The style has multiple regional variations in the United States, many calling for specific and unique sauce ingredients, types of hot dogs, or types of buns and referred to regionally under region-specific names.

[4] By the 1920s, it had reached Western New York, where numerous longstanding hot dog stands still remain, including a stand run by the Rigas Family (dating to 1921)[5] and Ted's Hot Dogs (which opened in 1927).

In southeastern Michigan, a Coney Island hot dog is a European-style Frankfurter Würstel (Vienna sausage) of German origin with a natural lamb or sheep casing, topped with a beef heart-based sauce, which was developed by Macedonian and Greek immigrants in the area.

The traditional wiener is made with a small, thin hot dog made of veal and pork, giving it a different taste from a traditional beef hot dog, served in a steamed bun, and topped with celery salt, yellow mustard, chopped onions, and a seasoned meat sauce.

In Washington, D.C., the half-smoke is similar to a hot dog, but usually larger, spicier, and with more coarsely-ground meat, the sausage is often half-pork and half-beef, smoked, and served with herbs, onion, and chili sauce.