XEOMIN®

XEOMIN® and BOCOUTURE®: One Molecule, Two Brand Names

XEOMIN® is incobotulinumtoxinA, a XEOMIN® botulinum toxin developed by Merz Pharmaceuticals (Frankfurt, Germany). BOCOUTURE® is neither a competitor nor a copy. It is the name Merz uses for the same molecule in aesthetic practice across the EU and UK. The formulation, the manufacturer and the vial contents are identical; only the carton and the market positioning change, because Merz uses the two brand names to navigate different regulatory frameworks.

Across the EU and UK, the BOCOUTURE® name is applied to aesthetic indications such as glabellar lines, crow’s feet and forehead lines. XEOMIN® is used internationally and in the United States, where the label reaches into therapeutic territory as well. A practitioner who sees either name on a vial is handling one and the same incobotulinumtoxinA.

Merz Pharmaceuticals in Germany manufactures XEOMIN®. The list of ingredients in XEOMIN® is short: purified 150 kDa botulinum neurotoxin type A, human serum albumin and sucrose [1]. No haemagglutinins or accessory proteins ride along, which is where the “naked toxin” nickname comes from. As a botulinum neurotoxin supplied for professional use only, XEOMIN® sits alongside every other type A product in the same regulatory class. In practical terms, XEOMIN®is a lyophilised powder that clinics reconstitute with preservative-free saline before intramuscular or intraglandular delivery.

Where XEOMIN® Sits Among Botulinum Toxin Products

Most botulinum toxin products practitioners meet are built on one of five distinct type A active substances. Each has its own manufacturing process, potency assay and international non-proprietary name:

• onabotulinumtoxinA: BOTOX® (Allergan Aesthetics, an AbbVie company)
• abobotulinumtoxinA: DYSPORT®, marketed for aesthetic use in the EU/UK as AZZALURE® (Ipsen, with Galderma)
• incobotulinumtoxinA: XEOMIN® / BOCOUTURE® (Merz)
• prabotulinumtoxinA: NABOTA®, marketed in the US as Jeuveau® (Daewoong)
• letibotulinumtoxinA: BOTULAX® in Korea and LETYBO® in Europe and the US (Hugel)

All five share the same acetylcholine-blocking mechanism, yet each is a separate pharmaceutical, and XEOMIN® is the only one supplied without complexing proteins. Clinics that buy botulinum toxins across mixed aesthetic and therapeutic caseloads tend to keep XEOMIN® on the shelf specifically for the protein-free profile: one vial that spans upper facial lines, cervical dystonia, blepharospasm, spasticity and sialorrhea within a single FDA-approved product.

Protein-Free Formulation and Room-Temperature Storage

Most toxins deliver the 150 kDa neurotoxin inside a larger complex of haemagglutinin and non-haemagglutinin proteins. During purification, Merz separates the neurotoxin from those accessory proteins [4]. Because the complexing proteins play no part in muscle relaxation, removing them leaves the pharmacological activity intact while lowering the foreign-protein load delivered with each injection of XEOMIN®.

• Immunogenicity: Patients who receive repeated botulinum treatments over many years can, rarely, develop neutralising antibodies that blunt the response. Published data on incobotulinumtoxinA report low rates of new antibody formation [3][4], which is why many injectors favour it for long-term patients [4]. The second is diffusion: without the complex, spread beyond the target muscle is often described as more contained, although dose, dilution and technique remain the bigger variables in any injection.
• Storage: Unopened XEOMIN® vials can be kept at or below 25°C for their full shelf life [1]. Among the toxins compared, XEOMIN® is the only one with that option; BOTOX®, DYSPORT® and the Korean products rely on refrigerated storage. For a clinic, that translates into simpler stock handling, less exposure to the cold chain, and fewer wasted vials when a delivery arrives outside strict temperature control. Once reconstituted, XEOMIN® should be refrigerated and used within 24 hours [1].

Is XEOMIN® FDA Approved? Indications and Mechanism

XEOMIN® holds one of the broadest FDA-approval sets in the botulinum toxin category, and the label has expanded steadily since 2010 [1]:

• Cervical dystonia in adults (2010)
• Blepharospasm in adults (2010)
• Glabellar lines (2011), expanded in 2024 to the simultaneous treatment of upper facial lines: frown lines, forehead lines and crow’s feet [5]
• Upper limb spasticity in adults (2015)
• Chronic sialorrhea (2018)

That indication set is wider than the labels of NABOTA®/Jeuveau® and LETYBO®, which the FDA has cleared for glabellar lines alone, although BOTOX® still holds the largest overall list of FDA-approved uses in the class.

Once injected into a target muscle, or into the salivary glands for sialorrhea, it blocks the release of acetylcholine from the presynaptic nerve terminal. Muscle contraction or glandular secretion is reduced for several months, until new nerve terminals restore signalling. In aesthetic practice, XEOMIN® is used to soften upper facial lines and the fine lines and wrinkles produced by repeated expression. In therapy, it covers cervical dystonia, blepharospasm, chronic drooling and XEOMIN® for muscle stiffness in the upper limbs. The benefits of XEOMIN® injections are well documented across both settings, and effective use of XEOMIN® depends on correct dosing, dilution and injection technique for each indication.

