Botox vs Dysport vs Xeomin: A Guelph Dermatologist’s Guide

TL;DR: Botox Cosmetic, Dysport Aesthetic, and Xeomin Cosmetic are all Health Canada-authorized botulinum toxin type A products, and in published trials they perform more alike than different. The real trap is the units: regulators state that one product’s units can’t be compared or converted into another’s, so “how many Dysport units equal Botox units” has no honest number. In the one large head-to-head trial, Xeomin matched Botox within a percentage point at week 4. My take after injecting all three: assessment, dosing, and technique matter more than the logo on the vial. And because all three are prescription drugs in Canada, a medical assessment comes first, every time.

Neuromodulator treatments were performed 9,883,711 times in the United States in 2024, up 4% in a single year (American Society of Plastic Surgeons, 2024, US data). Canada publishes no comparable national count, so I won’t invent one. What I can tell you from our Guelph clinic is this: “Botox vs Dysport” has become one of the first questions new patients ask. Usually “and what about Xeomin?” follows within a minute.

I’m Dr. Dusan Sajic, a board-certified dermatologist, and I inject all three products. So I don’t have a favourite horse in this race; I have labels, trials, and my patients’ own dose records. This guide compares the three the way I would across the consultation table, and it starts with the fact most comparison posts bury: the units aren’t interchangeable, and regulators say so in writing.

Key Takeaways

• Health Canada has authorized five cosmetic botulinum toxins: Botox Cosmetic (2001), Xeomin Cosmetic (2012), Dysport Aesthetic (2013), Nuceiva (2019), and Letybo (2023) (Health Canada Drug Product Database, queried Aug 2026).
• Units don’t convert between products: the FDA-approved Botox label states its units “cannot be compared to nor converted into” units of any other botulinum toxin product (FDA Prescribing Information, 2024), and Health Canada monographs carry the same caution.
• In the largest head-to-head trial, 381 patients, week-4 responder rates were 96.4% for Xeomin and 95.7% for Botox (Sattler et al., Dermatologic Surgery, 2010, Merz-sponsored).
• Across 65 randomized trials and 14,919 participants, every major toxin clearly outperformed placebo for facial lines (Cochrane Review, 2021).

What’s Actually Different Between Botox, Dysport, and Xeomin?

Botox Cosmetic, Dysport Aesthetic, and Xeomin Cosmetic are three brands built on the same active molecule: botulinum toxin type A. All three are authorized by Health Canada as prescription drugs, and all three relax the small facial muscles whose repeated contraction creases the skin (Health Canada Drug Product Database, queried Aug 2026). What separates them is formulation, not job description. Each manufacturer purifies the toxin differently, pairs it with different accessory proteins, or, in Xeomin’s case, removes those proteins, and measures potency with its own proprietary unit system. That last difference matters most. The FDA-approved Botox Cosmetic label states that potency units are specific to each preparation and “cannot be compared to nor converted into” units of any other botulinum toxin product (FDA Prescribing Information, 2024). Health Canada’s product monographs carry the same caution. In trials, their clinical results look far more alike than different. Their dosing systems don’t.

So who are the players? Defined properly:

• Botulinum toxin type A is a purified bacterial protein that temporarily blocks the nerve signal telling a treated muscle to contract. Less contraction means a softer crease, and movement returns as nerve endings recover.
• OnabotulinumtoxinA (Botox Cosmetic) is the longest-marketed cosmetic formulation in Canada, authorized since 2001.
• AbobotulinumtoxinA (Dysport Aesthetic) is a distinct formulation with its own manufacturing process and its own unit scale, authorized here for aesthetic use in 2013.
• IncobotulinumtoxinA (Xeomin Cosmetic) is formulated without complexing proteins and has been authorized in Canada since 2012.

All three sit on the same shelf in our clinic, and our Botox, Dysport and Xeomin service page covers how we use them day to day.

Which Cosmetic Botulinum Toxins Does Health Canada Authorize?

Five, as of a live Drug Product Database check in August 2026: Botox Cosmetic (2001), Xeomin Cosmetic (2012), Dysport Aesthetic (2013), Nuceiva (prabotulinumtoxinA, 2019), and Letybo (letibotulinumtoxinA, 2023) (Health Canada Drug Product Database, queried Aug 2026). Every one of them is a prescription drug. Consequently, each requires a medical assessment and a prescriber, not just a booking link.

Nuceiva and Letybo are the newer entrants, and more competition generally serves patients well. That said, this guide focuses on the three with the longest run on the Canadian market and the ones we work with in clinic: Botox, Dysport, and Xeomin.

How Many Dysport Units Equal One Botox Unit?

