The sky is the limit for injectables when it comes to the potential and youthful prowess of the popular procedures that are part of this booming aesthetic category. According to the most recent report from the American Society of Plastic Surgeons (ASPS), injectables are the most popular minimally invasive cosmetic procedures. 2015 saw the highest number of botulinum toxin (Botox) injections ever with more than 6.7 million injections. Fillers also got a boost, with 6 percent more procedures in 2015 compared to 2014. “The use of botulinum neurotoxins has revolutionized the treatment of several different problems seen in the plastic surgeon’s office, from facial wrinkles to painful conditions with limited treatment options,” says Marie E. Noland, M.D., senior plastic surgery resident physician at Dalhousie University (Halifax, Canada). Read up on the injectables making headlines, and learn how dermatologists believe the best is yet to come.
Botox Branches Out
According to a recent review published in the journal Plastic and Reconstructive Surgery, Botox is an effective treatment for a range of conditions. The international review analyzed research from procedures incorporating the injectable and found evidence of efficacy in eight conditions.
1. Facial Wrinkles: The evidence is strongest for its most common use—for forehead lines and crow's feet at the corner of the eyes.
2. Facial Movement Disorders: It calms various conditions, such as tics caused by benign essential blepharospasm, which is an involuntary closing or twitch of the eyelids.
3. Facial Nerve Palsy: Abnormal facial nerve regeneration, which can cause problems such as excessive tears or sweating, is effectively treated.
4. Hand Tremors: Botox can reduce hand tremors in patients with essential tremor, a nerve disorder characterized by uncontrollable shaking, although hand function may not improve.
5. Sweating: Patients with chronic, excessive sweating, especially of the hands, can find relief.
6. Upper Limb Spasticity: The toxin is safe and effective for upper arms and hands and also shows promise for muscle spasticity in children with cerebral palsy.
7. Migraines: Neuromodulator therapy has emerged as a useful new option for chronic migraine headaches.
8. Nerve-Related Pain: Injection is effective for the treatment of some important causes of neuropathic pain, including diabetes and surgical nerve damage
Botox Impairs the Perception of Emotions
According to new research completed by scientists at Sissa Medialab (Trieste, Italy), patients who have had Botox injections may misinterpret facial expressions and emotional information. The popular injectable relaxes expression lines as a result of mild paralysis, but it also causes a temporary block of proprioceptive feedback, which is a process that helps people understand others’ emotions by reproducing them on their own bodies. “The thankfully temporary paralysis of facial muscles that this toxin causes impairs our ability to capture the meaning of other people’s facial expressions,” says research scientist Jenny Baumeister. Baumeister assessed a sample of patients and their understanding of emotions immediately before and two weeks following a Botox-based procedure and a separate group with no injectable treatment. After comparing the measurements, she noted a significant difference in the post-Botox patients’ speed and accuracy interpreting facial expressions. “Our study was devised to investigate embodied cognition,” says researcher Francesco Foroni. “At the same time, we think that awareness of this consequence will be of use to those involved in aesthetic medicine, not least to adequately inform people seeking to undergo these treatments.”
Hyaluronic Acid Fillers Last Longer with Botox
According to experimental evidence reported in the journal Plastic and Reconstructive Surgery, there is a simple technique for prolonging the effects of hyaluronic acid (HA) dermal fillers. Researchers in Turkey showed that Botox can extend the life of HA fillers by reducing the muscle activity in the treated area. Says İsmail Küçüker, study author and faculty memberat the Ondokuz Mayıs University, “This study showed that HA filler application in combination with Botox significantly decreases the degradation process and increases the remaining volume at the end of the paralyzed period.”
Fake Out
While imitation may be the sincerest form of flattery, it’s certainly not appealing in injectable formulas. Unfortunately, counterfeit injectables are on the rise and come with severe side effects, like inflammatory reactions, infections, and scarring. However, with the proper precautions, you can ensure each injection is genuine and safe for clients. Here’s what Jeannette Graf, M.D., director of dermatology at Omni Aesthetics MD (New York City), says to look for and be aware of to guarantee safe injectables.
