Xeomin: Safe Anti-Aging Agent for Skin or Risky Treatment?

Every year hundreds of thousands of people around the world visitor their doctors for help reducing the appearance of wrinkles. Xeomin^® (pronounced Zeo-min) is one of the latest prescription treatments to be approved in the U.S. and over 50 other countries for the treatment of fine lines. Today, Xeomin is considered an alternative to Botox and Dysport injections, two popular treatments that have been shown to have skin-related anti-aging effects.

Are facial injections like Xeomin or Botox always safe? Xeomin has been used in many countries since 2005 and gained FDA approval in the U.S. in 2011. According to the American Academy of Facial Esthetics, “Worldwide, more than 84,000 people have been treated with Xeomin injections.” (1)  While Xeomin appears to be generally safe for most people, side effects are still possible — including serious allergic reactions, redness, swelling and dizziness.

While there’s some evidence that Xeomin can make you look more relaxed and less tired — and help to reduce the appearance of frown or forehead lines, crow’s feet, smile lines around your eyes, and wrinkles near your mouth — injections like Xeomin are not always necessary to make your skin look more youthful. Before you choose to pay for facial injections that can be both costly and potentially dangerous, consider trying natural remedies for wrinkles and fine lines instead, such as consuming collagen, frankincense and lavender essential oils, coconut and jojoba oil, and others.

What Is Xeomin?

Xeomin^® (incobotulinumtoxinA) is a prescription medication that is injected into facial muscles to treat fine lines. How does it work? Xeomin is a type of neurotoxin that works by blocking the release of chemicals that cause muscles under the skin to contract, contributing over time to wrinkles, frown lines and other signs of aging.

According to the makers of Xeomin^® (Merz Pharmaceuticals), the product is “a highly purified neurotoxin” that goes through a unique manufacturing process, allowing the most therapeutic components to be isolated and concentrated. The product contains the active ingredient called botulinum toxin type A, which is a type of protein that’s purified from the bacterium called Clostridium botulinum. Botulinum toxin type A acts on nerve endings in muscles to prevent muscle fibers from contracting and contributing to signs of aging. (2)

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Xeomin injections are sought after in hopes of improving the look of moderate to severe frown lines in adults, most often those that form between the eyebrows (technically called “glabellar lines”). It’s important to point out that injections like Xeomin and Botox are only a temporary solution for reducing wrinkles and need to be repeated within several months for skin to retain its improved appearance.

Much like with some other medications and over-the-counter products, facial injections don’t address the root cause of the problem (in this case aging skin). Injections won’t permanently improve skin health or address contributing factors to wrinkles — like sun damage, exhaustion, smoking, and eating a poor diet. To help improve your skin’s appearance in a lasting way, you’ll need to make dietary and lifestyle changes. You can also use natural oils and products on your skin that help fight wrinkles and fine lines without costing a lot or posing much risk for side effects (more on these below).

Xeomin vs. Botox vs. Dysport

There are other similar products to Xeomin available on the market, such as the medication called Dysport^®, which have the same active ingredient and indication as Xeomin. Of course, there is also Botox, probably the most well-known injectable medication for reducing wrinkles.

Clinical trials that have been conducted thus far suggest that Xeomin is just as effective as Botox. One advantage that Xeomin seems to have over Botox is this: while the two share an active ingredient called botulinum toxin type A, Xeomin goes through a unique manufacturing process that uses no additives. This may pose less risk of causing allergic reactions and side effects compared to Botox.

All three of these drugs — Xeomin and Botox and Dysport — have earned FDA approval for the treatment of facial wrinkles. Even though these drugs are indicated to treat lines between the eyebrows, they are also used by doctors “off label” to treat frown lines around the mouth, lines around the eyes called “crow’s feet” and forehead wrinkles. Sometimes they are even injected into the armpits to help reduce excessive sweating.

So what’s the biggest difference between Xeomin^®, Botox^® and Dysport^®?