Before You Buy XEOMIN® Wholesale: The Full Product Range

Merz supplies incobotulinumtoxinA as a lyophilised powder in single-dose vials [1]. At Medical Spa Rx, we see three unit sizes account for the majority of clinic orders, and matching the presentation to the caseload is where wholesale planning begins. Practitioners looking to buy XEOMIN® wholesale should choose from:

• XEOMIN® 50U — 50 units of incobotulinumtoxinA, well suited to small aesthetic areas and precise low-dose work.
• XEOMIN® 100U — the standard vial for most aesthetic and therapeutic protocols, produced in several labelling variants including English, English Alternative and English/Korean packaging.
• XEOMIN® 200U — for higher-dose therapeutic sessions such as cervical dystonia, upper limb spasticity and sialorrhea, or for multi-area treatments.
• BOCOUTURE® 50U and 100U — the EU/UK aesthetic carton of the same incobotulinumtoxinA, not a separate product (see the BOCOUTURE® section above).
• XEOMEEN® 100U — the Spanish-language presentation of the 100-unit vial.

Practitioners who also buy Korean botox brands at entry price points often pair them with XEOMIN® on the shelf as the protein-free Western alternative.

XEOMIN® Compared to Other Botulinum Toxin Products

XEOMIN® vs BOTOX®

BOTOX® and XEOMIN® share their mechanism but not their active substance. XEOMIN® is incobotulinumtoxinA; BOTOX® is onabotulinumtoxinA delivered together with its complexing proteins. The XEOMIN® and BOTOX® difference comes down to three practical points:

1. Formulation: protein-free versus protein-complexed.
2. Storage: XEOMIN® can be kept unrefrigerated up to 25°C before reconstitution, while BOTOX® must be refrigerated.
3. Long-term use: the lower foreign-protein load gives XEOMIN® a theoretical immunogenicity advantage.

On dosing, a head-to-head Phase III trial found XEOMIN® non-inferior to BOTOX® at the same unit dose (24 U each) [2], and a 1:1 ratio is widely used in practice when switching [3]. Prescribing information still states that units are specific to each product and not formally interchangeable [1], so any switch should follow clinical judgement rather than a naïve substitution. Consistent evidence for a speed difference has not emerged. Both usually start working within a few days and reach full effect around the two-week mark. Both are FDA-approved and authorised in Europe, with comparable aesthetic and therapeutic efficacy data.

XEOMIN® vs DYSPORT®

DYSPORT® (abobotulinumtoxinA, Ipsen with Galderma) is FDA-approved and authorised across Europe, where its aesthetic carton is AZZALURE®. The point that matters most in this comparison is units. DYSPORT® is dosed in Speywood units, which are not interchangeable with XEOMIN® or BOTOX® units.

For glabellar lines, the labelled doses (50 DYSPORT® units against 20 XEOMIN® units) imply a ratio near 2.5:1. Published reviews generally support around 2.5–3 DYSPORT® units for every one XEOMIN®/BOTOX® unit, with some authors recommending the lower end of that range in therapeutic use [3]. In everyday injection planning, a patient who received 50 DYSPORT® units would move to roughly 17–20 XEOMIN® units, never a naïve 50.

Formulation also differs. DYSPORT® carries complexing proteins; XEOMIN® does not. DYSPORT® is often described as spreading slightly further at typical aesthetic dilutions, which some injectors turn to their advantage across the forehead but which calls for extra restraint near the brow and eyelid. On storage, DYSPORT® must be held at 2°C–8°C, so the room-temperature option remains XEOMIN®’s edge.

XEOMIN® vs NABOTA®

NABOTA® (prabotulinumtoxinA, Daewoong, South Korea) is approved in the US as Jeuveau® (2019) and in Europe as Nuceiva®, in both cases for glabellar lines. That regulatory record makes it the Korean toxin closest to XEOMIN® in US standing. Both are commonly dosed 1:1 with BOTOX® units, so their doses are comparable in daily practice.

Elsewhere the two products diverge. NABOTA® is a protein-complexed toxin; XEOMIN® is protein-free. The XEOMIN® label also reaches well beyond glabellar lines, covering the full upper face and four therapeutic indications, whereas NABOTA®/Jeuveau® stays a single-indication aesthetic product on the US label.

XEOMIN® vs BOTULAX®

BOTULAX® is the Korean-market name for letibotulinumtoxinA, the same molecule Hugel exports as LETYBO®. The BOTULAX® carton itself is authorised by Korean and other national regulators rather than the FDA, and it comes in 100U and 200U sizes. The full complexing-protein structure remains intact, so the theoretical immunogenicity edge in repeated treatment stays with XEOMIN® [4].

BOTULAX® units are usually treated as equivalent to BOTOX® units, and by extension to XEOMIN® units, though that convention rests mainly on practitioner experience rather than the head-to-head Phase III data behind XEOMIN®’s 1:1 ratio [2]. BOTULAX® is typically chosen on value; XEOMIN® brings German development by Merz and more than 15 years of FDA-approved clinical use.

