What Is Xeomin?
Xeomin (incobotulinumtoxinA) is a prescription injection of botulinum toxin type A that temporarily relaxes the muscles it is injected into. In adults, the FDA has approved it to temporarily improve moderate to severe frown lines between the eyebrows, horizontal forehead lines and crow's feet. It also treats several medical conditions.
Xeomin was first approved in the United States in 2010. During manufacturing, the neurotoxin is separated from the accessory proteins that normally surround it. Xeomin is not protein-free, though: the toxin itself is a protein, and each vial also contains human albumin and sucrose.
Xeomin at a Glance
| Generic name | IncobotulinumtoxinA |
|---|---|
| Cosmetic uses (adults) | Moderate to severe frown lines (glabellar lines), horizontal forehead lines and crow's feet (lateral canthal lines) |
| Medical uses | Chronic drooling (sialorrhea), upper limb spasticity, cervical dystonia and blepharospasm |
| How it works | Blocks the nerve signal that tells a muscle to contract |
| How it's given | Injected by a clinician into muscle (or, for drooling, into salivary glands) |
| When it starts working | Median onset of 2 to 7 days |
| How long it lasts | Typically up to 12 to 16 weeks. Varies by person. |
| Downtime | Most people return to everyday activities immediately |
| Common side effects | Bruising or a small blood collection (hematoma) at the injection site, headache and, less often, a drooping brow |
| FDA status | Approved since 2010. Carries a boxed warning about spread of toxin effect. |
What Is Xeomin Used For?
Xeomin's FDA-approved cosmetic uses are limited to three upper-face areas in adults:
- Glabellar lines: the vertical "11s" between the brows (corrugator and procerus muscles)
- Horizontal forehead lines: frontalis muscle
- Crow's feet (lateral canthal lines): orbicularis oculi muscle around the eye
Medical uses include chronic sialorrhea and upper limb spasticity in people 2 and older, and cervical dystonia and blepharospasm in adults. Clinicians also use botulinum toxin in the lower face, midface and neck, which is off-label for Xeomin.
How Does Xeomin Work?
Xeomin works by blocking the release of acetylcholine, the chemical signal a nerve uses to make a muscle contract. Inside the nerve ending, it cuts a protein called SNAP25 that acetylcholine release depends on. The muscle relaxes, so the skin above it creases less. The effect is temporary because the nerve forms new endings.
What to Expect From Xeomin Treatment
Xeomin treatment is an injection given by a clinician, and most people return to everyday activities right away.
Before treatment
Tell your clinician about all medicines and supplements you take, any botulinum toxin injection in the past 4 months, bleeding problems, eye or face surgery, and pregnancy or breastfeeding.
During treatment
The clinician injects small amounts into specific muscles with a very fine needle. The label's frown-line dose is 20 units, given as 4 units into each of 5 sites.
After treatment
You can apply makeup right after treatment, but don't press or rub it in. The American Academy of Dermatology (AAD) advises not rubbing treated areas and waiting 2 hours before strenuous exercise, so the toxin doesn't spread. Retreatment should be no more often than every 3 months.
Xeomin Side Effects
Xeomin side effects after cosmetic treatment tend to be mild and temporary, according to the AAD's guidance on botulinum toxin. In two placebo-controlled trials of 730 adults treated for upper facial lines:
- Bruising occurred in 2% of people given Xeomin and 1% given placebo.
- A drooping brow (brow ptosis) occurred in 0.7%.
- With repeat treatments, a small blood collection under the skin (hematoma) was most common, at 8%, followed by headache (3%).
Serious side effects
Xeomin carries a boxed warning that the effects of Xeomin and all botulinum toxin products can spread beyond the injection site, with symptoms reported hours to weeks later. Get medical help right away for trouble swallowing, breathing or speaking, double or blurred vision, drooping eyelids or body-wide weakness. Serious allergic reactions, including anaphylaxis, have been reported with botulinum toxin products.
Who Shouldn't Get Xeomin?
Xeomin should not be given to anyone allergic to a botulinum toxin product or to its ingredients (human albumin and sucrose), or to anyone with an infection at the injection site. Extra caution is needed for:
- Nerve and muscle disorders such as ALS, myasthenia gravis or Lambert-Eaton syndrome, which raise the risk of serious swallowing and breathing problems
- Pregnancy and breastfeeding. Human data are lacking, and animal data suggest possible fetal harm.
