Xeomin

Xeomin is an FDA-cleared prescription medication with a well-established safety profile when administered by qualified clinicians. Like all botulinum toxin type A products, it carries an FDA-required black-box warning regarding the potential for the toxin to spread beyond the injection site.

FDA Black-Box Warning: The effects of all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulism, including unexpected loss of strength or muscle weakness, hoarseness, trouble speaking or swallowing, loss of bladder control, trouble breathing, or double vision. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life-threatening. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children and adults, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses. This warning applies to all botulinum toxin products, not uniquely to Xeomin.

Putting the warning in context for cosmetic patients: The FDA black-box warning was issued in 2009 and applies to all licensed botulinum toxin products. For healthy adults receiving cosmetic doses to treat upper facial lines, the absolute risk of serious distant-spread events is very low. The warning was prompted primarily by cases in pediatric spasticity patients receiving much higher doses. That said, the risk is real and is why Xeomin must be administered only by qualified clinicians — not purchased online or administered outside a licensed medical setting.

Common, expected side effects at cosmetic doses include:

• Temporary injection-site redness, swelling, or bruising
• Mild headache (usually resolves within 24–48 hours)
• Temporary eyelid drooping (ptosis) if the toxin migrates — rare with proper technique
• Dry eyes or tearing changes if treating near the orbital area

At Maison Zolara, every Xeomin treatment is performed by our licensed RN clinicians following a thorough consultation, with our on-staff Medical Director providing clinical oversight of all injectable services.

Xeomin (incobotulinumtoxinA) is one of several FDA-approved botulinum toxin type A products available in the United States. Maison Zolara also offers Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA), each with its own dedicated service page. The table below summarizes the key differences to help you understand your options — your RN clinician will discuss which product best fits your goals during your free consultation.

The unit systems for these products are not interchangeable — a unit of Xeomin is not the same as a unit of Dysport. Your clinician will discuss dosing in terms of the specific product being used.

Xeomin

Protein-free formulation with a long track record in both cosmetic and therapeutic indications. A good choice for patients who prefer a streamlined molecule, those who have had prior treatments with other neurotoxins and want to try a different formulation, or patients who have been advised by a clinician to consider a lower-protein-load product. Onset and duration are comparable to Botox. Maison Zolara's standard pricing starts From $12/unit.

Botox

The original and most widely studied botulinum toxin type A product, with the broadest FDA-approved cosmetic indication set. Botox contains accessory proteins and requires refrigeration. It remains the most recognized brand name in the category. Maison Zolara offers Botox on its dedicated Botox page. Dysport is also available — see the Dysport page for details.

Most healthy adults bothered by dynamic facial wrinkles — lines that appear with movement — are good candidates for Xeomin. The ideal candidate wants natural-looking softening of expression lines without surgery or downtime.

Good Candidates

• Adults 18+ with moderate-to-severe glabellar, forehead, or crow's feet lines
• Patients who want a natural, refreshed appearance without a "frozen" look
• Those who have previously responded well to other neurotoxins and want to try the protein-free formulation
• Patients in Lansing, Holt, Mason, Williamston, or surrounding mid-Michigan communities seeking a credentialed local provider
• Individuals looking for a quick, no-downtime treatment

Not a Good Fit

• Pregnant or breastfeeding individuals
• Patients with a known allergy to botulinum toxin or any Xeomin ingredient
• Individuals with neuromuscular disorders (e.g., myasthenia gravis, Lambert-Eaton syndrome) — these conditions may increase the risk of serious adverse effects
• Patients with active infection at the planned injection site
• Those with unrealistic expectations about the degree of change possible with a neurotoxin alone
• Patients currently taking aminoglycoside antibiotics or other agents that interfere with neuromuscular transmission

Xeomin (incobotulinumtoxinA) works by temporarily blocking the release of acetylcholine at the neuromuscular junction — the chemical signal that tells a muscle to contract. When injected into a targeted facial muscle, it causes that muscle to relax, which smooths the overlying skin and softens the appearance of dynamic wrinkles. The effect is temporary and fully reversible as the nerve-muscle connection gradually reestablishes itself over the following months.

