Empowering Medical Aesthetic Clinics, Practitioners, and Patients

Xeomin® vs Botox® vs Dysport® Explained

Reviewed by Jennifer T. Haley, MD, FAAD • Last updated: September 2026

Xeomin® vs Botox® vs Dysport® is still the comparison most injectors and patients start with — but the US market has changed underneath the question. All three are botulinum toxin type A, all three relax the same muscles, and all three are FDA-approved for frown lines. What separates them is formulation, dosing, storage and price. Xeomin® (incobotulinumtoxinA) is the purified one: the active 150 kDa neurotoxin with no accessory proteins, which is where the “naked injectable” nickname comes from.

There are now six FDA-approved botulinum toxin type A products in the United States, not three. Jeuveau® arrived in 2019, Daxxify® in 2022, and Letybo® was approved in February 2024 and fully commercialized in 2025. Any honest comparison in 2026 has to place the original three inside that wider field, because the newer products are what change the pricing and duration conversation.

This guide compares them the way a label does: approved dose, onset, duration, storage, immunogenicity and cost — with the numbers taken from current prescribing information rather than marketing copy. Every expert the IAPAM has queried agrees on one thing: the product matters far less than the hands holding the syringe, which is why any comparison ends in the same place — comprehensive, hands-on injectables training that covers all of them.

Key Takeaways

What Actually Differs Between Xeomin®, Botox® and Dysport®

All three contain the same active molecule. The differences sit in what surrounds it, how it is dosed, and how it is stored — and those three things drive almost every practical decision an injector makes.

1. Formulation: complexing proteins, or none

Botox® Cosmetic (onabotulinumtoxinA) is supplied as a botulinum toxin type A complex: the active neurotoxin surrounded by accessory proteins, stabilized with human albumin and sodium chloride. Dysport® (abobotulinumtoxinA) is likewise a complex, containing neurotoxin plus hemagglutinin and non-toxin non-hemagglutinin proteins, stabilized with human serum albumin and lactose. Dysport®’s label also warns that it may contain trace cow’s milk protein, which matters for any patient with that allergy.

Xeomin® (incobotulinumtoxinA) is different. Its label describes the active neurotoxin at a molecular weight of 150 kDa without accessory proteins. This is the basis of the “naked injectable” positioning and the theoretical immunogenicity argument that follows from it — an argument worth understanding precisely, because it is routinely overstated.

2. Onset and duration: what the labels actually say

Published onset figures for these products are the most confidently quoted and least well-sourced numbers in aesthetics. Here is what the prescribing information supports, with the trial evidence where the label is silent.

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Onset distributions overlap substantially. Ranking these products by a single “days to onset” number compares one product’s first visible effect against another’s full effect, which manufactures a difference the data do not support.

3. Storage: the one clear, practical Xeomin® advantage

This is where the differences are real, unambiguous, and directly relevant to running a clinic. Xeomin®’s label states that unopened vials are stored at or below 25°C and that refrigeration of unopened vials is not required. Botox® Cosmetic and Dysport® both require refrigeration at 2–8°C for unopened vials, and Dysport® must additionally be protected from light.

For a practice, that translates into simpler shipping, simpler storage, and one less cold-chain failure point. It is worth noting that Xeomin® is no longer the only room-temperature option: Daxxify® permits unopened vials at 20–25°C as well, and Daxxify® is the only product of the six that allows 72 hours after reconstitution rather than 24.

Units Are Not Interchangeable — and the Labels Say So

This is the single most misunderstood point in the whole category, and it is the reason per-unit price comparisons mislead so badly. Every one of the six FDA labels carries near-identical wording: the potency units of each product are specific to that preparation and assay method, and cannot be compared to or converted into units of any other botulinum toxin product.

That is not a technicality. It means a “unit” is a different size depending on which box it came out of. The approved glabellar doses make the point on their own:

All six products deliver the glabellar dose across the same five injection sites — two per corrugator and one in the procerus. The number of units differs; the number of injections does not.

