Botulinum toxin type A is a family of medications that tame overactive muscles and soften etched lines. In skilled hands, it can also refine facial shape, calm a gummy smile, or help with migraines and sweating. Three brands dominate cosmetic practice in the United States: Botox, Dysport, and Xeomin. They share the same core mechanism, yet they behave differently in the real world. Those differences matter to results, cost, and how natural you look along the way.
I have injected all three for more than a decade, across thousands of faces, foreheads, and masseters. Patients ask for the brand they see on billboards, then leave loving a plan tailored to their anatomy and goals. The label on the vial is only part of that plan. Dose, dilution, mapping, depth, speed of injection, and timing drive success. If you are deciding between Botox vs Dysport vs Xeomin, here is how I think through it, plus the patient-level details that rarely make it into glossy ads.
What they share, what sets them apart
Botox, Dysport, and Xeomin are all botulinum toxin type A neuromodulators. They block acetylcholine release at the neuromuscular junction, which relaxes targeted muscles. In aesthetic practice, that translates into softer forehead lines, crow’s feet, and frown lines. Off-label, we use them for a lip flip, bunny lines, chin dimpling, jawline slimming via the masseters, neck bands, brow lift shaping, and more.
The key distinction: the protein “packaging” and formulation.
- Botox Cosmetic contains complexing proteins around the core toxin. Dysport also contains accessory proteins and has a smaller unit size with different diffusion behavior. Xeomin is purified to the naked neurotoxin without accessory proteins.
In practice, those packaging differences can influence spread, onset, dosing ratios, and the theoretical risk of neutralizing antibody formation over the long term. For most first-time cosmetic patients, any of the three will work well when dosed correctly. Nuance matters more when you want a particular feel, have built tolerance, or need precision around delicate areas.
Onset and feel: how fast you notice change
Patients often ask, how soon will I see results? With Botox, I tell people to expect a gentle ramp. Subtle changes start around day 3 to 4, with peak effect near day 10 to 14. Xeomin follows a similar curve. Dysport tends to “arrive” a bit faster. Some see movement reduction within 24 to 48 hours and substantial change by day 4 to 5. If you have an event in five days and want forehead lines muted quickly, Dysport often gets the nod. If your timeline is flexible, the difference in onset becomes a footnote, not a deciding factor.
The feel under the skin differs too, although this is subjective. Botox and Xeomin feel precise to me in small muscle groups, especially the corrugators and procerus that create the 11’s. Dysport has a broader spread at typical dilutions, which can be helpful in large or strong muscles such as the frontalis or masseters, provided the injector understands how to steer that spread and avoid drift to neighboring muscles.
Diffusion and precision: spread is a tool, not a flaw
Clinicians talk about diffusion as if it is good or bad. It is neither. It is a tool. Dysport’s lattice-like spread at standard dilution can give smoother blending in the forehead, helpful in thicker skin and higher hairlines, or in athletic men who use their frontalis hard. I use it to soften broad frown patterns without the grid-like rigidity that looks “done.”
Botox, when placed in micro-aliquots at the right depth, offers surgical precision. It shines for the lip flip, mentalis (chin dimples), and fine-tuning a lateral brow lift where a millimeter matters. Xeomin behaves much like Botox in my hands, with a slightly lighter “footprint.” That makes it a nice choice around the mouth for patients prone to asymmetry or who want ultra-natural movement for speech and animation.
If you had a heavy brow after a previous treatment elsewhere, precision and dose control matter more than brand. The safest fix is a careful map of your frontalis’ vertical height, measured brow to hairline, with conservative, staggered units across the upper third. In that scenario, I favor Botox or Xeomin.
Duration: how long each brand tends to last
Duration varies by dose, metabolism, muscle strength, and how you animate. The usual range for all three is three to four months in the upper face at standard dosing. Lean, fast-metabolism patients and people who lift heavy or do high-intensity training often sit closer to 10 to 12 weeks. With repeat treatments at regular intervals, some patients stretch to four or even five months, particularly in the crow’s feet and frown lines.
Dysport can feel like it fades a touch sooner in very strong frontalis muscles unless the initial dosing accounted for that. Xeomin’s duration matches Botox closely in my practice, though a small subset reports a brisker fade around the mouth where micro-movements are constant. None of these products guarantees a fixed clock. A realistic plan expects variability and builds in a tidy touch up when needed.
