What is the difference between Xeomin, Botox, Dysport, vs. Jeuveau?

In 2021, FDA has approved 4 neurotoxins for use to reduce the wrinkles in the frown lines between the eyes. Let’s go over each of the botulinum toxins and find the difference between them. Although I am the medical director for the Park Medspa, I will give you an unbiased opinion on the 4 neurotoxins based on evidence-based medicine. Then, perhaps you’ll understand why we decided to start using Xeomin.

(Disclaimer: Dr. Jay Park is the medical director for the Park Medspa and there is a financial relationship with Xeomin.)

What are the different botulinum toxins?

Botox = ONAbotulinumtoxin A
Dysport = ABObotulinumtoxin A
Xeomin = INCObotulinumtoxin A
Jeuveau = PRAbotulinumtoxin A

Botulinum toxin A (“BoNT-A”) is a purified strain of botulinum toxin.

The different prefixes “Ona,” “Abo”, “Inco,” and “Pra,” indicate the differences in the biological properties of each botulinum toxin.

Which one is better?

This is a question that I get asked ALL OF THE TIME. For the sake of impartiality, let me show you a chart with many of the research publications that compare one toxin vs another.

There are a few studies that state that Dysport at a higher dilution rate (3:1) had better outcomes than Botox. There is one study that states that Xeomin had a better outcome than Botox.

Our best conclusion based on the data is that all four are effective and well-tolerated. A much larger double-blind clinical study needs to be performed before anyone botulinum toxin company can claim superiority. Anecdotally, we have not seen anyone botulinum toxin perform better than the others to smooth fine lines and wrinkles. They are not interchangeable, but they have similar efficacy and safety.

What is the unit equivalence?

Another common question is: If I get 20 units of Botox on my frown line, then how much of the other neurotoxins should I get?

Based on the package insert, here is the equivalent amount:
Botox 20 units
Dysport 50 units
Xeomin 20 units
Jeuveau 20 units

However, one research article suggests that the following should be the optimal equivalent amount:
Botox 20 units
Dysport 40–60 units
Xeomin 20 units

Is one purer than another?

Xeomin is the only currently FDA-approved botulinum toxin that uses the XTRACT Technology that removes unnecessary proteins. Xeomin contains only the core neurotoxin protein without other accessory proteins. In clinical trials, none of the 2650 patients developed secondary treatment resistance due to neutralizing antibodies. What does this mean? Well, a very small number of patients can build up neutralizing antibodies against botulinum toxin and the accessory proteins. This can cause the patient to require a higher dose. In rare cases, the patient becomes immune to the botulinum toxin completely. So, in theory, Xeomin may be less immunogenic than the other botulinum toxins.

Are there different handling requirements?

Xeomin is the only currently FDA-approved botulinum toxin that does not require refrigeration prior to reconstitution.

What is the cost of each vial?

Currently, the purchase price for Botox, Dysport, Xeomin, and Jeuveau are as follows:

Conclusion

All four botulinum toxins are generally accepted to have equal efficiency and safety. We decided to participate in the Xeomin Challenge, because Xeomin has an additional layer of purity, and is easier to handle due to the lack of refrigeration requirements. Finally, the Park Medspa offer of $99 for 20 units provides patients with a great opportunity to try a different botulinum toxin.

Originally published at ParkMedspa.com.