The conversion ratios injectors actually use are clinical convention drawn from published comparative work, not regulatory equivalence. Scaglione’s 2016 review in Toxins concluded that a Botox®-to-Dysport® ratio of 1:3 or lower is the most appropriate, noting that published ratios have ranged from 1:1 to 1:11; a 2015 double-blind randomised study in Movement Disorders validated 2.5:1. The same review put Xeomin® to Botox® at roughly 1:1.

Working ratios in practice: Dysport® 2.5:1 (range 2:1 to 3:1); Daxxify® approximately 2:1; Xeomin®, Jeuveau® and Letybo® approximately 1:1. Use them to sanity-check a treatment plan, never to substitute one product’s label dose for another’s.

Xeomin® vs Botox®

These two are the closest pairing of the six. Both use the same 20-Unit, five-site glabellar protocol. Both are FDA-approved across the full upper face — glabellar lines, lateral canthal lines and forehead lines. Both are lyophilized powders requiring reconstitution, both are stabilized with human albumin, and in comparative practice they are dosed at approximately 1:1.

The similarities:

1. Identical active molecule — botulinum toxin type A produced by Clostridium botulinum, blocking acetylcholine release at the neuromuscular junction.
2. The same approved glabellar dose and injection pattern, and a comparable onset and duration window of roughly three to four months.
3. Comparable clinical effect in the upper face, so the choice can reasonably sit with the injector or the patient.

The differences:

1. Structure. Botox® is supplied as a neurotoxin complex with accessory proteins; Xeomin® is the 150 kDa neurotoxin without them.
2. Storage. Unopened Xeomin® needs no refrigeration; unopened Botox® does.
3. Breadth of approval. Botox® carries nine therapeutic indications alongside four aesthetic ones; Xeomin® carries five therapeutic indications plus upper facial lines.
4. Manufacturer. Xeomin® is made by Merz. Botox® is an AbbVie product — AbbVie acquired Allergan in May 2020, and Allergan Aesthetics is now the AbbVie business unit that markets Botox® Cosmetic.

Botox® Cosmetic also added a fourth aesthetic indication in October 2024: moderate to severe vertical platysma bands, dosed at 26–36 Units across 18–28 injection sites. A masseter indication has been filed and is pending. Neither Xeomin® nor Dysport® currently holds a platysma indication, which is a genuine point of difference for practices marketing neck and jawline treatment.

Botox® vs Dysport®

Both products act at the neuromuscular junction, both are approved for glabellar lines, and both carry substantial therapeutic indications. A widely repeated claim that Dysport® is primarily a cervical dystonia drug while Botox® is not used for that condition is simply incorrect: Botox® has been FDA-approved for cervical dystonia since 2000, and it remains one of its core therapeutic uses. Dysport® received its cervical dystonia and glabellar lines approvals on the same day in April 2009.

Where they genuinely differ:

• Dosing scale. Dysport®’s glabellar dose is 50 Units in five 10-Unit aliquots; Botox®’s is 20 Units in five 4-Unit aliquots.
• Diffusion. Dysport® is widely reported to spread further from the injection point than Botox®. That can be an advantage over broad areas such as the forehead and a liability near the brow, where unintended spread raises the risk of eyelid ptosis. Field of effect is technique-dependent, which is exactly why it belongs in training rather than in a product brochure.
• Approval breadth. Botox® holds nine therapeutic indications; Dysport® holds cervical dystonia plus adult and pediatric spasticity.
• Duration. Dysport®’s label allows for up to four months; Botox®’s states approximately three to four. In practice the two are close enough that patient factors dominate.

For a deeper clinical discussion from IAPAM faculty on how these two behave in the chair, see our faculty expert discussion on Botox® vs Dysport®.