Dosing and unit conversions: why unit numbers mislead
Here is a common trap. A friend says she “got 60 units of Dysport” and you think that sounds heavy compared to your “20 units of Botox.” Units are brand specific bioassays, not a shared yardstick. For the glabella frown lines, the on-label recommended dose is 20 units of Botox or Xeomin, and 50 units of Dysport. That does not mean Dysport is stronger or weaker, just different unit calibration.
Typical ranges for common areas in an average adult:
- Frown lines (glabella): 20 units Botox or Xeomin, roughly 50 units Dysport. Forehead lines: 6 to 20 units Botox or Xeomin, 15 to 50 units Dysport, depending on forehead height and muscle strength. Crow’s feet: 6 to 12 units per side with Botox or Xeomin, 15 to 30 units per side with Dysport.
These are ballpark numbers, not a prescription. A narrow forehead with low brows needs fewer units placed higher. A rounder forehead and a high hairline can handle more spread. If a clinic quotes you a price per unit, ask for a total plan in units for your face, not just a headline price. Botox pricing by the unit can look cheap, then balloon when the actual units meet your anatomy.
Purity, antibodies, and long game strategy
Neutralizing antibody formation is rare in cosmetic dosing. Still, if you have years of frequent treatments, accessory botox proteins may theoretically contribute to antibody development. Xeomin, a naked neurotoxin without complexing proteins, appeals to patients who like that clean profile. I switch to Xeomin in two situations: a person who reports diminishing returns with Botox despite solid placement, and a patient who prefers a minimalist formulation.
Dysport’s complexing proteins have not prevented me from achieving consistent results. People who respond beautifully to Dysport do not need to change for the sake of purity. Antibody testing is not practical in the cosmetic setting. We infer resistance by clinical effect over at least two sessions with confirmed dosing and technique.
Texture changes vs frozen look: where technique trumps brand
Botox for wrinkles works because it reduces the repetitive folding that etches skin. The softer skin you see in botox before and after galleries often comes from movement control plus improved hydration and light skin remodeling from not creasing the same spot every hour. Over-treat and you lose micro-expressions, especially around the eyes. Under-treat and lines still stamp the skin.
To avoid the frozen look, I design a pattern that respects how your brow lifts when you speak. For people who talk with their brows, I keep forehead doses lower, bias injections higher, and allow some lateral fibers to run free. In crow’s feet, I spare the zygomatic complex that lifts the cheek in a smile, and I focus on the true orbicularis oculi. The brand matters less than the plan. That is also why botox for men sometimes requires more units and a different map, as men’s frontalis and corrugators tend to be stronger with naturally heavier brows.
Best uses by area: when each product shines
Glabella 11’s. All three brands perform well. If the crease is deeply etched, I combine neuromodulator plus a tiny droplet of hyaluronic acid filler after two weeks, once the muscle has quieted. Dysport can soften a very strong scowl quickly. Botox and Xeomin offer crisp control when you want to lift the medial brow subtly by treating the depressors without spilling into the elevator.
Forehead lines. Dysport’s spread often gives the smoothest canvas with fewer micro-injections in broad foreheads. In short foreheads where every millimeter counts, Botox or Xeomin keeps me honest and avoids drop.
Crow’s feet. Thin skin around the eyes benefits from finesse. I lean toward Botox or Xeomin for highly expressive patients who value a natural smile. Dysport works well when fine lines extend further across the temple.
Lip flip. Precision wins. Two to four units of Botox or Xeomin placed just above the vermilion border and near Cupid’s bow can roll the lip slightly and reduce a gummy smile. Dysport works, but the dosing increments make micro-tuning trickier.
Masseter slimming. Here I favor Dysport or Botox depending on jaw strength and bite pattern. Dysport spreads nicely through the bulky masseter. If clenching or TMJ symptoms are primary complaints, the choice often comes down to cost and availability. Xeomin also performs, though in my experience patients sometimes prefer the feel of Botox or Dysport in this thick muscle.
