BOTOX®

BOTOX® vs “Botox” — Understanding the Distinction

Although “Botox” is commonly used as a general term for botulinum toxin treatments, BOTOX® refers specifically to AbbVie’s branded formulation of onabotulinumtoxinA.

For healthcare professionals, this distinction is important because botulinum toxin type A is a category that includes several different products rather than a single interchangeable medication. Each product has its own active ingredient, regulatory approvals, potency measurement system, and clinical data.

The currently available BTX-A products include:

• BOTOX® / BOTOX® Cosmetic — onabotulinumtoxinA (AbbVie)
• DYSPORT® / AZZALURE® — abobotulinumtoxinA (Ipsen/Galderma)
• XEOMIN® / BOCOUTURE® — incobotulinumtoxinA (Merz)
• NABOTA® / JEUVEAU® — prabotulinumtoxinA (Daewoong/Evolus)
• LETYBO® / BOTULAX® — letibotulinumtoxinA (Hugel)

Because each product uses its own unit system, BOTOX® units should not be directly converted to another botulinum toxin product without appropriate clinical consideration.

OnabotulinumtoxinA is produced by fermenting Clostridium botulinum. The botulinum neurotoxin is purified together with its complexing proteins and supplied as a vacuum-dried powder alongside human albumin and sodium chloride. Its regulatory record is the longest in the class. The FDA cleared the therapeutic label for blepharospasm and strabismus in 1989 and the aesthetic label for glabellar lines in 2002 [1][4], and no other BTX-A product has matched the volume of clinical publication that has accumulated since.

Practitioners who buy botulinum toxins across more than one of these molecules should plan for the fact that units, potency assays, and storage temperatures all differ between products. Clinics that stock Korean-manufactured injectables such as NABOTA®, BOTULAX®, or LETYBO® in its Korean-market form will also buy Korean botox with different documentation and packaging conventions than BOTOX® ships with.

BOTOX® Cosmetic vs BOTOX® — The Same Product, Different Approval Pathways

BOTOX® and BOTOX® Cosmetic contain the same onabotulinumtoxinA, are reconstituted the same way, and are stored under the same conditions. The label is what separates them. BOTOX® Cosmetic carries the FDA’s aesthetic indications and is supplied in 50- and 100-unit vials [2]. Therapeutic BOTOX® in the United States is available as 100- and 200-unit vials only; the US 50-unit therapeutic vial has been discontinued, though some non-US markets, including Canada and the UK, still list a 50-unit therapeutic presentation [1]. In the UK and several other European countries, the aesthetic presentation is marketed as VISTABEL®. Whichever label a vial carries, BOTOX® Cosmetic is a prescription product and both administration and procurement are restricted to licensed professionals.

BOTOX® Products — What to Know Before You Buy BOTOX®

BOTOX® is supplied in a small set of vial sizes across the aesthetic and therapeutic labels. Choosing between these BOTOX® vials comes down to how many units a typical session uses and how quickly an opened vial will be finished, since reconstituted product must be used within 24 hours [1][2]. Clinics that buy BOTOX® wholesale usually match vial size to their average appointment.

BOTOX® Cosmetic 50 Units

The 50-unit vial suits one- or two-area appointments. Label doses are 20 units for the glabellar complex (BOTOX® frown lines) and 24 units for lateral canthal lines (BOTOX® around eyes, given as 12 units per side) [2]. In practice, 50 units of BOTOX® covers either area outright, or both together with 6 units left over for a touch-up. Because reconstituted BOTOX® has to be used within 24 hours, the smaller vial also helps clinics running many short appointments avoid unused product.

BOTOX® Cosmetic 100 Units

The BOTOX® 100 unit vial is built for full upper-face sessions. Under the US label, treating forehead lines means 20 units in the frontalis given alongside 20 units in the glabellar complex, and adding bilateral crow’s feet at 24 units brings the session total to 64 units [2]. The remaining units cover a second short appointment on the same day, which is the reason high-volume aesthetic practices tend to standardise on this format. Platysma band protocols of 26, 31, or 36 units, depending on band severity, also fit within one 100-unit vial [2].

BOTOX® (Therapeutic) 100 Units

The therapeutic 100-unit vial is the standard presentation for mid-dose indications. The recommended dose for overactive bladder is 100 units, severe primary axillary hyperhidrosis is treated at 50 units per axilla, and blepharospasm, strabismus, and many cervical dystonia and spasticity sessions are dosed from the same vial [1]. Cervical dystonia is the outlier: the pivotal trial ran a mean dose of 236 units, and the label advises a lower starting dose for toxin-naïve patients, so some sessions draw on more than one 100-unit vial [1].