• According to Advanced Dermatology, “The active ingredient in Xeomin, botulinum toxin, is exactly the same as in Botox and Dysport.  Patients whose cosmetic results with Botox or Dysport are unsatisfactory may have more success with Xeomin.” (3)
• The makers of Dysport state that the product delivers “natural looking results” and is “proven to help smooth the appearance of moderate to severe frown lines between the eyebrows without changing the look or movement of the rest of your face.” (4) Dysport has been approved for longer than Xeomin has and is currently approved for use in over 69 countries. Xeomin is currently approved in 51 countries.
• Patients tend to see results from both Xeomin and Dysport within two to three days, but stop seeing results in about two to four months. Not every patient experiences positive results from these treatments; studies have found that 40% or more of adults receiving Xeomin injections don’t notice any benefit after one treatment.
• Dysport and Xeomin can cause similar  side effects, especially in people who are allergic to their active ingredient. Dysport is not indicated for people who are allergic to cow’s milk protein, but this warning doesn’t seem to apply to Xeomin.
• A study published in the Journal of Neurological Sciences found that Xeomin showed “non-inferiority” compared to Botox when used in the same doses to treat fine lines. This means that according to to the study, both Botox and Xeomin are safe and effective. Both of these injections tend to cause results within a week, and results tend to last for a similar duration of time (about three months but sometimes longer, such as up to six months).
• One advantage of Xeomin is that it has no additives and just contains botulinum toxin type A. Some proteins that are found in other medications that may trigger a negative response by the immune system are removed, which may mean it leads to fewer side effects. Some speculate that less proteins means less chance for antibodies to develop and less risk for an allergic response. (5)
• Xeomin is also the first drug of its kind that does not need to be refrigerated before use. This helps with distribution, which may make it more widely available and possibly cheaper.
• All three of these drugs can cause similar side effects, such as bleeding and bruising at the injection site and allergic reactions, such as skin irritation, itching, swelling or shortness of breath.
• The cost of these medications ranges depending on where they are administered. Costs are usually comparable for the different drugs, although Xeomin may be less costly compared to Botox.

Benefits and Risks

Benefits of Xeomin Injections

Are there any studies showing that Xeomin is effective and also safe? There have only been two randomized, double-blind, placebo-controlled clinical trials that have found that Xeomin is effective in adults for reducing fine lines near the eyes/forehead. As of 2011, the FDA approved Xeomin for use in treating glabellar lines. (6) The product has not been approved for other uses, although again, it’s used off label in some instances.

The two studies that focused on Xeomin’s effects included 547 healthy adults with an average age of 46. Each patient received 20 units of Xeomin. If patients were found to have a two-grade improvement on a four-point scale in terms of their severity of fine lines, then they were considered to be a “positive responder” to Xeomin (meaning the product worked to improve the appearance of their skin). Compared to placebo, Xeomin was successful at reducing fine lines in 60 percent of participants in one study and 48 percent of participants in another. In both studies, 0 percent of participants receiving the placebo experienced skin improvements.

You can see that Xeomin appears to work better than a placebo, but it still doesn’t work 100 percent of the time. In fact, it only helped reduce wrinkles after one treatment in 48 percent to 60 percent of people involved in the two trials, meaning 40 percent to 52 percent of participants did not have a positive response.

Risks and Side Effects Associated with Xeomin

Research suggests that Xeomin appears to be safe overall for most people, but it can still potentially cause serious side effects, even some that can be very serious or life-threatening. Side effects are most likely to occur in people with an allergy to any of the ingredients found in Xeomin®, such as incobotulinumtoxin A, human albumin or sucrose. When symptoms of an allergic reaction to Xeomin occur, they can include itching, rash, redness, swelling, wheezing, asthma symptoms, or dizziness or feeling faint. (7)

If you’ve ever had a bad reaction to any other botulinum toxin products — such as rimabotulinumtoxinB (found in Mybloc®), onabotulinumtoxinA (found in Botox) or abobotulinumtoxinA (found in Dysport) — then Xeomin may also cause you to have an allergic reaction. You should definitely avoid using Xeomin if you’re at high risk for a negative reaction, since these can sometimes be severe and painful.