The mechanism is the same as other botulinum toxin type A products. What distinguishes Xeomin is its formulation: the manufacturing process removes the accessory proteins (hemagglutinins and non-hemagglutinins) that surround the active toxin in other preparations, yielding a highly purified molecule. According to a 2021 peer-reviewed study published in Frontiers in Neurology by researchers at multiple academic institutions, patients with cervical dystonia who had developed resistance to other botulinum toxin preparations showed clinical improvement after switching to incobotulinumtoxinA, which the authors attributed in part to the absence of complexing proteins. ↗

Clinical bottom line: Most patients begin to notice softening of treated lines within 3–5 days, with peak results visible at 10–14 days. Results typically last 3–4 months, though individual variation is normal.

Before Your Treatment

Your journey begins with a free consultation with one of our licensed RN clinicians. We review your medical history, discuss your aesthetic goals, and assess your facial anatomy and muscle movement. You'll learn exactly which muscles will be treated, how many units are anticipated, and what results are realistic for your anatomy. Please arrive with a clean face and avoid blood-thinning medications (aspirin, ibuprofen, fish oil) for 3–5 days prior if medically appropriate — your clinician will advise you.

During Treatment

The appointment itself typically takes 15–30 minutes. Your clinician will mark injection points, cleanse the skin, and administer a series of small injections using a very fine needle. Most patients describe the sensation as a brief pinch. No anesthesia is required, though a topical numbing cream is available on request. The number of injection points varies by treatment area — glabellar lines typically require 5 injection points; forehead and crow's feet add additional sites.

After Treatment

You can return to most normal activities immediately. Avoid lying flat, rubbing the treated area, or engaging in vigorous exercise for 4 hours post-treatment. Results begin to appear within 3–5 days, with full effect visible at 10–14 days. We recommend a follow-up check at 2 weeks to assess your results and address any asymmetry. Most patients return for maintenance every 3–4 months.

Proper aftercare in the first 24 hours helps ensure the toxin stays precisely where it was placed and reduces the risk of bruising or unwanted migration.

The following guidelines apply to the day of treatment and the 24 hours that follow:

Do

• Stay upright for at least 4 hours after injection
• Apply a cold compress gently to reduce swelling (do not press hard)
• Keep your face clean and avoid touching the treated areas
• Perform gentle facial exercises (raising brows, frowning) if your clinician recommends it to help distribute the product
• Use SPF 30+ sunscreen daily — sun exposure accelerates skin aging and can shorten results
• Contact us if you notice any unexpected symptoms

Avoid

• Lying flat or bending forward for 4 hours post-treatment
• Rubbing, massaging, or applying pressure to the treated area for 24 hours
• Vigorous exercise, saunas, or hot tubs for 24 hours (increased circulation may affect distribution)
• Alcohol for 24 hours (increases bruising risk)
• Blood-thinning supplements (aspirin, ibuprofen, fish oil) for 24 hours unless medically required
• Facials, microneedling, or laser treatments in the treated area for at least 2 weeks

Xeomin (incobotulinumtoxinA) at Maison Zolara is priced From $12 per unit for standard patients. Maison Circle members receive member pricing starting From $10 per unit and can track their treatment journey in the Zolara Care app (available on the App Store).

The total cost of your treatment depends on the number of units used, which varies by treatment area and individual muscle strength. Typical unit ranges by area:

• Glabellar lines (frown lines): 20–30 units
• Forehead lines: 10–20 units
• Crow's feet (both sides): 20–30 units
• Combined upper face: 40–60+ units

Final pricing is always confirmed at your free consultation — we never surprise you with costs after treatment. There are no hidden fees for the consultation or the follow-up appointment.

Maison Circle members receive member pricing on Xeomin and can track their treatment journey in the Zolara Care app (available on the App Store).

The term "naked toxin" refers to Xeomin's unique manufacturing approach. Most botulinum toxin type A products contain the active neurotoxin surrounded by accessory proteins — molecules that are not responsible for the therapeutic effect but are present as part of the bacterial complex. Merz Pharmaceuticals developed a proprietary double-filtration process that removes these accessory proteins, leaving only the 150-kDa core neurotoxin molecule.

