Botox Cosmetic generated $2.602 billion in global revenue in 2025, down 4.1% year-over-year. Dysport and Galderma's neuromodulator portfolio grew 14.3% over the same period. Most med spa bookkeeping systems are not tracking which vendor their injectors used last month, so the shift is invisible at the P&L level.
That invisibility has a cost. When a practice switches from Allergan to Galderma products, or mixes vendors across treatment rooms, the per-treatment COGS changes. If QuickBooks is recording injectable revenue against a COGS model built on last year's Allergan pricing, the margin figure is wrong. Not slightly wrong. Structurally wrong, in a way that compounds every week invoices go unreconciled.
What is injectable COGS reconciliation? Injectable COGS reconciliation is the monthly process of matching vendor invoices (Allergan, Galderma, Evolus, Merz) to treatment revenue recorded in the POS, coded to vendor-specific accounts in QuickBooks so gross margin is computable per brand rather than as a blended single line. Without it, the neurotoxin market's 2025 vendor shift (Botox -4.1%, Galderma neuromodulators +14.3%) silently distorts reported margin by 10 to 20 points.
What the 2025 neurotoxin revenue numbers actually show
The numbers are not ambiguous.
AbbVie reported on February 4, 2026 that "full-year global net revenues from the Aesthetics Portfolio were $4.860 billion, a decrease of 6.1 percent on a reported basis, or 5.9 percent on an operational basis." Within that portfolio, "global Botox Cosmetic net revenues were $2.602 billion" for full year 2025, down 4.1%. Juvederm fell further, dropping 15.3% year over year.
Galderma told a different story. On March 5, 2026, the company reported "record 2025 results with net sales of 5.207 billion USD, up 17.7% at constant currency." The neuromodulator segment, which includes Dysport and Relfydess, reached "$1,471 million, 14.3% year-on-year at constant currency."
The shift is real and it is ongoing. AbbVie noted that "economic headwinds have continued to impact market conditions globally in aesthetics, and category growth is anticipated to remain challenged in 2026." That is the brand losing ground on macro conditions while Galderma took share. For practices that have not adjusted their COGS models, both movements created silent margin errors.
Why Galderma gaining and Allergan losing changes your per-unit COGS
Botox and Dysport are not interchangeable at the unit level. They use different unit definitions, different dilution ratios, and different pricing structures. A practice that ran 100% Allergan two years ago and is now splitting volume between Allergan and Galderma has a blended COGS that is different from what either vendor's price list shows individually.
The practical effect: if your injectors switched vendors mid-year and your bookkeeper is still coding all injectable product costs to a single "Injectable Supplies" line, you cannot calculate an accurate gross margin by product. You know roughly what you spent on product. You do not know what it cost to deliver each treatment type.
Precise vendor-level tracking matters more when one vendor is under pricing pressure and another is growing at 17.7%. Galderma's growth suggests it is gaining on competitive pricing or clinical preference. Either way, the cost per unit may differ from what your practice has historically modeled, and the difference flows directly to margin.
| Product | 2025 Revenue | YoY Change |
|---|---|---|
| Botox Cosmetic | $2.602B | -4.1% |
| Juvederm | $993M | -15.3% |
| AbbVie Aesthetics Total | $4.860B | -5.9% |
| Galderma Neuromodulators (Dysport/Relfydess) | $1.471B | +14.3% |
| Galderma Fillers/Biostimulators | $1.101B | +8.0% |
| Galderma Total | $5.207B | +17.7% |
Source: AbbVie Full-Year 2025 Financial Results, February 4, 2026; Galderma Full-Year 2025 Financial Results, March 5, 2026.
How most med spas fail to track vendor costs in QuickBooks
The default chart of accounts for a medical spa in QuickBooks does not distinguish between injectable vendors. Most practices code all neurotoxin and filler purchases to a single line: Injectable Supplies, Medical Supplies, or Cost of Goods Sold. That setup made sense when one vendor dominated the market. It does not work when you are splitting volume between Allergan, Galderma, Evolus, and Merz.
Three specific failure patterns appear most often in med spa books:
- Invoices entered late or batched quarterly. Allergan and Galderma invoices arrive weekly or after each order. When a bookkeeper processes them monthly or quarterly, the COGS in any given period does not match the treatments delivered in that period. Revenue is current. COGS is stale. Margin is fiction.
