin: what it is, cost, results and how it compares to Botox

Xeomin is the brand name for incobotulinumtoxinA, a botulinum toxin type A injection made by Merz.

The FDA first approved it on July 30, 2010, for two medical conditions: cervical dystonia, a disorder of the neck muscles, and blepharospasm, involuntary eyelid spasms.

The cosmetic approval for glabellar (frown) lines followed on July 20, 2011.

In July 2024 the label was expanded again, to cover simultaneous treatment of the three upper facial lines — glabellar lines, horizontal forehead lines and lateral canthal lines (crow's feet) — at up to 64 units.

The label also carries medical uses: cervical dystonia, blepharospasm, upper limb spasticity and chronic sialorrhea (drooling).

It works on muscles.

The Botox Cosmetic label describes the mechanism: the toxin blocks acetylcholine release at nerve endings, producing a partial, localized reduction in muscle activity that slowly reverses as the nerve connection regrows.

How common are these injections?

The American Society of Plastic Surgeons' 2025 Procedural Statistics report says neuromodulator injections — it names Botox, Dysport, Letybo, Xeomin, Jeuveau and Daxxify — accounted for about half of all minimally invasive procedures performed in 2025.

Xeomin's headline difference sits in the vial.

Its active ingredient is purified down to the 150 kDa neurotoxin itself, without the accessory (complexing) proteins that accompany the toxin in Botox and Dysport.

The formulation still contains human albumin and sucrose.

Botox Cosmetic's label, by contrast, describes the neurotoxin as a complex with accessory proteins; its formulation also contains human albumin.

Storage differs too.

Unopened Xeomin vials can be stored at or below 25°C (77°F), and its label says refrigeration before reconstitution is not required; once the drug is reconstituted, the label calls for refrigerated storage and use within 24 hours.

Unopened Botox Cosmetic must be stored refrigerated, at 2°C to 8°C (36°F to 46°F).

Those are handling details for the office, not statements about how either product performs.

The units are not interchangeable.

Xeomin's label says its units cannot be converted into units of any other botulinum toxin, and Botox Cosmetic's label says the same about its own.

For frown lines, each label happens to set 20 units — the same number on paper, with each product's units still its own.

One published comparison is a 2016 review in the journal Toxins, which reported Xeomin was as effective as Botox with a comparable adverse-event profile when the two products were dosed one to one.

Its evidence base was mostly therapeutic and neurologic use — spasticity and similar conditions — not cosmetic dosing.

Xeomin sits alongside Botox, Dysport, Letybo, Jeuveau and Daxxify among the neuromodulator injections the ASPS report names; our neurotoxin brands guide compares them brand by brand.

Xeomin's current aesthetic label covers three upper-face areas in adults: glabellar lines (the frown lines, or "11s," between the brows), horizontal forehead lines, and lateral canthal lines (crow's feet).

The label sets a dose for each: 20 units for glabellar lines, given as 4 units into each of 5 sites; for forehead lines, 20 units into the forehead together with 20 units into the glabella, 40 units in total; and 12 units per side, 24 units in total, for crow's feet.

Treating all three areas in one session carries a maximum of 64 units.

Each product's label stands alone.

Botox Cosmetic carries a fourth cosmetic area — the vertical platysma bands of the neck — while Xeomin's aesthetic label covers the three upper-face areas.

Any use beyond the areas on the label is off-label: it is not on any current US label for the product.

That includes treatments you may see on med spa menus, such as a lip flip, jaw slimming, a brow lift, bunny lines or a gummy-smile treatment — no current US label for any botulinum toxin lists them.

Offices typically price botulinum toxin one of two ways: per unit, or per treatment area.

With per-unit pricing, the price of an area is roughly the number of units times the per-unit price.

The label's doses give a floor for that count: 20 units for frown lines, 40 units for forehead lines treated together with the glabella, 24 units for crow's feet, and up to 64 units for all three areas at once.

Do not compare a Xeomin price per unit with a Botox price per unit.