What the Proteins Are

Accessory complexing proteins (hemagglutinins and non-hemagglutinin proteins) are naturally present in the bacterial fermentation process. They do not contribute to the wrinkle-relaxing effect of the toxin.

Why Removal Matters

The clinical rationale for removing accessory proteins centers on the immune system. Over repeated treatment cycles, some patients develop neutralizing antibodies directed against the accessory proteins rather than — or in addition to — the active toxin. Removing these proteins may reduce the antigenic load presented to the immune system.

What the Research Shows

A 2013 randomized, double-blind study published in Journal of Neural Transmission (PMC3834167) found no subjects developed neutralizing antibodies during repeated incobotulinumtoxinA injections, supporting the theoretical advantage of the protein-free formulation. ↗ It is important to note that neutralizing antibody formation with any botulinum toxin product is relatively uncommon in cosmetic use, and no formulation has been proven to eliminate the risk entirely.

Stability Advantage

Because Xeomin contains no accessory proteins, it does not require refrigeration during shipping and has a longer shelf life at room temperature than some competing products — a manufacturing and logistics benefit that does not affect the patient experience.

According to a 2013 peer-reviewed study published in Journal of Neural Transmission by Evidente et al., no subjects receiving repeated incobotulinumtoxinA injections developed neutralizing antibodies over the course of the study period, consistent with the theoretical benefit of the protein-free formulation. ↗

Maison Zolara is located at 4820 W Saginaw Hwy in west Lansing, MI 48917 — conveniently accessible from I-96 and W Saginaw Hwy. We serve patients throughout the greater Lansing metro area, including East Lansing, Okemos, Holt, DeWitt, Grand Ledge, Mason, Charlotte, St. Johns, and Williamston.

Our clinic is open 9:00 AM – 7:00 PM Monday through Friday and 9:00 AM – 5:00 PM on Saturdays. Free consultations are available — book online or call us to schedule.

Whether you're coming from the Michigan State University corridor in East Lansing, the growing communities of DeWitt and Grand Ledge to the northwest, or the southern suburbs of Holt and Mason, our west Lansing location puts credentialed, MD-supervised Xeomin injections within easy reach of mid-Michigan.

1. Evidente VGH, Fernandez HH, LeDoux MS, et al. A randomized, double-blind study of repeated incobotulinumtoxinA (Xeomin®) in cervical dystonia. J Neural Transm. 2013;120(12):1699–1707. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834167/

2. Jost WH, Kohl A, Brinkmann S, Comes G. Sustained efficacy and safety of repeated incobotulinumtoxinA (Xeomin®) injections in blepharospasm. J Neural Transm. 2013;120(11):1345–1353. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751217/

3. Jost WH, Benecke R, Hauschke D, et al. Clinical improvement after treatment with incobotulinumtoxinA (XEOMIN®) in patients with cervical dystonia resistant to botulinum toxin preparations containing complexing proteins. Front Neurol. 2021;12:636590. https://pmc.ncbi.nlm.nih.gov/articles/PMC7900567/

4. U.S. Food and Drug Administration. FDA Requires Boxed Warning for Botulinum Toxin Products (April 2009). https://www.fda.gov/news-events/press-announcements/fda-warns-companies-over-illegal-marketing-botox-and-related-products

5. Carruthers A, Carruthers J, et al. Efficacy and safety of incobotulinumtoxin A for the correction of glabellar lines among patients with skin types IV to VI. Dermatol Surg. 2015. https://pubmed.ncbi.nlm.nih.gov/25844607/

Page Disclaimer: The information on this page is provided for educational purposes only and does not constitute medical advice. Clinical references are sourced from peer-reviewed research and named institutions as cited below. Individual results vary. Consult a qualified healthcare provider before beginning any treatment.

The Medical Director provides clinical oversight of treatments performed at this practice. The Medical Director does not author, review, or endorse website content.

Xeomin® is a registered trademark of Merz Pharmaceuticals.