- All vendors coded to one account. A single "Injectable Supplies" line makes it impossible to calculate Allergan margin separately from Galderma margin. When the vendor mix shifts, the blended margin changes and there is no way to see why.
- Product cost not reconciled against treatment count. The only way to verify that invoices are complete is to compare total product cost against total treatments delivered in the same period. Most practices never run this check. Missing invoices go undetected for months.
"Economic headwinds have continued to impact market conditions globally in aesthetics, and category growth is anticipated to remain challenged in 2026.", AbbVie Full-Year 2025 Financial Results, February 4, 2026
Step-by-step: reconciling Allergan and Galderma invoices against treatment revenue
The reconciliation process is mechanical. It takes about two hours the first time and 30 minutes each subsequent month. The steps:
- 1Pull total injectable service revenue from your POS for the period. Use Zenoti, AestheticsPro, or Boulevard, not QuickBooks. The POS has the treatment-level detail. QuickBooks has the invoice-level detail. They need to be compared, not conflated.
- 2Collect every Allergan, Galderma, Evolus, and Merz invoice for the same period. Total the product cost by vendor. Do not mix vendors into one figure at this step.
- 3Calculate gross margin per vendor. Gross margin equals revenue minus COGS, divided by revenue, times 100. Run this for each vendor segment if your POS tracks treatments by neurotoxin brand. If not, run it for total injectables against total vendor COGS.
- 4Compare against the 60 to 70 percent benchmark. Above 75% means invoices are missing. Below 55% means pricing, waste, or vendor cost increases need investigation.
- 5Enter each vendor invoice to the correct COGS account in QuickBooks. Code to Injectable COGS - Allergan, Injectable COGS - Galderma, Injectable COGS - Evolus, Injectable COGS - Merz. Not to General Supplies.
Worked example: Allergan-to-Galderma blended COGS on a 200-unit month
2024 model (100% Allergan): 200 Botox units at $6.50/unit = $1,300 COGS
2026 reality (60% Allergan, 40% Galderma): 120 Botox units at $6.50 + 80 Dysport units at $2.80 (Dysport is priced per unit differently, roughly 2.5x Botox dosing) = $780 + $224 = $1,004 blended COGS
Reported COGS if books still use 2024 model: $1,300
Actual COGS delivered: $1,004
COGS overstatement: $296 on $16,000 in revenue at $80/unit blended ticket
Margin understated by 1.85 points in the opposite direction from the typical error. The vendor shift can cut either way. Without vendor-level tracking, the practice does not know which.
Common mistake: coding all neurotoxin purchases to "Injectable Supplies"
A single Injectable Supplies line collapses Allergan, Galderma, Evolus, and Merz into one number. When Galderma's share of the practice grows from 10% to 40% over 12 months, the blended COGS per treatment changes and the P&L cannot show it. Create four separate vendor-level COGS accounts in QuickBooks, tag each invoice to the correct one, and the margin shift becomes visible within two reporting periods. Without vendor separation, the shift is invisible until someone runs a manual reconciliation, which most practices never do.
This setup takes about an hour to configure in QuickBooks. The accounts need to be created once. After that, the discipline is weekly entry rather than monthly or quarterly batching.
What the corrected injectable margin looks like when vendor data is in the books
When vendor invoices are reconciled weekly and coded to separate COGS accounts, two things become visible that were not visible before.
First, you can see whether your Galderma margin differs materially from your Allergan margin. If Dysport is priced more competitively per unit and your injectors are shifting volume toward it, the COGS per treatment may be lower on Galderma treatments. Or the opposite. The point is that you can see it rather than guessing.
Second, you can detect missing invoices. If total injectable service revenue for the month is $80,000 and total vendor invoices are $12,000, the implied gross margin is 85%. That number is too high. Standard injectable margins run 60 to 70%. The gap almost always means invoices are missing or product purchases are being coded to the wrong account.
The injectable gross margin calculation becomes actionable only when vendor data is current, complete, and coded correctly. With AbbVie facing continued market headwinds and Galderma taking share, practices that have not revisited their COGS model since 2023 or 2024 are working from numbers that no longer reflect market reality.
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