Dysport, Xeomin, and Botox: How a Provider Chooses

Botox Cosmetic, Dysport, and Xeomin are all FDA-approved botulinum toxin type A, made by three different companies from the same family of molecule. The difference that matters most in a treatment room is which areas each one is approved to treat, because that list is not the same for all three.

All three work the same way. A small amount of purified protein is placed in a specific muscle, where it blocks the signal telling that muscle to contract. The muscle softens, the skin over it stops creasing as hard, and the line relaxes. What differs is how each is built. Botox Cosmetic and Dysport arrive as a complex, meaning the active neurotoxin plus accessory proteins from manufacturing. Xeomin is purified so the neurotoxin is separated from those proteins.

Which areas is each one FDA-approved to treat?

Botox Cosmetic is FDA-approved in adult patients for temporary improvement in the appearance of four areas, each described on its label as moderate to severe: glabellar lines (the frown lines between your brows), lateral canthal lines (crow's feet), forehead lines, and platysma bands (the vertical cords on the neck). It is the only one of the three approved for the neck.

Xeomin is FDA-approved in adult patients for three areas, grouped on its label as upper facial lines and each described as moderate to severe: glabellar lines, horizontal forehead lines, and lateral canthal lines. It is not approved for platysma bands. Its cosmetic approval once covered frown lines only and was widened to all three upper face areas in 2024.

Dysport is FDA-approved for one cosmetic area: moderate to severe glabellar lines, in adults less than 65 years of age. It is not approved for crow's feet, for forehead lines, or for the neck, and it is the only one of the three with an upper age limit.

Providers do treat areas outside a product's cosmetic label, using clinical judgment. That is off-label use: legal, ordinary across medicine, and a normal part of how experienced injectors work. A good provider says so plainly while planning your treatment, without you having to raise it.

Why are the unit numbers so different between them?

All three labels say the same thing in slightly different words: the potency units of that product are specific to that product, and cannot be compared to or converted into the units of any other botulinum toxin product. Units are not a shared measurement the way milligrams are. Each product has its own scale.

You can see it in the approved doses for the same patch of skin. For frown lines, the approved total is 20 units of Botox Cosmetic, 20 units of Xeomin, and 50 units of Dysport. Nobody receives more than twice as much treatment with Dysport. The number counts something different.

So a unit count on its own tells you very little. Converting between products is your provider's decision.

How fast does each one work, and how long does it last?

The labels put all three in a similar range. The Botox Cosmetic label describes the injected muscles starting to relax one to two days after treatment and building through the first week, with the effect on frown lines lasting approximately three to four months. The Xeomin label puts median onset within two to seven days, and a typical duration of up to 12 to 16 weeks that varies between individuals. The Dysport label says the clinical effect may last up to four months.

Studies that compare onset directly do not agree. A 2025 randomized trial using 3D imaging found abobotulinumtoxinA, the toxin in Dysport, among the fastest at day three. A 2013 randomized study found incobotulinumtoxinA, the toxin in Xeomin, reached onset earliest. The gaps in both are a day or two, and individual response varies more than the products do.

You will also read that Dysport spreads further after it is injected. How far a product travels from the injection point depends heavily on how it is diluted, how much goes in, and how many injection points are used and where. Those are the injector's decisions, not a ranking you can read off the box.

How does a provider choose between them for your face?

It depends on you, and the list a provider runs through is short.

First, which area is being treated and whether it sits on that product's label. Frown lines put all three in play. Crow's feet and forehead lines narrow the field. Neck bands point to one. Second, what you have had before and how it went, because a product that gave you a clean result at a comfortable interval is usually the one you stay with. Third, your anatomy: muscle strength, brow position, and the way your face moves change where a dose goes and how much is needed. Fourth, how many areas you are treating at once and how long it has been since your last visit.

None of it is a ranking of the brands. It is about fitting a product to a face and a plan.

If Botox stopped working, should you switch to Xeomin?

Possibly, though the reason it faded is probably not antibodies.

True antibody resistance, where your immune system neutralizes the toxin, is very rare at cosmetic doses. Across the Botox Cosmetic crow's feet trials (916 treated subjects), the Dysport frown line program (1,554 subjects over up to nine treatment cycles) and the Xeomin frown line trials (464 patients), no one developed neutralizing antibodies. Each label also notes that testing methods differ enough between products that these numbers should not be ranked against one another.

Xeomin does contain the neurotoxin without accessory proteins, and that is on its label. Most of what has been studied about that formulation and resistance comes from conditions like cervical dystonia and spasticity, where doses run many times higher and treatments come closer together. Those findings do not transfer cleanly to a frown line treatment.

When a treatment feels weaker than it used to, the ordinary explanations come first: the dose, where it was placed, a longer gap between appointments, a change in muscle strength, or a first result that has grown a little in memory. Trying a different product is something a provider may well suggest. It is a reasonable next step rather than a proven fix.

What are the risks, and what does the boxed warning mean?

The everyday side effects are local and short lived: soreness at the injection sites, small bruises, swelling, redness, and sometimes a headache for a day or two. In the frown line trials, eyelid drooping was reported in about 3 percent of Botox Cosmetic subjects and about 2 percent of Dysport subjects. It resolves on its own, though the Botox Cosmetic label notes that effects like this, while often short lived, can last several months or longer. Careful placement is how a provider keeps it uncommon.

All botulinum toxin products, these three included, carry a boxed warning from the FDA about distant spread of toxin effect. It describes toxin effects appearing away from the injection site, hours to weeks after treatment, including muscle weakness and difficulty swallowing or breathing. The label states that swallowing and breathing difficulties can be life threatening and that there have been reports of death. It is also specific about where the risk concentrates: it says the risk is probably greatest in children treated for spasticity, and that symptoms can also occur in adults treated for spasticity and other conditions, particularly in patients with an underlying condition that predisposes them. Those are therapeutic uses. The Botox Cosmetic label adds that cases of spread have been reported at doses comparable to those used for cervical dystonia and spasticity, and at lower doses. The wording varies a little between the three labels.

The warning applies to the whole drug class, and it is one reason dose and placement belong with a trained, licensed injector. Tell your provider about any condition affecting your nerves or muscles, and about every neurotoxin treatment you have had and when. That history is what they build the plan on.

What to expect at Redbud

At Redbud, choosing between these is part of the consultation rather than a menu you pick from in the waiting room. We look at your face at rest and while it moves, ask what has been bothering you and what you have had before, and talk through which product fits the area and the result you want. If you have never had a neurotoxin, we start conservatively and build, because it is easy to add and slow to subtract.

Appointments are unhurried and performed by licensed, experienced providers in our boutique Denver studio. Read more about Botox Cosmetic, Dysport, and Xeomin on their own pages, and about our team and credentials. On timing rather than product, see when to start Botox, how long Botox lasts, and five common myths about Botox and neurotoxins. General questions about first visits and candidacy live on our FAQ page.

Ready to talk it through?

If you are trying to choose between Botox, Dysport, and Xeomin, a consultation is the simplest way to settle it. Book an appointment at Redbud Medical Spa in Denver. We will look at the areas you want treated, go through what you have had before, and tell you plainly which product we would use and why. Book a consultation.

Medical disclaimer: This article is for general education and is not medical advice. Botox Cosmetic, Dysport, and Xeomin are FDA-approved for the cosmetic areas described above and for those areas only, and treatment of any other area is off-label. All botulinum toxin products carry a boxed warning about distant spread of toxin effect. Units are specific to each product and are not interchangeable, and nothing here is a dosing guide. Results vary from person to person. Whether any of these is right for you is a decision to make with a licensed provider who has reviewed your face and your health history.