Xeomin (Zee-Oh-Min) from Merz Aesthetics has been used in Europe since 2008. It received FDA approval in November of 2011 and is the newest Neurotoxin on the US market. However, Xeomin (inco-botulinumtoxinA) did not come out of the gate smoothly. It was pulled in March of 2012 following a federal court ruling that Merz collected consumer lists and sales figures from Allergan (the maker of Botox). The confidential information was obtained through Allergan sales representatives. So after a rocky start, it was re-launched in early 2013.

Botox and Xeomin are very similar. Xeomin is sometimes described as “The Naked Botox” due to its absence of the carrier proteins present with Botox. In theory this absence of protein carriers results in fewer allergic reactions or resistance to the neurotoxin. Xeomin, due to its lack of these additives, does not need to be refrigerated. It is the only one of the three neurotoxins that has this feature.

Lets discuss these ‘advantages’

1. In theory, less people will develop resistance via antibody formation. If you have a cold, the body makes antibodies to fight off that virus. When that virus comes around again, the antibodies quickly neutralize it. Hence, the body is resistant. The human body doesn’t commonly makeantibodies to Botox In the small percentage that do, the effect and duration of action of Botox are markedly reduced. In the very few patients I have seen with this resistance, I switch to Dysport.
2. In theory, fewer allergic reactions. Merz aesthetics attributes this to the absence of carrier proteins as well. After injecting Botox for over 10 years I can honestly say I have never experienced a patient allergy to Botox. James Bonaparte, MD, Cosmetic Surgeon and researcher would seem to agree as he notes, “After reviewing 20,000 patients and a number of randomized studies, there are no reports of allergies with Botox.”
3. No refrigeration needed. Botox and Dysport are shipped in dry ice. Hence, Xeomin is cheaper to ship and adds a measure of convenience here.

Quicker onset or Longer lasting? No.

Botox and Xeomin are essentially identical in terms of the active neurotoxin ingredient. One unit of Botox = One unit of Xeomin.  (One unit of Botox = 2.5 Units of Dysport). Thus the conversion is simple. If you had a good result on your brow with 20 units of Botox, you should get the same result with 20 units of Xeomin (or 50 units of Dysport).

Dysport clearly has a faster onset of action than Botox. (1-3 days vs. 3-5 days on average). Xeomin’s 3-5 day onset of action mirrors Botox.  There are case reports claiming Xeomin works faster, however I have been unable to locate literature supporting this. Certainly if such a study existed, Merz Aesthetics would have let us know. Equally common are reports of Xeomin being cheaper because it ‘doesn’t last as long.’ There is no study supporting this either.

Xeomin and Botox both last 3-6 months. Results vary person to person and are affected by factors such as activity level, amount injected and area injected.

Cost

Xeomin may cost the doctor less than Botox depending on how much they are buying (up to 15% less). Whether or not they pass the savings along to you depends on each individual practice.  Many offices, to simplify matters,  charge the same per unit price for Botox and Xeomin. Based on the practices I reviewed, the average for Botox is $12-$14/unit and Xeomin $9-12/unit. Overall the average savings is $1-2 less per unit of Xeomin (vs Botox). Merz Aesthetics has offered different promotions in the past, such as a $50 gift card when 30 units or more of Xeomin were purchased.

Having three products instead of one is good for consumers as each company is vying for your business and your loyalty. Through rebates, gift cards and award programs, many discounts are available as each company wants you using their product and are willing to reward you for doing so.

Tried and True Factor

Products like Coca-Cola, Heinz, Kleenex, Viagra, and Botox  have had great success along with names that bring forth a clear image to consumers. They are known and trusted brands. There are other colas, catsups, tissues, erectile dysfunction medications and neurotoxins, but if someone says “Botox”, the vast majority of the population knows what you are talking about. It’s the gold standard; the tried and true neurotoxin used a long time while giving predictable results. Dysport was called “The new Botox” and Xeomin has been called “The naked Botox.” Even competitors of Botox are described in ‘Botox’ terms. Botox is a strong, enduring and trusted brand.

The Xeomin Verdict

The most tangible benefits to recommend Xeomin are firstly, its slightly lower cost (in some offices), and secondly, the fact that it does not need to be refrigerated. The theories that it will cause less resistance or allergies are not likely to make one shred of difference in the success or failure of Xeomin.

As it stands in 2015, Botox is to medical aesthetics as CocaCola is to soft drinks. Time will tell how Xeomin will fit in as a player in the neurotoxin market. The fact that it really does NOT have a glaring downside is important. I certainly feel it is an effective and worthy neurotoxin to use as an alternative to Botox or Dysport. There are plenty of positives with Xeomin.  Similarly, there was much to recommend the soft drink ‘Slice’ …until Sierra Mist came along.

Be Well,

Dean M. Tomasello, MD