BOTOX® (Therapeutic) 200 Units

The BOTOX® 200 unit vial serves higher-dose neurology and urology protocols. Detrusor overactivity associated with a neurologic condition is treated with 200 units per session, and the PREEMPT chronic migraine protocol places 155 units across 31 sites spread across seven head and neck muscle areas, which exceeds a single 100-unit vial [1][3]. Spasticity clinics treating several muscle groups also default to this size to keep vial count down, while staying inside the maximum cumulative adult dose of 400 units in any three-month interval [1].

Complete BOTOX® Product Range

BOTOX® Reconstitution, Dilution, and Dosing

BOTOX® reconstitution uses sterile, preservative-free 0.9% sodium chloride only. Inject the diluent slowly and discard any vial that does not pull the diluent in under vacuum. Mix by gently rotating the vial rather than shaking it, and use only a clear, colourless solution [1]. To reconstitute BOTOX® at the standard aesthetic concentration of 4 units per 0.1 mL, add 1.25 mL of saline to a 50-unit vial or 2.5 mL to a 100-unit vial [2].

Common BOTOX® dilution options are as follows:

A 100-unit vial reconstituted with 2.5 mL of saline holds all 100 units in 2.5 mL of solution. Reconstituted with 1 mL, those same 100 units sit in 1 mL. The syringe dose then follows the same arithmetic: the volume drawn multiplied by the concentration gives the unit count. Drawing 0.3 mL from a 4 U/0.1 mL preparation loads 12 units, which is enough for one side of a crow’s feet protocol at 4 units per site. For therapeutic dosing, work from the current AbbVie prescribing information, since doses and BOTOX® injection sites differ for each indication [1].

Unopened vials belong in refrigeration at 2°C to 8°C. After reconstitution, keep the vial at 2°C to 8°C and use it within 24 hours [1][2].

BOTOX® Indications — Aesthetic and Therapeutic

Aesthetic indications (BOTOX® Cosmetic, adults) [2]:

• Moderate to severe glabellar lines (FDA-approved 2002)
• Moderate to severe lateral canthal lines, known as crow’s feet lines (2013)
• Moderate to severe forehead lines (2017)
• Moderate to severe platysma bands, the vertical bands connecting the jaw and neck (2024)

BOTOX® injection sites differ for each area: five glabellar points, three points per side lateral to the orbit, five frontalis points, and a pattern along the jawline and neck bands for platysma treatment. Used this way, BOTOX® shots for wrinkles soften the appearance of facial wrinkles caused by repeated muscle contraction. They do not correct static lines driven by volume loss.

Therapeutic indications (BOTOX®, adults) [1]:

• Chronic migraine prophylaxis (15 or more headache days per month)
• Overactive bladder, and detrusor overactivity associated with a neurologic condition
• Upper and lower limb spasticity
• Cervical dystonia
• Severe primary axillary hyperhidrosis (excessive sweating)
• Blepharospasm and strabismus

BOTOX® Compared to Other BTX-A Products

BOTOX® vs DYSPORT®

The difference between BOTOX® and DYSPORT® starts with the unit. DYSPORT® (abobotulinumtoxinA, Ipsen/Galderma) is dosed in Speywood units, which are not equivalent to BOTOX® units. The US labels make the gap concrete. Glabellar-line treatment calls for 20 units of BOTOX® Cosmetic against 50 units of DYSPORT® for the same indication. Published guidance generally places the clinical ratio at about 2.5 to 3 DYSPORT® units per BOTOX® unit, and review evidence cautions that ratios above 3:1 risk overdosing abobotulinumtoxinA [5]. A practitioner moving a patient from 20 units of BOTOX® would therefore plan roughly 50 to 60 units of DYSPORT®. Treating the two products unit-for-unit is the most common switching error, so any conversion should be deliberate and recorded in the patient file.

Clinically, BOTOX® vs DYSPORT® discussions often cite a slightly faster onset for DYSPORT®, usually within two to three days, along with a wider field of effect. That spread can suit large areas such as the forehead but needs care near the eye, even though dilution and technique affect spread as much as the product itself. Both molecules are FDA-approved, and in the European aesthetic market abobotulinumtoxinA is sold as AZZALURE®.