XEOMIN® vs LETYBO®

LETYBO® (letibotulinumtoxinA) is Hugel’s toxin in its US and European presentation, approved by the FDA in February 2024 for glabellar lines. Like the other Korean products, LETYBO® contains complexing proteins and requires refrigerated storage, while XEOMIN® is protein-free and can sit at room temperature until reconstitution.

The regulatory gap is wide. LETYBO® holds one aesthetic FDA indication, whereas XEOMIN® has carried FDA approval since 2010 and now covers upper facial lines plus four therapeutic uses [1][5]. Because LETYBO® and BOTULAX® share one active substance, comparing either of them with XEOMIN® is effectively comparing Merz’s toxin with a single Hugel toxin sold under two market names.

XEOMIN® Side Effects and Safety

The most common XEOMIN® side effects sit within the class profile and are usually mild and short-lived: bruising, tenderness or swelling at the injection site, and headache.

A side effect of XEOMIN® that depends heavily on technique is eyelid or brow ptosis after upper-face treatment. Difficulty swallowing, neck weakness and dry mouth are more relevant at therapeutic doses in the neck and salivary glands. Like other botulinum toxins, XEOMIN® may cause serious side effects in rare cases, including spread of toxin effect beyond the injection site [1]. Patients should seek urgent care for signs of a life threatening allergic reaction, wheezing or asthma symptoms, trouble swallowing or breathing, or dizziness or feeling faint. Individual results may vary.

Where to Buy XEOMIN® Online

XEOMIN® is a prescription-only medicine, so licensed medical professionals buy XEOMIN® online only through authorised channels rather than open retail. Verified practitioners who plan to purchase XEOMIN® online should confirm that:

• the distributor is authorised and can document its supply chain;
• shipping paperwork accompanies each carton, with LOT numbers and certificates of authenticity;
• the transaction complies with the licensing rules of the practitioner’s country or state;
• transit temperatures are recorded, because even a room-temperature-stable toxin benefits from controlled shipping.

For practitioners weighing where to buy XEOMIN® wholesale, Medical Spa Rx support staff can provide guidance on verified supplier access, product documentation and sourcing. Contact the team to learn more.

Frequently Asked Questions

Are XEOMIN® and BOCOUTURE® the same medication?

Yes. Both contain incobotulinumtoxinA from Merz. BOCOUTURE® is the aesthetic brand used in parts of Europe and the UK, while XEOMIN® is used internationally and in the US.

Which aesthetic and therapeutic uses are approved for XEOMIN®?

Its US indications include upper facial lines, cervical dystonia, blepharospasm, upper limb spasticity, and chronic sialorrhea.

Can XEOMIN® units be substituted directly for DYSPORT® units?

No. DYSPORT® uses a different potency system, so its units are not interchangeable one-for-one with XEOMIN® units.

What happens to XEOMIN® after it is reconstituted?

After reconstitution, XEOMIN® should be refrigerated and used within 24 hours according to the product information.

Why is XEOMIN® sometimes considered for repeated long-term treatment?

Its lack of complexing proteins reduces the amount of foreign bacterial protein administered. Research associates incobotulinumtoxinA with low rates of neutralizing-antibody formation, although this should not be interpreted as guaranteed superiority.

How can clinics get XEOMIN® sourcing guidance from Medical Spa Rx?

Medical Spa Rx can assist licensed practitioners with verified supplier information, product documentation, and sourcing requirements.

Disclaimer

The page and all of its displayed contents are for medical professionals, designed to inform only, and not as a replacement for medical advice.

Citations and Resources

[1] U.S. Food and Drug Administration. “BOTOX® (OnabotulinumtoxinA) for Injection: Prescribing Information.” U.S. Food and Drug Administration, revised 2024, www.accessdata.fda.gov/drugsatfda_docs/label/2024/125360s099lbl.pdf.

[2] Sattler, Gerhard et al. “Noninferiority of incobotulinumtoxinA, free from complexing proteins, compared with another botulinum toxin type A in the treatment of glabellar frown lines.” Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] vol. 36 Suppl 4 (2010): 2146-54. doi:10.1111/j.1524-4725.2010.01706.x

[3] Scaglione, Francesco. “Conversion Ratio between Botox®, Dysport®, and Xeomin® in Clinical Practice.” Toxins vol. 8,3 65. 4 Mar. 2016, doi:10.3390/toxins8030065

[4] Bellows, Steven, and Joseph Jankovic. “Immunogenicity Associated with Botulinum Toxin Treatment.” Toxins vol. 11,9 491. 26 Aug. 2019, doi:10.3390/toxins11090491

[5] Joseph, John et al. “IncobotulinumtoxinA in the Treatment of Upper Facial Lines: Results From Two Randomized, Double-Blind, Placebo-Controlled, Phase III Studies.” Aesthetic surgery journal vol. 45,3 (2025): 293-304. doi:10.1093/asj/sjae222

Written and reviewed by the Medical Spa Rx Editorial Team 

All clinical and product claims on this page have been checked against peer-reviewed research, manufacturer data, and regulatory sources in accordance with our Editorial Policy .