Antibodies, Resistance and the “Naked Injectable” Claim

The most common claim made for Xeomin® is that removing accessory proteins removes the risk of antibody formation. The theory is reasonable. The absolute version of the claim is not supported by Xeomin®’s own label.

Of 2,649 patients treated with Xeomin® in clinical trials, 9 (0.3%) were positive for neutralizing antibodies after treatment and 4 further patients (0.2%) developed them. What the label does state — and this is the defensible version — is that no patient demonstrated a secondary lack of treatment response due to neutralizing antibodies. Antibodies formed; they did not cause treatment failure. That is a meaningful safety signal, and it is not the same claim as “no antibody formation.”

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Note the pattern: in the aesthetic trial populations specifically, Botox® Cosmetic, Dysport®, Daxxify® and Letybo® all report zero neutralizing antibodies. Xeomin®’s pooled 0.3–0.5% spans therapeutic indications dosed far higher than any cosmetic treatment. True clinical resistance in aesthetic dosing is rare across all six products.

The practical takeaway for a patient who genuinely stops responding: switching products is reasonable, and Xeomin® is a defensible choice in that scenario. But secondary non-response is far more often a dosing, dilution, placement or expectation problem than an immunological one — a distinction that is taught, not guessed.

Cost in 2026: Patient Price vs Practice Acquisition Cost

Most cost comparisons in this category quietly mix two completely different numbers: what a patient pays and what a practice pays. They are separated here.

What patients pay in 2026

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Ranges reflect US market pricing in 2026 and vary widely by metro. The American Society of Plastic Surgeons publishes an average cost of $435 for botulinum toxin injections, though ASPS stopped publishing dated cost tables for minimally invasive procedures in its 2025 statistics report.

Price also tracks who is holding the syringe and where the practice sits. Board-certified plastic surgeons and dermatologists typically charge $16–$25 per unit; nurse practitioner and registered nurse injectors and med spas typically run $10–$16. Metro pricing spreads from roughly $15–$25 per unit in New York down to $8–$13 in rural and suburban markets. Scope of practice varies by state and is worth confirming before building a pricing model — our guide to whether nurse practitioners can inject Botox® covers the state-by-state picture.

Manufacturer loyalty programs move the effective patient price meaningfully: Allē for Botox®, ASPIRE Galderma Rewards for Dysport®, Merz Xperience+ for Xeomin® (advertised at up to $240 per year in Xeomin® savings), and Evolus Rewards for Jeuveau®.

What practices pay

For clinic owners, the relevant number is acquisition cost per vial. As of early 2025, published wholesale ranges ran approximately: Botox® $6–$7 per unit ($600–$700 per 100-unit vial); Xeomin® $4–$5 ($400–$500 per 100-unit vial); Letybo® $4–$5; Jeuveau® $3–$4; Daxxify® $8–$10 ($400–$500 per 50-unit vial); and Dysport® $0.60–$1.00 per unit ($300–$500 per 500-unit vial). Actual pricing depends heavily on order volume, so a new practice will pay more than a high-volume account.

Two things follow from those numbers. First, Dysport®’s acquisition cost per treatment is genuinely competitive once the 2.5× unit scale is applied — just not the four-fold advantage the per-unit figure implies. Second, Daxxify®’s economics only work if a practice can hold a premium price justified by duration, because its 40-Unit dose and higher per-unit cost stack.

All Six FDA-Approved Neurotoxins at a Glance

Comparing only three products no longer describes the market an injector works in. Here is the full field as of September 2026.

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Note the mandatory four-letter suffixes on the three newest products — they are part of the nonproprietary name and should be reproduced in clinical documentation. Daxxify® is also the only one of the six formulated without human albumin, using a stabilizing peptide instead.

Two structural points separate the field. Jeuveau® and Letybo® are aesthetics-only products with no US therapeutic indications, which is part of why they are priced below Botox®. Daxxify® is the only product with median duration data near six months, and the only one permitting 72 hours between reconstitution and administration. For practices evaluating the newest entrant, our provider’s guide to Letybo®’s US launch covers its clinical profile and pricing position in detail.