- Proof of authenticity: Legitimate providers of injectables give proof of authenticity on the packaging, such as holograms, lot numbers, and expiration dates.
- New packaging: Even if it’s not counterfeit goods, injectables should never come in old packaging.
- Valid license: It is essential to order only from licensed distributors of the brands in the U.S.
- Temperature control: Most injectables require refrigeration. Not refrigerating them results in ineffective products. They must be handled in a way that ensures their safety and stability.
Dysport Banishes Knee Pain
According to a study published in the American Journal of Sports Medicine, researchers at Imperial College London and Fortius Clinic discovered Dysport is an effective treatment for a painful knee condition common in active people. The knee pain affects professional and amateur runners and cyclists, as well as other active people, and symptoms include inflammation and sharp localized pain that prevents continued activity. Recovery may take several days. Current treatment methods include physiotherapy, anti-inflammatory medication, steroid injections, and surgery, but pain often persists. Participants found pain relief when researchers injected Dysport into a muscle guided by ultrasound at the front and outside of the hip. Researchers found 69 percent of participants required no further medical care and had complete pain relief even five years later. “Patients traveled from all over the country to take part in this study, which is an indication of their eagerness to find a solution to their discomfort,” says David Urquhart, co-author of the study from Chelsea and Westminster Hospital (London). “All had longstanding pain that had failed to respond to physiotherapy and conventional treatment. Our findings show botulinum toxin has revolutionized the treatment of these patients.”
Allergan Expands Product Portfolio
Through acquisitions and approvals, Allergan has added several significant injectables to its lineup. This summer following clinical trials, Allergan received approval from the FDA to market Juvéderm Volbella XC for lip augmentation and for correction of perioral rhytids, which are lines around the mouth.
In early 2016, Allergan acquired Anterios, a clinical stage biopharmaceutical company, for $90 million and additional payments related to proprietary delivery technology in development. The delivery system would enable local, targeted transfer of neurotoxins through the skin without the need for injections. Anterios is also developing Botox-based prescription products to use with the novel technology. With the deal, Allergan also acquired global rights to ANT-1207, an investigational topical formulation of Botox to treat excessive sweating, acne, and crow’s feet.
Last fall, the global pharmaceutical company acquired Kythera Biopharmaceuticals valued at approximately $2.1 billion. Kythera is best known for its launch of Kybella to treat double chins without surgery and is focused on the discovery, development, and commercialization of novel prescription products for the medical aesthetics market. Says Brent Saunders, CEO and president of Allergan, “We can now provide a broader range of market-leading aesthetics products to our customers.”
Facial Fanfare
Younger clients are conquering their fear of needles and booking Botox and fillers in greater numbers. Now, 64 percent of American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) members report more patients under 30. According to Edwin Williams, M.D., a facial plastic surgeon in New York City and president of AAFPRS, Botox and fillers are the most popular procedures for younger clients. “When people see celebrities they idolize getting procedures done, it drives fans to get the same procedure performed,” says Norman Rowe, M.D., a board-certified plastic surgeon at Rowe Plastic Surgery (New York City). “Millennials in my practice are seeking Botox and fillers. They are using fillers primarily to augment facial features and fill in acne scars. They are using Botox to stave of the effects of aging and maintain their youthful appearance.” He promotes both the therapeutic and preventative effects of Botox and recommends it for the younger group. Jessie Cheung, M.D., dermatologist and director of Jessie Cheung MD Dermatology and Laser Center (Willowbrook, IL), agrees and says injectables are the best tools for younger clients who want enhancement without the risks of plastic surgery. “The prevailing trend of social media has accelerated the visibility of and interest in cosmetic surgery,” she says. “Kylie Jenner is a prime example of a social media darling who sparked a trend in lip and cheek augmentation. Clients come in for a consultation, take out their smartphones, and pull up examples of desired features. They want to put their best face forward for their selfies, and often, injectables are their gateway into the cosmetic world.”