BOTOX® vs BOCOUTURE® / XEOMIN®

Incobotulinumtoxin A is the same Merz molecule under two labels. XEOMIN® is the name used in the US and many international markets, while BOCOUTURE® is the aesthetic brand in the EU and UK. The formulation strips the complexing proteins out and leaves only the core neurotoxin, whereas BOTOX® keeps the full protein complex. Clinical evidence supports a 1:1 dose ratio between the two, so switching does not require a conversion [5].

Storage is the practical differentiator. Unopened XEOMIN® vials tolerate room temperature up to 25°C, while BOTOX® has to sit in refrigeration between 2°C and 8°C. The absence of complexing proteins has also been proposed as a possible reason for lower neutralising-antibody development over long treatment courses. Both products are FDA-approved with comparable upper-face indications.

BOTOX® vs NABOTA® / JEUVEAU®

NABOTA® is Daewoong’s prabotulinumtoxinA, and in the US the same molecule is sold by Evolus as JEUVEAU®, which the FDA cleared in 2019 for glabellar lines. It contains complexing proteins like BOTOX®, and its Phase III programme, which included a direct comparison against BOTOX®, supports 20-unit glabellar dosing on a 1:1 basis. JEUVEAU® entered the US market positioned mainly on price against BOTOX® Cosmetic.

The regulatory contrast is scope. JEUVEAU® holds one US aesthetic indication, glabellar lines. BOTOX® Cosmetic covers four aesthetic indications, and BOTOX® itself carries a therapeutic label dating back to 1989.

BOTOX® vs LETYBO®

LETYBO® is Hugel’s letibotulinumtoxinA, an INN in its own right rather than a prabotulinumtoxinA. The FDA cleared it in February 2024 for moderate to severe glabellar lines, based on three Phase III trials with more than 1,000 subjects, which makes it one of the most recent US approvals in the class. LETYBO® contains complexing proteins, requires refrigeration in the same 2°C to 8°C range as BOTOX®, and is labelled at 20 units for glabellar lines, matching BOTOX® Cosmetic on dose.

LETYBO® holds one US indication. BOTOX® covers four aesthetic uses plus chronic migraine, cervical dystonia, limb spasticity, overactive bladder, and axillary hyperhidrosis.

BOTOX® vs BOTULAX®

BOTULAX® is the name Hugel uses to market letibotulinumtoxinA in South Korea and many export markets, so the substance is identical to LETYBO®. The BOTULAX® brand itself holds no FDA approval, which means BOTULAX®-labelled vials are not for use in the US even though the underlying molecule is approved there under the LETYBO® name. Where BOTULAX® is authorised, it is generally dosed 1:1 with BOTOX® in clinical practice and positioned as a cost-competitive option.

BOTOX® still carries decades of therapeutic and aesthetic trial data and a far wider approved indication set.

Safety and Side Effects

Most BOTOX® side effects are mild, local, and short-lived: pain at the injection site, bruising, swelling, and headache. A headache after BOTOX® is among the more commonly reported events and typically settles within a few days. Indication-specific reactions include eyelid ptosis and dry eye after upper-face aesthetic treatment, and urinary retention or urinary tract infection after bladder injections [1][2][4].

Serious reactions are rare but must be recognised early. Like every botulinum toxin product, BOTOX® carries a boxed warning for distant spread of toxin effect. The reported effects include general muscle weakness, double vision, blurred vision, drooping eyelids, and difficulty swallowing, speaking, or breathing, and they can appear anywhere from hours to weeks after injection [1]. Patients who develop weakness, vision changes, or dizziness within hours of treatment with BOTOX® should not drive, and any allergic reaction needs immediate care. BOTOX® injections near the neck also demand extra attention to swallowing.

At labelled doses and in trained hands, BOTOX® holds more than three decades of clinical use and one of the best-characterised safety profiles of any injectable pharmaceutical. That record depends on patient selection, dose planning, and injection technique, so every BOTOX® treatment should be done by a qualified practitioner.

Where to Buy BOTOX® Online

BOTOX® is a prescription pharmaceutical, available only to licensed medical professionals through authorised supply channels. Clinics that buy BOTOX® online for restocking or that stand up a new therapeutic service both follow the same core procurement checks:

• Confirm that the distributor is authorised and properly licensed.
• Require unbroken cold-chain shipping at 2°C to 8°C, with temperature records on arrival.
• Request LOT numbers, expiry dates, and certificates of authenticity, and match them to the vial in front of you.
• Treat unfamiliar vial sizes or packaging as a red flag.
• Check the licensing and import requirements that apply in your jurisdiction.