There’s no honest number, and that’s the regulators talking, not me. The FDA-approved Botox Cosmetic label devotes an entire warning section, 5.1, titled “Lack of Equivalency Between Botulinum Toxin Products,” stating that potency units are specific to each preparation and “cannot be compared to nor converted into Units of any other botulinum toxin product” (FDA Prescribing Information, 2024). Health Canada’s product monographs make the same point: each product’s units are its own measuring system.

Why can’t we just convert? Because a “unit” isn’t a universal quantity like a milligram. Each manufacturer defines its units through its own proprietary potency assay. In plain terms, comparing 20 units of one brand with 20 units of another is like comparing prices in two currencies with no published exchange rate. The numbers look parallel; they aren’t.

You’ll still find conversion ratios floating around online. However, none of them appears on any Canadian or US label, and I don’t dose from them. In my practice, when a patient switches brands, I re-plan the dose from that product’s own label, their anatomy, and their treatment history. A clinic that presents cross-brand unit math as settled fact is offering a shortcut, and shortcuts in prescription medicine deserve questions.

Which One Kicks In Faster and Lasts Longer?

The labels sit closer together than the marketing implies. Botox’s label describes the effect building over the first week, with benefit typically holding about 3 to 4 months (FDA Prescribing Information, 2024). Dysport’s reports results for up to 4 months, with retreatment no more often than every 3 months (FDA label via DailyMed). Xeomin’s Canadian monograph describes effects appearing around 3 to 7 days and lasting about 3 months (Health Canada product monograph, via the Drug Product Database).

| Product | What its own label reports | Label source | |—|—|—| | Botox Cosmetic (onabotulinumtoxinA) | Effect builds over the first week; benefit typically about 3-4 months | FDA Prescribing Information | | Dysport Aesthetic (abobotulinumtoxinA) | Results reported up to 4 months; retreat no more often than every 3 months | FDA label, DailyMed | | Xeomin Cosmetic (incobotulinumtoxinA) | Effects appear around 3-7 days; benefit about 3 months | Health Canada product monograph (DPD) |

Read this table honestly: the figures come from separate registration trials with different designs, endpoints, and patients. They are not a head-to-head race. A label that says “up to 4 months” has not beaten a label that says “about 3-4 months.”

So which one wins the calendar? None of them, on current evidence. In my experience, the spread between two patients on the same product is wider than the spread between the label figures. Consequently, I tell patients to plan on roughly a season, then treat their own documented response, photos and dates, as the data that guides round two. New to all of this? My first-timer’s guide to Botox in Guelph walks through that first month step by step.

Is One of Them More Effective Than the Others?

Not by any margin a trial has convincingly shown. The largest direct comparison randomized 381 patients to Xeomin or Botox, 24 units each, and found week-4 responder rates of 96.4% versus 95.7% (Sattler et al., Dermatologic Surgery, 2010, Merz-sponsored). Two caveats belong in the open. It was a non-inferiority trial, designed to show Xeomin was “not worse”; it cannot show “better.” And Merz, Xeomin’s manufacturer, sponsored it.

Zoom out and the picture holds. A Cochrane review pooled 65 randomized trials with 14,919 participants and found all four major toxins clearly beat placebo for facial lines (Cochrane Review, 2021). Meanwhile, the same review flagged one safety signal worth knowing: major adverse events, chiefly eyelid ptosis, a droop of the upper lid, were probably somewhat more frequent with onabotulinumtoxinA at the standard 20-unit dose, with moderate certainty.

Does that make Botox the risky one? No. We’ve found that injection depth, pattern, and dose selection do far more to prevent ptosis than brand choice, which is why the assessment takes longer than the injecting. If social media has handed you scarier claims, my Botox myths post sorts documented risks from folklore.

Does Xeomin’s Protein-Free Formulation Matter?

The formulation fact is true and regulator-documented: Xeomin is made without the complexing proteins that accompany the toxin in other products (Health Canada product monograph, via the Drug Product Database). The marketing leap, that this means “no resistance risk,” is where I pump the brakes. Neutralizing antibodies are already rare with conventional products at cosmetic doses: 3 of 810 glabellar-line patients, or 0.4%, in pooled registration data, with none persisting (pooled analysis, 2023, AbbVie-funded).

In other words, the theoretical advantage targets a problem that almost never occurs at cosmetic doses, and no cosmetic trial has established a real-world difference. In our Guelph clinic, when someone tells me their product “stopped working,” we review photos, dose records, and timing before anyone blames immunology. Far more often the explanation is dosing drift, technique, or expectations that quietly rose. That’s often fixable without switching brands, though switching stays on the table.

How Should You Choose Between Botox, Dysport, and Xeomin?

