Botox vs. Xeomin in Paintsville: Which to Choose First

By Robin Arora, MD, MBA · Medically reviewed by Robin Arora, MD · October 10, 2026

Botox and Xeomin are close cousins. Both are botulinum toxin type A, both soften frown lines, forehead lines and crow’s feet, and in a head-to-head trial they worked equally well at the same dose. The real differences are the formula, the price per unit and, for some people, how their face responds. In Paintsville, Botox is $12 a unit and Xeomin is $10 a unit, so for many first-timers Xeomin is the slightly less expensive way to start.

Below, our team at Serene Med Spa Paintsville explains how the two compare on results, onset, units and cost, and how we help you choose.

How do Botox and Xeomin work?

Every time you frown, squint or raise your eyebrows, small facial muscles fold the skin. Over years, those folds etch into lines that stay even when your face is relaxed.

Both products block the nerve signal that tells those specific muscles to contract. The muscle relaxes, the skin above it smooths out, and the line softens. Nothing is filled or added; the effect simply wears off as the nerve endings recover, usually in three to four months.

Both are prescription medicines. Both are FDA-approved for frown lines between the brows, horizontal forehead lines and crow’s feet. Since July 2024, Xeomin’s label also covers treating all three upper-face areas in the same visit.

What is the difference between Botox and Xeomin?

The active ingredient is the same type of toxin. What surrounds it is different.

• Botox Cosmetic (onabotulinumtoxinA) carries the toxin together with accessory, or “complexing,” proteins. It has the longest track record of any wrinkle relaxer.
• Xeomin (incobotulinumtoxinA) is purified so that only the active toxin remains, without those accessory proteins. That is why it is sometimes called a “naked” toxin.

Some experts believe a formula without accessory proteins may be less likely to trigger antibodies over many years of treatment. That idea is reasonable, but it has not been proven at cosmetic doses, and true resistance is rare with either product. We would not choose one over the other for that reason alone.

Is Xeomin as effective as Botox?

The best head-to-head evidence says yes. In a randomized trial of 381 adults with frown lines, patients received 24 units of either Xeomin or Botox. Four weeks later, independent raters judged 96.4% of Xeomin patients and 95.7% of Botox patients to be responders at maximum frown. The authors concluded Xeomin was noninferior to Botox.

A later review of 11 studies comparing the two reached the same practical conclusion: unit for unit, they should be treated as equally potent.

That said, faces are individual. Some people find that one product lasts a little longer or feels a little smoother for them. If you have tried one and loved it, that is a perfectly good reason to stay with it.

How fast do they work and how long do they last?

• Onset: the Xeomin label puts the median onset at two to seven days. Botox is similar. Most patients notice softening around day three.
• Full result: by about two weeks, which is when we see you for a check.
• Duration: typically three to four months for both. Both labels advise waiting at least three months between treatments.

Results vary from person to person. Very strong muscles, a fast metabolism and lots of sun or heat exposure can all shorten how long results last. Our guide to making Botox last longer covers what actually helps.

How many units will I need, and what will it cost in Paintsville?

Botox and Xeomin are dosed with the same unit numbers on their labels, which makes cost easy to compare. These are the label doses for the three upper-face areas:

• Frown lines (the “11s”): 20 units. About $240 with Botox or $200 with Xeomin.
• Forehead lines: 20 units, treated together with the frown lines.
• Crow’s feet: 24 units total (12 per side).
• All three areas: up to 64 units. About $768 with Botox or $640 with Xeomin at the full label dose.

Many first-time patients need fewer units than the label maximum, especially for a natural look, and some need more. We confirm your unit count and price at your free consultation before anything is injected. Current rates are always on our Paintsville pricing page.

We also offer Dysport at $4 a unit. Dysport units are smaller (about 2.5 to 3 Dysport units equal one Botox unit), so the per-unit prices are not directly comparable. Ask us if you are curious about it.

Which should I choose for my first visit?

Picture two patients. One has had Botox twice elsewhere and liked the result. The other has never had a wrinkle relaxer and wants to start gently. Both are good candidates, and the choice is mostly practical:

• Stay with what works. If you have had a good result with one product, there is no need to switch.
• Consider Xeomin if you want the lower per-unit price, or prefer a formula without accessory proteins.
• Consider Botox if you want the product with the longest track record, or have had a shorter-than-expected result with another toxin.

For a first visit, we usually start conservatively, see how your muscles respond at two weeks and adjust from there.

Risks and how we keep you safe

When an experienced injector uses an appropriate dose, both products have long safety records. The most common side effects are mild and short-lived:

• a little redness, swelling or a small bruise where the needle went in
• a mild headache
• occasionally, a heavy brow or a drooping eyelid, which is temporary and usually fades over a few weeks

Both labels carry an FDA boxed warning: in rare cases the toxin effect can spread beyond the treated area and cause weakness, trouble swallowing or breathing, or vision changes. Call us or seek care right away if that happens. The label notes the risk is greatest in children treated for muscle spasticity, at doses far higher than cosmetic treatment uses.

We reduce risk by taking a full medical history, mapping your muscles before dosing, using label-based doses and avoiding treatment if you are pregnant, breastfeeding or have a neuromuscular condition. Results vary, and a consultation determines whether you are a candidate. Our article on long-term Botox safety answers the most common worries about years of treatment.

Getting Botox or Xeomin in Paintsville

Our office is at 705 Broadway St, Suite 2, in downtown Paintsville. We see patients from across Johnson and Floyd counties, including Prestonsburg, Staffordsville, Inez, Louisa and Salyersville.

Appointments are Monday through Friday, 9 AM to 5 PM. The injections themselves take about 15 minutes. There is no downtime, so many patients come in on a lunch break and go straight back to work.

How we do it at Serene

• Who treats you: Katrina Watkins, NP, performs every treatment in Paintsville, following protocols set by our physician medical director, Robin Arora, MD.
• Consultation first: we watch how your face moves, talk about the look you want and give you a unit estimate and price before anything is injected. Consultations are free.
• Natural results: we aim for you to look rested, not frozen, and start conservatively on first visits.
• Two-week check: you come back at no charge so we can review the result together and fine-tune if needed.

Learn more on our Botox, Xeomin and Dysport page, or see current specials. New patients get 20% off your first visit — applies to any product or service; can't be combined with another discount — plus a free consultation.

Next step

Book a free consultation at Serene Med Spa Paintsville, 705 Broadway St, Suite 2, Paintsville, KY 41240. Book online through Vagaro or call (606) 963-0001. We will help you decide between Botox and Xeomin, and we will always tell you honestly what will and won’t work for you.

This article is for education and is not medical advice. Results vary, and a consultation determines whether a treatment is right for you.

1. Sattler G, et al. Noninferiority of incobotulinumtoxinA compared with another botulinum toxin type A in the treatment of glabellar frown lines. Dermatol Surg (2010)
2. XEOMIN (incobotulinumtoxinA) Prescribing Information, U.S. FDA (2024)
3. BOTOX Cosmetic (onabotulinumtoxinA) Prescribing Information, AbbVie
4. Relative potency of incobotulinumtoxinA vs onabotulinumtoxinA: a meta-analysis of key evidence. J Drugs Dermatol (2012)