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What's So Special About Xeomin?

By: Stephen Hsieh, MD


What's so special about Xeomin?

The development of skin wrinkles can be linked to many causes including the loss of subcutaneous fat, degradation of skin collagen, the effects of environment, and exacerbated by the action of underlying subcutaneous muscle activity. One of the most popular treatments for wrinkles is the use of botulinum toxin A to partially paralyze the muscles under the wrinkle to provide a temporary smoothing of the overlying skin wrinkles.

When Dr. Juergen Frevert invented Xeomin [1] in 2005, he thought he had achieved a tremendous breakthrough in neuroscience. He was formerly a leading research scientist at Allergen Pharmaceuticals and collaborated with their development of Botox. But he left Allergen and set up his own company placing his entire career on the line on the bet that he could produce botulinum toxin A in its pure form WITHOUT the presence of the controversial complexing protein. His bet was that a pure form of botulinum toxin A without this complexing protein could be produced, that it would work as well as Botox, and would have the same shelf life as Botox and other similar toxins.

Up until this point, scientists had many theories about the role of naturally occurring complexing protein which was  always associated with botulinum toxin. Some theories suggested it allowed the toxin to be stable when stored by its natural pathogen Clostridium botulinum.[2] Others theorized that the protein prevented diffusion of the toxin when injected into the skin to produce a more local effect. Additionally, some surmised that complexing protein was a natural defense against gastric acid degradation.

Until this point, all pharmaceutical companies produced botulinum toxin A with complexing protein [3] due to a poor understanding of the actual role that complexing protein played. However, they all knew that there was an association between complexing protein and the phenomenon of botulinum resistance.[4] This is the development of resistance to botulinum toxin which causes the need for larger and larger doses, and can cause the time between treatment intervals to become shorter and shorter.

When Xeomin is studied against competitors Botox and Dysport, efficacy and stability is comparable.[5] This lends credence to the true role of complexing protein protecting the botulinum toxin A from gastric acid. By extension, Dr. Frevert theorizes that Xeomin should have less issues with neurotoxin resistance when compared to its competitors, but this has not been definitively proven.

While true allergies to neurotoxin are exceedingly rare, resistance to neurotoxin can be a significant nuisance to those who want to maintain their wrinkle free appearance. There are strategies to minimize or delay neurotoxin resistance.[6] Changing to a different form of neurotoxin such as botulinum toxin B (Myobloc) can allow the body's natural resistance to neurotoxin A to subside with time. However, Myobloc is considered significantly less potent than its toxin A competitors.[7]  Often taking an extended holiday from neurotoxin may restore sensitivity with time. Remember that neurotoxin is always a temporary remedy, and there are other modalities such as radiofrequency and laser skin resurfacing which build up natural collagen in your skin leading to lasting results.

I hope that you see that the decision to use neurotoxin for aesthetic purposes can be a complicated venture. The selection of toxin and timing can be a dynamic challenge and should always be discussed with your aesthetic provider. Select a provider who has experience with the different types of neurotoxin and who can offer a selection of toxin to suit your needs. Ideally, an aesthetic provider should offer a range of modalities to address skin wrinkles.

Should you be in the Winston-Salem area, we would be happy to discuss your aesthetic needs and concerns regarding neurotoxin and other skin tightening modalities.

Works Cited:

[1] "Dr. Juergen Frevert, Head of Botulinum Toxin Research at Merz Pharmaceuticals" by Lara Devgan, MD, MPH, January 8, 2020, on

[2] "Immunogenicity of Botulinum Toxin" by Syeo Young Wee and Eun Soo Park, January 15, 2022, Archives of Plastic Surgery 2022;49(1):12-18, on

[3] "Complexing Proteins in Botulinum Toxin Type A Drugs: A Help or Hinderance?" by Juergan Frevert and Dirk Dressler, December 9, 2010, on

[4] "Xeomin: An Innovative New Botulinum Toxin Type A" by Juergan Frevert, December 7, 2009, European Journal of Neurology, on

[5] "A Mixed Treatment Comparison to Compare the Efficacy and Safety of Botulinum Toxin Treatments for Cervical Dystonia" by Yi Han et al, February 25, 2016, on

[6] "How to Overcome Botox Resistance" by Adebola Dele-Michael, MD and Jennifer Mueller, JD, August 28, 2022, on

[7] "Botulinum Toxin Type B (MYOBLOC) vs. Botulinum Toxin Type A (BOTOX) Frontalis Study: Rate of Onset and Radius of Diffusion" by Timothy Flynn and Robert Clark, May 2003, on

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.