Choose the assessment first; the brand follows. Remember, the only large head-to-head separated two of these products by 0.7 percentage points (Sattler et al., 2010, Merz-sponsored). Meanwhile, the differences that actually change outcomes, dose planning, injection pattern, and facial assessment, don’t appear on any vial. Where does that leave you? With a short decision list:

• Happy with your current product? Stay with it. Your own documented response beats any trial average.
• Switching brands or clinics? Expect a fresh, product-specific dosing plan, never a “converted” unit number.
• Results fading faster than expected? Bring dates and photos to your review. Labels promise roughly a season, not a year.
• Thinking past expression lines? Neuromodulators are one tool among several. My injectables guide maps the full toolkit, and facial balancing shows how the pieces combine.

However you lean, the regulatory floor doesn’t move: in Canada, these are prescription drugs requiring a medical assessment. A proper consultation includes the option of “not yet,” and a good clinic lets it end that way.

Frequently Asked Questions

How many units of Dysport equal one unit of Botox?

None; no valid conversion exists between any of the five Health Canada-authorized cosmetic toxins. The FDA-approved Botox label states its units “cannot be compared to nor converted into” units of any other botulinum toxin product (FDA Prescribing Information, 2024). Each product is dosed in its own system, after a medical assessment.

Is Dysport or Xeomin as effective as Botox?

Trials point to broad parity. In a 381-patient head-to-head, week-4 responder rates were 96.4% for Xeomin versus 95.7% for Botox (Sattler et al., 2010, Merz-sponsored). Across 65 randomized trials, every major toxin clearly beat placebo (Cochrane Review, 2021). In my view, injector skill separates results more than brand does.

How long do Botox, Dysport, and Xeomin last?

Per their own labels: about 3-4 months for Botox (FDA Prescribing Information), up to 4 months for Dysport with retreatment no sooner than every 3 months (DailyMed), and about 3 months for Xeomin (Health Canada monograph). However, those figures come from separate trials, so they can’t rank the products.

Do I need a prescription for Botox, Dysport, or Xeomin in Canada?

Yes. All five cosmetic botulinum toxins authorized in Canada, from Botox Cosmetic in 2001 through Letybo in 2023, are prescription drugs (Health Canada Drug Product Database, queried Aug 2026). That means a medical assessment, a prescription, and qualified supervision, not a walk-in beauty purchase.

Can I switch from Botox to Dysport or Xeomin?

Usually, yes, with a fresh dosing plan in the new product’s own units. True resistance is rare: neutralizing antibodies appeared in 3 of 810 pooled glabellar-line patients (0.4%), none persisting (pooled analysis, 2023, AbbVie-funded). In our experience, “it stopped working” traces to dosing or expectations far more often than antibodies.

Comparing Neuromodulators in Guelph?

Bring your questions, your old unit numbers, and your skepticism; I’ll bring the labels and the trials. Whether the right plan turns out to be Botox, Dysport, Xeomin, or no needle at all this year, you’ll hear the reasoning behind it. Request a consultation at our Guelph clinic; we also see patients from Kitchener-Waterloo, Cambridge, and Fergus.

Medically reviewed by Dr. Dusan Sajic, MD, PhD — dermatologist, deRMA Skin Institute, Guelph, ON.

Sources

1. Health Canada, Drug Product Database: authorization records for Botox Cosmetic (2001), Xeomin Cosmetic (2012), Dysport Aesthetic (2013), Nuceiva (2019), and Letybo (2023); queried August 2026, https://health-products.canada.ca/drug-product-database/ 2. FDA Prescribing Information, Botox Cosmetic (onabotulinumtoxinA), rev. 2024, section 5.1 “Lack of Equivalency Between Botulinum Toxin Products”, https://www.rxabbvie.com/pdf/botox-cosmetic_pi.pdf 3. Health Canada product monograph, botulinum toxin type A (unit non-equivalency caution), https://pdf.hres.ca/dpd_pm/00069264.PDF 4. FDA label, Dysport (abobotulinumtoxinA), via DailyMed, https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=97513722-8426-4ce3-b85d-0e08e436a140&type=display 5. Sattler G, et al., non-inferiority randomized trial of incobotulinumtoxinA versus onabotulinumtoxinA, 24 units each (n=381), Dermatologic Surgery, 2010 (Merz-sponsored), https://pubmed.ncbi.nlm.nih.gov/21134045/ 6. Camargo CP, et al., Cochrane systematic review of botulinum toxin type A for facial wrinkles (65 RCTs, 14,919 participants), 2021, https://pubmed.ncbi.nlm.nih.gov/34224576/ 7. Pooled analysis of neutralizing antibody formation in onabotulinumtoxinA glabellar-line registration trials (3 of 810 subjects, 0.4%), 2023 (AbbVie-funded), https://pmc.ncbi.nlm.nih.gov/articles/PMC10224273/ 8. American Society of Plastic Surgeons, 2024 Plastic Surgery Statistics Report (US procedural data), https://www.plasticsurgery.org/documents/news/statistics/2024/plastic-surgery-statistics-report-2024.pdf