Neck bands (platysmal bands). Modest doses of any of the three can soften bands and sharpen the jawline. This is an advanced area. Misplacement can affect speech or swallowing. Brand choice follows injector preference and patient anatomy.
Brow shaping. Subtle lateral brow lift depends on micro-dosing around the tail and respecting the frontalis’ lifting fibers. I reach for Botox or Xeomin most often here.
Sweating (hyperhidrosis). For underarms, palms, and scalp sweating, onset speed and spread can help. Dysport can feel faster in the first week, although all three last three to six months depending on dose and site. Insurance coverage and clinic pricing often decide.
Migraines. Medical Botox protocols follow fixed patterns mapped by neurology studies. If migraine relief is your goal, stay with Botox unless your physician has a reason to deviate.
Cost, value, and what “deals” usually mean
Botox cost varies by region, injector expertise, and whether pricing is by unit or by area. Unit prices can range widely. Dysport sometimes appears less expensive per unit, but remember the unit conversion. Xeomin often lands close to Botox in pricing, with occasional packages that bring the per-area cost down. Botox specials and botox packages are real during slower seasons, though deep botox deals can signal heavy dilution. Watered-down product means shorter duration and blurred outcomes. If you see a price far below local norms, ask direct questions: dilution, units per area, and who is injecting.
For value, judge by results duration, natural look, and satisfaction with your face in motion. A three-month, natural result that preserves your brow language beats a four-month mask every time. Patient reviews and ratings help, but prioritize a botox consultation with a certified provider to see how they think about your anatomy.
Safety, risks, and how to avoid common pitfalls
Botox therapy, Dysport, and Xeomin are safe when injected by a trained professional with medical-grade product. Side effects are usually minor: a small bruise, a transient headache, or a bead-like bump that smooths within an hour. Unwanted spread can cause a droopy brow or eyelid. That risk rises with poor mapping, heavy doses low in the forehead, or injection into a swollen or recently manipulated area.
Medical red flags are rare but must be respected. Do not schedule treatment during pregnancy or active breastfeeding. Delay injections if you have an infection at the site. Disclose neuromuscular disorders and all medications, especially blood thinners. If you are planning a dental appointment or a long flight, book your botox appointments at least 24 to 48 hours apart from those events to limit swelling and positional spread.
What the first visit feels like
Most first time botox patients are surprised by how quick the botox procedure feels. After a targeted botox consultation, photos, and mapping, the injecting part often takes less than ten minutes. The needle is fine. Most describe it as a series of tiny pinches. If needles make you tense, ask for ice or a vibrating distraction device. Makeup should be cleanly removed in the areas treated. Aftercare is simple: avoid rubbing the area for the rest of the day, skip strenuous workouts and hot yoga for 24 hours, and keep your head upright for four hours. You can wash your face and apply gentle skincare that evening.
Expect a botox results timeline of early changes at day 3 to 4, with full botox effects by two weeks. That two-week mark is the moment for a botox follow up. If a small line persists or the left brow peaks more than the right, a two-unit botox touch up can balance it. Do not chase perfection at day 5. Let the medicine settle.
Maintenance, intervals, and the “baby Botox” approach
How often to get botox depends on your goals and how you animate. Three to four months is typical. If you like a very natural look, baby botox or micro botox uses lower doses placed strategically to preserve motion while reducing the most obvious lines. Preventative botox for beginners in their late 20s and early 30s can slow the formation of static lines. The best age for botox is less about the calendar and more about etched creases at rest. If the 11’s linger when your face is neutral, you are a candidate.
For long-term skin quality, combine botox rejuvenation with a simple routine: sunscreen, retinoid or retinol at night, and a mid-depth resurfacing treatment once or twice a year if needed. Neuromodulators do not replace volume loss. If you have hollowing or deep folds, consider hyaluronic acid filler such as Juvéderm as a complement. Think of botox vs filler as teammates, not competitors: botox relaxes motion, filler restores structure.
Choosing a provider: credentials over brand
Results come from the hands and eyes of your injector. A botox nurse injector or botox aesthetician who is trained, certified, and supervised by a physician can deliver superb results. Look for a botox clinic with medical oversight, robust before and after photos of cases that look like you, and a willingness to say no when a request is unsafe. A botox professional should guide you through botox procedure steps, explain botox risks, and set expectations for botox downtime, which is usually minimal.
