Advanced Dermatology participated in the study that led to FDA approval of Xeomin as an alternative to Botox and Dysport. Although introduced in the US in 2010, Xeomin has been used successfully in other countries since 2005. Like Botox and Dysport, Xeomin is designed to treat brow wrinkles, crow’s feet, bunny lines, and frown lines. The active ingredient, 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.



How do I know if I need Xeomin?


If you have frown or forehead lines, crow’s feet, smile lines around your eyes, or all of these, Xeomin injections will make you appear more relaxed and less tired. If you received Botox or Dysport and found that your improvement is less than expected, didn’t last as long as it should, or has decreased for a given dosage, you may respond better to Xeomin. Our experience shows that people who respond poorly to Botox often respond well to Xeomin. Failure to respond to Botox may be due to the formation of antibodies to proteins that surround the active ingredient of Botox. Since the active ingredient of Xeomin is not coated with protein, antibodies do not form and the patient responds better. You should not have Xeomin if you are pregnant, have an infection at the site of Xeomin injection, or have multiple sclerosis, myasthenia gravis, or Lambert-Eaton syndrome. If you have any neurological disease or history of temporary paralysis, loss of vision, or double vision, you should not have Xeomin injections. These disorders may increase the risk of complications with Xeomin injection and worsen an underlying disorder.


How does Xeomin work?


Most patients find that the procedure is very tolerable. The needle is tiny and cold air and ice packs minimize the slight burning sensation during injection. The treatment takes only 10 minutes. Patients who have the injections for the first time are relieved afterwards because the procedure was easier than they anticipated. For cosmetic injections, your provider will cleanse the target area and ask you to frown, smile, or look surprised. These facial expressions will cause you to activate the muscles to be injected. The provider will mark the injection spots with a washable pen and then proceed with the treatment, usually 5 to 20 injections.


What benefits can I expect?


Results depend on the area treated. Wrinkles on your forehead and around your eyes may become smoother, your brow may be lifted and your eyelid may become more opened. Your overall facial expression will be one of greater relaxation and alertness. Wrinkle reduction varies among patients and improvement typically lasts 3 to 4 months before another treatment is necessary. The time between injections increases with repeated treatments, sometimes up to 6 months to maintain the benefits. Treatments given too early (less than 3 months) may reduce the effectiveness of Xeomin.


What are the risks and side effects?


Occasionally Xeomin injections cause the natural asymmetry of the face to become more pronounced. Or, the injections may abruptly cause a relaxed area of the face to look more active. The eyebrows become pointed, like Mr. Spock’s. Either of these side effects is corrected by injecting a small amount of Xeomin. Other side effects include drooping eyebrow or eyelid, double vision, and weakness in closing the eyes. These conditions are rare and occur only if Xeomin migrates to nearby tissues. If they do occur, they disappear in a few months because the effects of Xeomin are temporary. Prescription eye drops may also help. Xeomin may also cause a headache, even though it may be given to relieve a headache. The new headache occurs because other muscles start contracting to compensate for the muscles that have relaxed. A severe headache may persist up to 2 weeks after Xeomin injections, but this is very rare. Prior to treatment all potential risks and side effects will be discussed with you by your medical provider and cosmetic coordinator.


How will I look and feel during and after this treatment?


To prevent bruising after treatment, do not take aspirin-containing products or high-dose vitamin E supplements (unless your doctor has recommended otherwise) for 10 days before the procedure. The vitamin E of a typical multivitamin may be taken during this time. The injected area will look like a mosquito bite for 20 to 60 minutes and be swollen for a few hours. Little red areas may appear but they resolve in a few days. Bruising is uncommon but if it occurs, it may require 7 to 10 days to clear. In the meantime the bruise can be camouflaged with makeup, which may be applied immediately after treatment. You can speed up Xeomin absorption by making frowns, raising your eyebrows, smiling, and squinting. Do this several times for a few hours after the injections. Try not to lay back or fall asleep during this time because the injected Xeomin may spread to nearby areas and cause unwanted relaxation of other muscles. Feel free to resume your regular skin care immediately after treatment. Try to avoid aspirin containing products or high-dosage vitamin E supplements for 48 hours unless your doctor has recommended otherwise.