Xeomin Review: Why 70% of Patients With Botox Resistance Responded Again

Xeomin Review: Botox Resistance Suspected —

Why 70% of Patients Responded Again

Last Tuesday in the clinic, I saw a patient in her late 40s who told me,

"Even after Botox, it wears off in about a month now."

She had been getting the same brand for three years straight.

What used to last four months gradually got shorter,

and now she said she could barely feel any effect at all.

That's when I suggested we try switching to Xeomin.

What Makes Xeomin Different

From Other Toxins

Xeomin is a purified botulinum toxin type A

with all complexing proteins removed.

Unlike other products, it strips away the protective protein shell

that surrounds the toxin molecule —

because that shell is the primary trigger

for antibody formation in the body.

I've covered this topic in detail in another post,

so today let's focus on the patient cases.

Why Does Switching to Xeomin

Bring Back a Response?

Key Insight from Dr. Wi Young-jin

Because Xeomin is a pure toxin with complexing proteins removed,

it's a common switch for patients who have developed resistance.

In practice, more than 70% of patients who started losing efficacy

after their 4th Botox session respond again after just one Xeomin procedure.

In my clinic, about 6 to 7 patients a week come in saying

"Botox just doesn't seem to be working as well anymore."

The core issue is antibodies. Among patients who receive Botox repeatedly,

some develop an immune response to the complexing proteins.

Once those antibodies are established, the toxin gets neutralized

before it ever reaches the nerve — so increasing the dose doesn't help.

A 43-year-old patient who had masseter botox last autumn

saw the effects disappear within one month after her 4th session.

Starting from her 5th session, we switched to Xeomin,

and results lasted about three and a half months again.

In my clinical experience, about 70% of patients who switch

see their response return with the very first Xeomin session.

The remaining 30% involve other variables beyond antibodies —

such as injection depth or changes in muscle hypertrophy.

Key Takeaway from Dr. Wi Young-jin

If you feel like the effects of Botox are getting shorter over time,

the first step before increasing your dose

is to try switching the type of toxin.

Xeomin has a lower risk of antibody formation by design,

making it the most frequently recommended option

when patients need to make a switch.

Xeomin Dosing: How We Approach Each Area

The standard conversion for Xeomin is 1:1 with Botox (Allergan).

That said, patients who didn't get adequate results from Botox

often respond better to Xeomin at the same unit count.

A 48-year-old patient who had a trapezius procedure last spring

received 60U per side and maintained results for about five months.

On her follow-up visit, we proceeded with the same dose,

and by week one she noticed the feeling of heaviness lifting.

There's no need to automatically increase the dose at each session.

If the first session produced a solid response,

the same amount is typically sufficient.

The 3 Questions I Hear Most Often

in the Clinic

Q1. Reviews say Xeomin takes longer to kick in —

is that actually true?

From what I see in the clinic, the difference isn't that significant.

Most patients notice a response around days 3 to 5,

with full effect visible by week two.

Botulinum toxin naturally works gradually as a medication,

so there's no need to worry that you're the only one seeing a delayed response.

Q2. Xeomin costs more than Botox — is it worth it?

If you're getting a toxin procedure for the first time,

there's no particular need to start with Xeomin.

However, if you've had three or four sessions or more

and the effects are getting shorter, think of it as insurance

against antibody buildup — and making the switch is a sensible choice.

Q3. Does Xeomin have side effects too?

What should I watch out for?

The general side effect profile is nearly identical to Botox.

This includes Bruise, temporary headache, and rarely eyelid drooping.

When patients say "my expressions looked unnatural,"

that's usually due to the injector's placement and depth —

not a difference in the product itself.

If there's one thing to take away from today —

— when Botox effects start wearing off faster,

switch the type of toxin to Xeomin

before reaching for a higher dose.

In the next post, I'll cover

'what to try next for the 30% who still don't respond well to Xeomin.'

This has been Dr. Wi Young-jin.