What’s Coming Next: Two Products That Would Change the Comparison

Two candidates in the US pipeline would break the framing this whole category rests on, and both moved in 2026.

TrenibotulinumtoxinE — a different serotype entirely

AbbVie’s trenibotulinumtoxinE is a serotype E neurotoxin, not type A, with a fundamentally different profile: onset as early as 8 hours and duration of only two to three weeks. Its Phase 3 program covered more than 2,100 patients. The FDA issued a Complete Response Letter on 23 April 2026 citing manufacturing process information only — no safety concerns, no efficacy concerns, and no request for additional clinical studies. AbbVie indicated it would respond within months.

If approved, it would be the first non-type-A botulinum toxin approved for aesthetics in the United States, and it would open a use case none of the six current products serve: a same-day, short-duration trial treatment for a hesitant first-time patient.

RelabotulinumtoxinA — the first ready-to-use liquid

Galderma’s relabotulinumtoxinA (marketed as Relfydess® outside the US) is the first liquid neuromodulator requiring no reconstitution, dosed volumetrically. The FDA accepted Galderma’s resubmitted application on 2 February 2026; it remains investigational in the US while already approved in more than 20 markets including the EU, UK and Australia. Its READY program enrolled over 1,900 participants and reported onset as early as day 1 with results sustained to six months.

Every one of the six currently approved products is a lyophilized or vacuum-dried powder that must be reconstituted. A ready-to-use liquid would remove a step from every treatment and a variable from every dilution — a meaningful change to injector workflow and training.

Also worth noting for anyone tracking the market: Daxxify® changed hands in February 2025, when Crown Laboratories completed its acquisition of Revance Therapeutics. Letybo® was fully commercialized in the US in 2025 and Hugel has since built a direct US sales force. Merz marked Xeomin®’s fifteenth year in the US in February 2026. And Letybo®’s FDA approval for glabellar lines remains the most recent addition to the approved field.

So Which One Should a Practice Use?

Honestly: more than one. The products are close enough in the upper face that the deciding factors are usually practical rather than clinical.

• Choose Xeomin® when cold-chain logistics are a constraint, when a patient has genuinely stopped responding to a complex-containing product, or when a lower acquisition cost lets the practice compete on price without cutting dose.
• Choose Botox® when breadth of approved indication matters — it is the only product approved for platysma bands — or when brand recognition is doing real work in patient conversion.
• Choose Dysport® for broader areas where a wider field of effect is an advantage, and where the injector is confident controlling spread near the brow.
• Consider Daxxify® for the patient who explicitly wants fewer visits per year and will pay for it.
• Consider Jeuveau® or Letybo® where price sensitivity is the barrier to conversion and the treatment is purely aesthetic.

What does not vary is the requirement underneath all of it: correct facial assessment, correct dilution, correct depth and correct placement for the product in hand. Every expert the IAPAM has queried has landed on the same conclusion — the key to using any of these products safely is comprehensive injectables training that covers all of them, not fluency in one.

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Frequently Asked Questions

Is Xeomin® the same as Botox®?

They share the same active molecule, botulinum toxin type A, but not the same formulation. Botox® Cosmetic is supplied as a neurotoxin complex surrounded by accessory (complexing) proteins. Xeomin® is purified down to the 150 kDa active neurotoxin with no accessory proteins. Both are dosed at 20 Units across five injection sites for glabellar lines, and both are FDA-approved for frown lines, crow’s feet and forehead lines.

How much does Xeomin® cost per unit in 2026?

US patient pricing for Xeomin® generally runs about $8 to $18 per unit in 2026, with major metros at the top of that range and rural or suburban clinics at the bottom. A standard 20-unit frown line treatment typically totals $200 to $300. Practice acquisition cost is a separate number: a 100-unit vial of Xeomin® wholesaled around $400 to $500 as of early 2025, depending on order volume.