Each brand's units are its own — the labels state they cannot be compared to or converted into each other — so the same area can carry different unit counts on different products, and a per-unit price is not comparable across brands.

We could not confirm a current national average price for Xeomin.

The American Society of Plastic Surgeons' 2025 statistics report omits fees for minimally invasive procedures, and other national price sources were not retrievable when we checked in October 2026.

What moves the number: how many units you actually receive, and whether the office prices per unit or per area.

Ask for both numbers in writing — the per-unit price and the total for the areas you want treated.

Start with the clearest figure on the label: retreatment no more often than every three months for the upper facial lines.

That is a minimum interval between sessions, not a promise of how long results last.

How long the results last is harder to pin down.

We could not confirm how long Xeomin's cosmetic results last in the sources we checked in October 2026, so treat any month count you see online as unverified — and ask a licensed provider what they see in practice.

There is one recent head-to-head trial.

In a 2025 randomized trial published in JAMA Dermatology, 143 women at a single center each received one of four toxins for the frown lines: Botox 20 units, Dysport 60 units, Jeuveau 20 units or Xeomin 20 units.

Dysport and Jeuveau showed the fastest onset at day 3, while Jeuveau and Xeomin retained efficacy at day 180 against their own baselines.

Read that as one study, one center and one muscle-movement measure — not a wrinkle-severity scale — and not a ranking.

Nothing in a trial average predicts the result any one person gets.

In Xeomin's upper-facial-line trials, which treated 545 subjects, injection site bruising was the adverse reaction reported above placebo most often — 2% against 1% on placebo — and brow ptosis, a drooping or heavy brow, occurred in 0.7%.

In the glabellar-line trials, headache was reported in 5% of treated subjects, against 2% on placebo.

On antibodies, Xeomin's label reports that across 2,649 clinical-trial patients, 0.2-0.3% developed or tested positive for neutralizing antibodies, and none showed a secondary lack of response because of them; among the 464 glabellar-line patients, none developed neutralizing antibodies.

For comparison, the Botox Cosmetic label reports that in its crow's-feet trials, 1.5% of 916 treated subjects developed binding antibodies and none developed neutralizing antibodies.

Neither label turns those numbers into a head-to-head claim.

Xeomin's label makes no immunogenicity comparison against other toxins, so marketing language such as "antibody-proof" or "prevents resistance" does not come from the label.

For pregnancy and breastfeeding, the labels and the FDA say safety is not established for injectables such as botulinum toxin.

Nothing here is a verdict on your own case; that is a conversation for a licensed provider who knows your history.

Reviews are the hardest part of this page to source responsibly.

We do not republish review-site scores as facts, and we could not confirm a reliable patient-satisfaction figure for Xeomin in our research.

What stands in for reviews is the controlled evidence: in the one 2025 head-to-head trial, Xeomin was among the products that still showed efficacy at day 180 against baseline; a 2016 review reported effectiveness comparable to Botox with a similar adverse-event profile, in mostly therapeutic use; and in Xeomin's label trials, the adverse-reaction rates were 2% for injection-site bruising, 0.7% for brow ptosis and 5% for headache, each against its own placebo group.

For lived experience, the best source is the injector in front of you: how often they treat patients with Xeomin, how they decide between it and other toxins for a given area, and what their own patients come back reporting.

Who may legally inject Xeomin is state law, and it differs by state.

AmSpa, a med spa trade association, frames the baseline: injecting a prescription drug such as botulinum toxin is the practice of medicine, so it must be done by a physician, an independent-practice nurse practitioner, or another licensed professional acting within their scope, under their state's rules.

The CDC's consumer advice is to get botulinum toxin injections only from a licensed, trained provider using product from an authorized source — and it notes that even with FDA-approved product given correctly, the procedure is not without risk.

Four questions to bring to a consultation: Who will inject me, and what is their license?

Which toxin product will be used?

How many units does the quote include — for frown lines, the Xeomin label's dose is 20 units?

And what is the total cost if the treatment needs more?