- Interacting medicines, such as aminoglycoside antibiotics, anticholinergic drugs, and allergy, cold or sleep medicines
- Drooping eyelids or brows, or marked facial asymmetry
Xeomin vs. Botox
Xeomin and Botox Cosmetic are both botulinum toxin type A injections for the same upper-face lines, and a head-to-head trial found Xeomin no less effective than Botox for frown lines.
| Xeomin | Botox Cosmetic | |
|---|---|---|
| Generic name | IncobotulinumtoxinA | OnabotulinumtoxinA |
| Accessory (complexing) proteins | Removed | Present |
| FDA-approved cosmetic areas | Frown lines, forehead lines, crow's feet | Frown lines, forehead lines, crow's feet, neck (platysma) bands |
| Onset | Median 2 to 7 days | 1 to 2 days, building over the first week |
| Duration | Typically up to 12 to 16 weeks | About 3 to 4 months for frown lines |
In a trial of 503 Chinese adults with frown lines, 92.5% responded to 20 units of Xeomin and 95.1% to 20 units of Botox at day 30. Units of one brand can't be converted into units of another.
The missing proteins may matter for people who stop responding to treatment. A 2025 review found neutralizing antibodies developed with formulations containing clostridial proteins, such as Botox and Dysport, but not with Xeomin or daxibotulinumtoxinA. Evidence on how much antibodies cause treatment failure remains mixed.
Xeomin at GENEVA
At GENEVA Primary Care & Med Spa in Alpharetta, GA, a provider evaluates the lines you want to soften, your medical history and any past botulinum toxin treatments. Your provider then recommends treatment at GENEVA or a referral to a specialist.
Learn more about Xeomin at GENEVA or compare it with Botox injections. GENEVA serves patients from Alpharetta, Johns Creek, Milton, Roswell and Cumming.
Related Terms
Xeomin FAQs
Is Xeomin safe?
Xeomin is FDA approved, and the AAD says botulinum toxin side effects tend to be mild and temporary. Xeomin carries a boxed warning that the effects of Xeomin and all botulinum toxin products can spread beyond the injection site. In two placebo-controlled trials of 730 adults treated for upper facial lines, bruising affected 2% of people given Xeomin versus 1% given placebo, and a drooping brow affected 0.7%. The AAD says serious breathing or swallowing problems have never been reported when dermatologists use botulinum toxin to treat signs of aging. Get care right away for trouble swallowing, breathing or speaking.
How long does Xeomin last?
Xeomin typically lasts up to 12 to 16 weeks, though duration varies from person to person. The AAD says botulinum toxin for lines and wrinkles lasts about 3 to 4 months, and sometimes longer. The effect wears off because treated nerves grow new endings that restore the signal to the muscle. The FDA label says retreatment should be no more often than every 3 months. The AAD notes that with repeat treatments for lines and wrinkles, the muscle may thin, which can make results last longer. Plan a follow-up when movement returns.
How long does Xeomin take to work?
Xeomin usually starts working within 2 to 7 days, which is the median onset reported in the FDA label. MedlinePlus notes it can take a couple of days or up to a week to feel the full benefit, and clinical trials measured results at day 30. If you see little change, contact the provider who treated you rather than getting another toxin elsewhere, because overlapping toxins can cause excess weakness.
What is the difference between Xeomin and Botox?
Xeomin and Botox are both botulinum toxin type A injections, but Xeomin is purified to remove the accessory proteins that surround the toxin in Botox. Both are FDA approved for frown lines, forehead lines and crow's feet, and Botox Cosmetic is also approved for neck (platysma) bands. In a trial of 503 Chinese adults, 92.5% responded to Xeomin and 95.1% to Botox for frown lines at day 30, meeting the noninferiority test. Their units can't be converted, so doses aren't interchangeable.
What are the side effects of Xeomin?
The most common side effects of cosmetic Xeomin are bruising or a small blood collection (hematoma) at the injection site, headache and, less often, a drooping brow. In repeat-dose upper-face trials, hematoma occurred in 8% of people, headache in 3%, bruising in 3% and brow drooping in 1%, and these became less frequent with later treatments. The AAD also lists swelling, redness and soreness, and says bruising lasts about a week. Rarely, the toxin spreads and causes trouble swallowing, breathing or speaking, which needs emergency care.
Can a primary care provider give Xeomin?
Yes, a primary care provider can evaluate whether Xeomin is a good fit for you. At GENEVA Primary Care & Med Spa in Alpharetta, a provider reviews your concerns, medical history and past botulinum toxin treatments, then recommends treatment at GENEVA or a referral to a specialist. The AAD advises asking who will give your injections and how many of these procedures they have performed. The AAD also warns against buying botulinum toxin online or getting injections at a non-medical spa, salon, party or someone's home.