A new form of botulism toxin has recently been approved for use in the United States. It is called Xeomin and represents the smallest molecule for botulism toxin type A. it is called incobotulinumtoxinA and has been available for quite a few years in Europe.BOTOX® has been most layers of protective proteins around the active molecule and this is followed by Dysport which has been available in the US for several years. I performed my own double blinded study involving the use of BOTOX® and Dysport on a group of 6 patients. I found that the onset of action of the Dysport was faster by approximately 12 hours but the difference after that was not noticed. Reports of increased tendency to spread the neurotoxin after injection of Dysport was both worrisome and useful. While reports indicated increasing numbers of levator ptosis after glabellar frown lines treatments, the possibility of decreasing the number of injections needed to treat the crows feet and does minimizing the percentage of superficial hematomas and is very vascular area was exciting. The other area in which some benefit of something spreading rather easily would be beneficial would be in treatment of hyperhidrosis of the axilla. The possibility of using it high in the forehead horizontal lines was also intriguing. The original argument that it would be less expensive to use was debunked after the average dilution ratios compared to BOTOX® was 2.5 to one, thus negating any cost savings per treatment area. I have to admit that I like to use for the hyperhidrosis and keep some on hand for chest this use. Xeomin has an even smaller molecule and thus we can expect greater spread then BOTOX® and perhaps even more than Dysport. It does not require refrigeration and this would make storage much easier. The package insert claims a one to one dilution compared to BOTOX®. Cost savings at least initially appear intriguing and could conceivably make this product a bit more competitive if the unit for unit of BOTOX® is truly the same. I am looking forward to using it and giving you feedback here from Naples,Florida .