Botox vs Dysport vs Xeomin: which one, and does it matter?

Botox, Dysport and Xeomin are all botulinum toxin type A, and for most people in most areas the result you see in the mirror will be very similar. The differences are real, but they are differences of formulation, dosing units and diffusion, not differences of category. If a clinic tells you one of the three is dramatically superior, ask them to explain why for your specific muscle and your specific goal.

We carry all three at our Bradford clinic, which is the only reason we can write this honestly. A clinic that stocks one brand has an obvious incentive to tell you that brand is best.

All three products contain the same active molecule

Botox, Dysport and Xeomin are all botulinum toxin type A, a purified protein that temporarily blocks the nerve signal telling a muscle to contract. The generic names differ because the manufacturing and formulation differ: Botox is onabotulinumtoxinA (AbbVie), Dysport is abobotulinumtoxinA (Ipsen/Galderma), and Xeomin is incobotulinumtoxinA (Merz). The mechanism of action is identical in all three. What changes is what surrounds the active molecule in the vial and how the product is measured.

The units are not interchangeable, which is why per-unit prices cannot be compared

One unit of Dysport is not equivalent to one unit of Botox, so a lower per-unit price does not mean a cheaper treatment. Commonly used conversion ratios sit somewhere around 2.5 to 3 Dysport units for every 1 Botox unit, and that is a working rule of thumb rather than an exact equivalence. Botox and Xeomin units are generally treated as roughly comparable to each other. The practical consequence: if one clinic quotes you a per-unit price for Dysport and another quotes a per-unit price for Botox, those two numbers are not the same currency. Ask both clinics what the total cost is to treat the area you care about.

Xeomin is formulated without the accessory proteins found in the other two

Xeomin contains the active toxin without the complexing proteins that accompany it in Botox and Dysport, which is why it is sometimes described as a “naked” toxin. Merz markets this as a purity difference, and it is a genuine formulation fact rather than a slogan. The theory is that fewer non-active proteins means less material for the immune system to respond to over years of repeat treatment. This is a reasonable theory. It is not a promise that Xeomin will work for you when the others have not, and you should be sceptical of anyone who presents it that way.

Dysport is often chosen for broad areas and Xeomin or Botox for small precise ones

Dysport is widely described as spreading further from the injection point than the other two, which makes it a common choice for large flat areas like the forehead, and a more cautious choice near the eyes or brow where a millimetre matters. Xeomin is generally described as spreading the least. These descriptions are useful, but be aware that how far any of these products travels is heavily influenced by how much saline it is diluted with and how the injector places it. Technique and dilution can easily outweigh brand. This is a reason to care more about who is injecting you than which box the product came out of.

If you have a cow’s milk protein allergy, Dysport is the one to avoid

Dysport contains a trace of lactose derived from cow’s milk, so it is contraindicated for people with a known allergy to cow’s milk protein. Botox and Xeomin both contain human serum albumin. Any known allergy to a product component, or a previous reaction to a botulinum toxin injection, is a reason to choose a different product or not to treat at all. Tell your injector about every allergy, including ones you think are irrelevant.

“My Botox stopped working” usually has a simpler explanation than resistance

True antibody-mediated resistance to botulinum toxin exists but is uncommon in cosmetic dosing, and it is not the first thing we look for. Far more often, a disappointing result traces back to an underdose for the muscle mass in question, a treatment interval that has crept longer than you remember, a change in the area being treated, or an expectation that softened lines would disappear entirely. Photographs from your previous appointments settle this argument quickly, which is one practical reason to have your injector take them. If genuine non-response is suspected, switching to Xeomin is one of the options that gets discussed, alongside reviewing dose and interval.

We will not tell you how long your result will last

How long a neuromodulator result lasts varies with the dose used, the muscle treated, how strong that muscle is, how you metabolise the product and what you are comparing it to. Published brand-versus-brand comparisons have not produced a duration difference that we would consider decisive for an individual patient, and any clinic quoting you a confident number for your face before assessing it is guessing. Your injector will give you a realistic expectation at your appointment, based on the dose actually planned for you, and will adjust it after they have seen how you respond once.

Which we would suggest, and when

For a broad forehead where even softening across a wide area is the goal, Dysport is a sensible default. For the frown lines between the brows, crow’s feet, or anywhere the boundary of the effect matters, Botox or Xeomin are easier to place precisely. For someone who has had many years of treatment and wants to minimise long-term exposure to non-active proteins, Xeomin is a defensible choice. For a first-time patient with no particular constraint, any of the three is a reasonable starting point, and the honest answer is that you would probably not be able to tell which you had received.

All three are prescription medicines in Canada

Botox, Dysport and Xeomin are prescription drugs in Canada, which means a physician or nurse practitioner must assess you and authorise the treatment. Injections are performed by regulated health professionals; estheticians may not inject in Ontario. At Bradford Skin Clinic, Alex Dinovich, FNP-PHC, is a nurse practitioner and authorised prescriber, and our injectors are Registered Practical Nurses. If you are ever unsure who is treating you and under what authority, ask. A clinic that cannot answer that question clearly has told you something important.

Written at Bradford Skin Clinic & Medical Spa, 444 Holland St W, Unit #2, Bradford, Ontario, where all three products are stocked. Clinically reviewed by Alex Dinovich, FNP-PHC, Nurse Practitioner and Medical Director.