Why is Dysport® cheaper per unit than Botox® or Xeomin®?

Because a Dysport® unit is not the same size as a Botox® unit. Dysport®’s approved glabellar dose is 50 Units where Botox® and Xeomin® use 20 Units, so roughly 2.5 times as many units are needed for the same area. Dysport® at $5 per unit works out to about $15 per unit in Botox®-equivalent terms. Compared per treatment area rather than per unit, Dysport® costs about the same as Botox®, not 60 percent less.

Can botulinum toxin units be converted between products?

No. Every FDA label for these products carries near-identical wording stating that units of biological activity cannot be compared to or converted into units of any other botulinum toxin product. Conversion ratios used in practice, most commonly 2.5:1 for Dysport® to Botox® and 1:1 for Xeomin® to Botox®, are clinical convention drawn from published studies, not established equivalence. Dose each product to its own label.

Does Xeomin® really cause no antibody formation?

No, and Xeomin®’s own label says otherwise. Of 2,649 patients treated in clinical trials, 9 (0.3%) were positive for neutralizing antibodies after treatment and 4 more (0.2%) developed them. What the label does support is that no patient demonstrated a secondary loss of treatment response caused by neutralizing antibodies. Immunogenicity is low across all six approved products, and the aesthetic trial populations report the lowest rates of all.

Which neurotoxin works fastest and which lasts longest?

Onset distributions overlap heavily. Xeomin®’s label states a median onset of two to seven days. Botox®’s label describes chemical denervation one to two days after injection, with 74 percent of patients responding by day 7. Dysport® carries no label onset figure, but pooled trial data put the median at two to three days. For duration, Botox® is labelled at approximately three to four months and Xeomin® at 12 to 16 weeks. Daxxify® is the only product with median duration data near six months, at roughly 24 weeks in the SAKURA trials.

Which botulinum toxin products do not need refrigeration?

Two of the six. Xeomin®’s label states that unopened vials are stored at or below 25°C and that refrigeration is not required. Daxxify® permits unopened vials at room temperature of 20 to 25°C or refrigerated. Botox®, Dysport®, Jeuveau® and Letybo® all require refrigeration at 2 to 8°C. Once reconstituted, every product must be refrigerated and used within 24 hours, except Daxxify®, which allows 72 hours.

Train on All of Them, Not Just One

The comparison that matters for a practice is not which vial is best in the abstract — it is which product suits this patient, this area and this budget, injected by someone who understands why the dose changes with the box. Product knowledge is the easy half. Facial assessment, dilution, depth, placement and complication management are what separate a good result from a call-back.

The IAPAM’s hands-on Botox® training and certification program covers all of the major neurotoxins as part of the didactic, with live-patient injection experience under board-certified dermatologist instructors at our Scottsdale, Arizona clinic. If you would rather start smaller, take the free Botox® module and 1 CME above and see how we teach before you commit.

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Botox® and Botox® Cosmetic are registered trademarks of Allergan, Inc., an AbbVie company. Dysport® is a registered trademark of Ipsen Biopharm Limited. Xeomin® is a registered trademark of Merz Pharmaceuticals, LLC. Jeuveau® is a registered trademark of Evolus, Inc. Daxxify® is a registered trademark of Revance Therapeutics, Inc., a Crown Laboratories company. Letybo® is a registered trademark of Hugel, Inc. The IAPAM is not affiliated with, endorsed by, or sponsored by any of these manufacturers.

Disclaimer: This guide is for informational and educational purposes only and does not constitute medical advice. Dosing, dilution and injection technique must be tailored to each patient by a qualified, licensed provider, and every product must be used according to its own FDA-approved labeling. Units of biological activity are not interchangeable between botulinum toxin products. Always follow product labeling, your scope of practice, and your state medical and nursing board regulations.