You should always report any allergies that you’re aware of to your doctor before treatments. Also let your doctor know right away if you experience any of these side effects that indicate you’re reacting badly to the product:

• Problems with swallowing, speaking or breathing. If you’ve had breathing problems in the past, you may be at a higher risk fo experiencing these side effects. Rarely swallowing problems can become bad enough that they last for several months and require tube feeding in order to receive food and water.
• A disease called botulism, which is due to toxins spreading in the body. Botulinum toxin may affect areas of the body away from the injection site and cause side effects like loss of strength, muscle weakness, double vision, blurred vision, drooping eyelids, hoarseness, trouble speaking, lack of bladder control, trouble breathing and trouble swallowing.

Xeomin® is not safe for everyone, especially adults dealing with any of the health conditions below. If you have a history of one of these medical conditions, you should thoroughly understand the risks involved with using Xeomin before receiving any treatment:

• Any disease that affects your muscles and nerves (such as ALS or Lou Gehrig’s disease)
• Breathing problems, such as asthma or emphysema
• Swallowing problems
• Fluid into your lungs (aspiration)
• Bleeding problems
• Drooping eyelids
• Recent surgery, especially on your face
• You’re pregnant or breastfeeding
• You are younger than 18 years of age, since Xeomin® is only indicated for adults over 18

Even if you don’t react badly to facial injections, there are still downsides to consider, including the high cost and need for repeat treatments. You may also find that your skin feels tight, sensitive or stiff following treatments, although this tends to go away within several days.

Natural Alternatives

Before you give facial injections like Xeomin, Botox or Dysport a try, I recommend trying more natural and less invasive options. For example, there are many great uses for essential oils, including helping to combat signs of aging and also protecting skin against infections, breakouts, dryness and more. You can use both essential oils and carrier oils to make homemade anti-aging serums, saving you trips to the doctor’s office, time and money.

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Some of my favorite anti-aging oils and products include:

1. Jojoba oil — a hydrating, anti-inflammatory carrier oil that contains many beneficial ingredients, including vitamin E, vitamin B complex, silicon, chromium, copper and zinc. Jojoba can be used to combat wrinkles and fine lines, skin infections, acne, slow healing wounds, and excess oil or shininess. Jojoba also helps prevent bacteria from growing in wounds, speeds up wound closures and stimulates collagen synthesis.
2.  Pomegranate oil — contains bioflavonoids that help reduce free radical damage and protect skin from sun damage. In fact, some research even shows that pomegranate oil has a natural SPF of eight. It also has lubricating fatty acids that reduce dryness.
3. Frankincense oil — can help reduce the appearance of sunspots and age spots and is one of the best essential oils for skin tightening. Frankincense can be used anywhere on the skin that is prone to sagginess, such as the abdomen, jowls or under the eyes. Mix six drops of oil to one ounce of an unscented oil like jojoba oil and apply it directly to the skin. For help fighting lines around the eyes, try this Homemade Eye Cream Recipe.
4. Lavender oil — helps heal various skin conditions, including burns and cuts, wrinkles, inflammation and irritation. It contains antioxidants that fight free radical damage, the root cause of wrinkles and fine lines. Try using lavender essential oil mixed with frankincense, aloe vera and/or coconut oil, such as in this recipe for a Homemade Anti-Aging Serum.
5. Rosehip oil — a rich source of vitamin C and essential fatty acids, including oleic, palmitic, linoleic and gamma linolenic acid, which decrease dryness and wrinkles. Rose hip may also aid in collagen production, helping to keep skin firm and elastic.
6. Shea butter — contains vitamins A and E and has high amounts of saturated fatty acids to boost hydration. Can help to reduce inflammation, burns and sun damage, and support collagen production.
7. Coconut oil — coconut oil is loaded with good fats and antibacterial acids that hydrate skin and help prevent breakouts or infections. Coconut oil also is able to penetrate your skin on a deeper level than your average product because of its low molecular weight and the way it bonds with proteins. It can be used directly on the face or added to body butters, scrubs, serums, masks, night creams and more.