Practices that buy BOTOX® wholesale for a busy aesthetic list should also plan refrigerated storage capacity before delivery day, since a cold-chain shipping arrival cannot sit unrefrigerated while a fridge is cleared. Licensed practitioners who want to order BOTOX® online or purchase BOTOX® for a new service line can contact the Doctor Medica support team for guidance on verified supplier access, cold-chain shipping requirements, LOT documentation, and sourcing information.

FAQs

What is BOTOX®?

BOTOX® is AbbVie’s registered brand for onabotulinumtoxinA, a purified botulinum neurotoxin type A drawn from Clostridium botulinum fermentation. It has been on the US market since 1989 and holds the largest peer-reviewed evidence base of any BTX-A product.

What is BOTOX® Cosmetic vs BOTOX®?

Both contain the same onabotulinumtoxinA. BOTOX® Cosmetic is labelled for aesthetic indications; BOTOX® is labelled for therapeutic indications such as chronic migraine and cervical dystonia. Both require a prescription.

How does BOTOX® work?

OnabotulinumtoxinA acts inside the motor nerve terminal by cleaving SNAP-25, a protein the nerve needs to release acetylcholine. Without that signalling step, the target muscle cannot contract until new SNAP-25 is synthesised, which typically takes three to four months in aesthetic use.

What are the BOTOX® vial sizes and how is it reconstituted?

BOTOX® comes in 50-, 100-, and 200-unit vials, with BOTOX® Cosmetic supplied in 50 and 100. Add preservative-free 0.9% saline. 2.5 mL in a 100-unit vial gives 4 units per 0.1 mL. Refrigerate and use within 24 hours.

What are BOTOX®’s approved indications?

Aesthetically: glabellar lines, crow’s feet lines, forehead lines, and platysma bands. Therapeutically: chronic migraine, overactive bladder, limb spasticity, cervical dystonia, axillary hyperhidrosis, blepharospasm, and strabismus. It has the broadest FDA indication set held by any BTX-A product.

What are the side effects of BOTOX®?

Common reactions are bruising, swelling, pain at the injection site, and headache. Area-specific reactions include ptosis in upper-face treatment and urinary retention in bladder work. Serious events from distant toxin spread are rare and can appear hours to weeks after injection.

What is the difference between BOTOX® and fillers?

BOTOX® relaxes the muscles behind dynamic lines; dermal fillers such as JUVÉDERM® add volume to static folds. They work differently and are often combined in the same treatment plan.

What should practitioners know before using or buying BOTOX®?

Practitioners should review current prescribing information, approved indications, dosing recommendations, storage requirements, and product-specific considerations before administering BOTOX®. Treatment should only be performed by qualified healthcare professionals following applicable clinical guidelines. Contact Doctor Medica representatives for more information and guidance.

For licensed medical professionals only. This content is for informational purposes only and does not constitute medical advice.

Citations and Resources

[1] AbbVie Inc. “BOTOX® (OnabotulinumtoxinA) for Injection: Full Prescribing Information.” AbbVie, revised Nov. 2023, www.rxabbvie.com/pdf/botox_pi.pdf.
[2] AbbVie. BOTOX® Cosmetic (onabotulinumtoxinA) for injection, for intramuscular use. Full Prescribing Information. https://www.rxabbvie.com/pdf/botox-cosmetic_pi.pdf
[3] Dodick, David W et al. “OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program.” Headache vol. 50,6 (2010): 921-36. doi:10.1111/j.1526-4610.2010.01678.x
[4] Carruthers, J Alastair et al. “A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines.” Journal of the American Academy of Dermatology vol. 46,6 (2002): 840-9. doi:10.1067/mjd.2002.121356
[5] Scaglione, Francesco. “Conversion Ratio between Botox®, Dysport®, and Xeomin® in Clinical Practice.” Toxins vol. 8,3 65. 4 Mar. 2016, doi:10.3390/toxins8030065

Written by Doctor Medica’s Editorial team

The content on this page has been written and fact-checked in accordance with our Editorial Policy. Clinical claims are sourced from peer-reviewed literature, regulatory documentation, and manufacturer specifications. Where citations are provided, it is always in accordance to our editorial standards.

Doctor Medica sources products exclusively through authorized distributors and established procurement channels. Products are verified as genuine, and supplied in the original packaging with their seal intact. Learn more about how we guarantee product authenticity, sourcing compliance, and traceable delivery to our clients.