During scheduling, ask about botox booking details: which product they recommend and why, total units planned, cost estimate, who injects, and their policy on touch ups. A thoughtful provider will tailor brand choice to the plan rather than forcing a single product on every face.
My decision tree in practice
When someone sits in my chair, I listen to what bothers them, watch how their face moves in conversation, and note muscle thickness with my fingers. If they want quick smoothing for a wedding this weekend, Dysport’s faster onset helps. If they fear heaviness from a past experience, I default to Botox or Xeomin and keep doses conservative while we build trust. If we need sharp precision near the lip or brow tail, Botox or Xeomin wins. For a strong, square jaw with clenching, Dysport or Botox based on their past response and price comfort. If the patient has had years of treatments and suspects reduced response, I trial Xeomin for two cycles.
I also plan a budget with them. Some prefer paying by area with a predictable number. Others like unit-based pricing and detailed breakdowns. Either way, I document the exact pattern in their chart, including depths, dilution, and injector notes about brow dynamics. That record turns a good first outcome into an even better second one.
Myths, facts, and sensible expectations
People worry that neuromodulators “age you” when they wear off. They do not. If anything, consistent treatments slow the deepening of dynamic lines. Another myth says more units last longer. Past a certain point, extra units just make you stiff and raise the risk of side effects without adding months. There is also chatter about “natural botox” creams. Topicals cannot block acetylcholine inside the nerve terminal. They may hydrate or brighten, but they are a botox alternative only in marketing.
Asking does botox hurt is fair. For most, discomfort is brief and mild. Asking is botox safe is essential. In the right setting with a certified provider, the safety profile is excellent. Is botox worth it depends on your goals and budget. If you want smoother lines with minimal downtime and a reversible effect, the value is high. If you crave dramatic lifting or volume restoration, surgery or filler will do more for you.
Practical numbers and planning
New patients often ask, how much botox do I need. A typical first session for the upper face might use 40 to 60 units of Botox or Xeomin, or 100 to 150 units of Dysport, divided among the glabella, forehead, and crow’s feet. Smaller “baby botox” sessions might use 10 to 25 units total for a whisper of softening. Your unit guide should adapt to your anatomy and expression patterns. If you chew through product quickly or want longer intervals, talk about stepping up doses in strong muscle groups or pairing with skincare that supports collagen.
Downtime is minimal. Most people go back to work the same day. Visible bumps fade in 15 to 30 minutes. Bruises are uncommon but possible. If a bruise appears, it is usually a pinpoint you can cover with makeup the next day. Aftercare is simple: avoid rubbing the area, skip facials or aggressive massage for a few days, keep workouts light for 24 hours, and hold off on tight hats and goggles that press on injection sites.
Two quick checklists to help you decide
- Questions to bring to your botox consultation: Which brand do you recommend for my goals and why? How many total units and how are they distributed? What result should I expect at rest and in motion? What is the plan for touch up and maintenance? What will this cost today and over a year? Signs you found a botox certified provider you can trust: They study your expression before marking your face. They explain trade-offs and suggest conservative dosing for first time botox. They photograph botox before and after at consistent angles and lighting. They offer clear aftercare and a built-in follow up. They are comfortable saying no to unsafe requests.
Where Botox, Dysport, and Xeomin fit in a broader plan
Neuromodulators are one pillar of facial rejuvenation. Sun protection and a retinoid do more for fine lines than many realize. For etched static lines that persist even after botox, targeted laser or microneedling can help resurface. For volume deflation in the temples or midface, consider filler. For skin laxity and jowls, energy devices or surgery may serve you better than another syringe.
The smartest botox treatment plan respects both the map of your muscles and the architecture of your face. That is why the brand comparison only goes so far. If you value fast onset and softer spread, Dysport might be your best fit. If you want the industry workhorse with broad medical data, Botox is the obvious choice. If you prefer a cleaner formulation and precise micro-dosing, Xeomin is a strong contender. With any of them, aim for subtle botox that keeps your expressions readable and your features balanced.
The right approach reduces lines without erasing personality. It keeps your brows lifted, your smile warm, and your face yours. That is the goal, whether your appointment card reads Botox, Dysport, or Xeomin.