What are other ways you can naturally help prevent fine lines and wrinkles from forming?

• Consume collagen. Collagen is the most important and abundant protein in the body, keeping tissues (including skin) youthful and strong. Collagen is used in many beauty products because it can help repair wounds, firm skin, aid in hydration, and prevent damage caused by environmental factors or aging. It may also have a protective role in terms of preventing skin aging since it improves the activity of antioxidants.
• Eat a healthy diet that includes anti-aging foods like quality proteins, fish, berries, citrus fruits, leafy greens, nuts and seeds, bone broth, turmeri, maca powder, and cocoa.
• Get enough sleep.
• Stay hydrated by drinking enough water.
• Manage stress.
• Exercise.
• Don’t let your skin burn from too much sun exposure.
• Use quality products on your skin, including natural/organic cleansers, lotions and makeup.

Other Common Questions About Facial Injections

How much does Xeomin and similar injections cost?

The cost for Xeomin and other cosmetic treatments depends on the amount of the medication that’s needed. This varies among patients. Usually men need more units than women because their muscles are larger. The cost is determined by the number of units being injected. The cost is usually about $9 to $11 per unit of Xeomin. Botox prices can be similar, although they tend to be slightly higher at about $10 $15 per unit.

This can equate to about $200 per treatment of Xeomin but depends on the size of the area being treated. Some treatments may be as little as $50, while others are as high as $400. (8)

How long does each treatment take?

Each Xeomin treatment usually takes about 10–20 minutes and is performed at your doctor’s office. Your doctor injects Xeomin^® into the muscles in your forehead near your eyebrows. No anesthesia is usually required because the injection is usually not very painful. Some physicians will choose to use a topical anesthetic or cold pack however to reduce any pain or discomfort. You will need more than one injection during each treatment. Your doctor will mark tiny dots on your skin where an injection will need to be inserted, and then he or she will use about five to 20 injections per treatment session.

How long will results last?

Most people notice improvements in their skin between three to four days after receiving an injection. The average time to see improvements is within one week. Maximum effects will last for about one month (30 days), but you will likely still notice an improved appearance for about three to four months. Each person reacts a bit differently to treatment; some people will retain results for longer, and some for less than three months. The time between injections increases with repeated treatments, so after you’ve been using Xeomin for a while you may retain results for about six months instead of three.

How many treatments are needed?

This is really up to you, depending on your goals. You can receive just one treatment and retain results for several months, then decide not to have any more treatments, or you might choose to visit your doctor for treatments every several months in order to keep seeing results.

Final Thoughts

• Xeomin^® (incobotulinumtoxinA) is a prescription medication used to treat fine lines. It’s typically injected into the muscles near the eyebrows but can also be used to treat other wrinkles on the face.
• Clinical trials that have been conducted thus far have found that Xeomin is as effective as other medications with the same indication, including Botox and Dysport. The active ingredient in Xeomin, called botulinum toxin A, is exactly the same as in Botox and Dysport.
• One advantage of Xeomin is that it has no additives and just contains botulinum toxin type A. Some proteins that are found in other medications that may trigger a negative response by the immune system are removed, which may mean it leads to fewer side effects.
• Xeomin is generally safe for adults over 18 but can potentially cause some side effects. These can include an allergic reaction, pain at the injection site, redness, bumps, itching, or potentially even problems swallowing, speaking or breathing.
• Because Xeomin doesn’t work 100% of the time, can be expensive and may cause side effects, I recommend natural alternatives first. Oils and products that can help fight wrinkles and fine lines include: jojoba oil, coconut oil, lavender and frankincense essential oils, rosehip oil, pomegranate oil, collagen, and more.

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