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Botox: Past, Present, and Future

Jan 25, 2017 02:00PM ● Published by Arden Haley

By Becca Newell

After more than a decade in the beauty industry, Botulinum toxin has become synonymous with anti-aging. Commonly known as Botox, this wrinkle-removing favorite is a go-to for many women—and men—looking to soften harsh lines, particularly around the eyes and between the brows. So it’s not surprising that it was arguably the most mentioned word at last year’s anti-aging conferences. So does Botox have any more surprises in store for us? What does the future of this cosmetic staple look like? We asked our local experts to weigh in.

Just Like Botox?

Many dermatology and plastic surgery offices carry more than the original brand of the beloved wrinkle eraser. In recent years, a product called Dysport has appeared alongside Botox. Certified Aesthetic Nurse Specialist Kelly Sutter, who teaches physicians, registered nurses, and physician assistants how to inject Botox and dermal fillers in patients, uses both brands at her Annapolis-based center, Skin Wellness MD. She says Botox has a larger name recognition because it was the first product of its kind in the United States; Dysport, she adds, is more popular in Europe.

“Some patients have a strong preference for one product over another,” Sutter says. “Most will do well with either one.”

For those unfamiliar with either brand, both products work by relaxing muscles that cause wrinkles from repeated motions, says Dr. Orin M. Zwick, a partner at Chesapeake Eye Care and Laser Center in Annapolis. “Dysport is almost identical, both biologically and chemically, to Botox with the exact mechanism of action in the muscle,” he says. “Dysport is useful for some people who do not respond to Botox.”

Botox and Rosacea

While none of the local practitioners we contacted currently perform Botox treatments for Rosacea, most were familiar with the concept. According to Zwick, there have been some anecdotal reports that Botox can be a useful tool to help address redness and flushing in patients with Rosacea.

A recent study, published by the Journal of Dermatologic Surgery, resulted in positive findings. The control group reported a noticeable decline in flushing, redness, and inflammation of the skin within one week and results persisted for up to three months. “This is because the injections were done intra-dermally, as opposed to deeper in the skin, which is where Botox is injected to treat wrinkles,” says Owner Laura Hardnett, of Effective MedSpa in Gambrills.

The process uses microdroplets, adds Dr. Henry D. Sandel IV of The Sandel Center in Annapolis, emphasizing the precision and diligence this application requires to ensure Botox isn’t injected below the skin in the cheek area. “Much care has to be taken … to avoid unwanted paralysis of the smile muscles,” he says.

Tossing the Needle?

For those with a fear of needles, the idea of an injection-less Botox is extremely appealing. But according to our experts, it’ll probably be close to a decade before such a product hits the market. Still, the general consensus remains optimistic about this potentially ground-breaking feat.

In the spring of 2016, Allergan—the manufacturer of Botox—acquired a company that is developing a topical Botox product, in addition to creating its own homegrown topical Botox, says Sutter. “Both of these products have yet to be far enough along in studies to be considered for FDA approval anytime soon,” she adds.

Dr. Paul Buhrer, a plastic surgeon with Plastic Surgery Specialists in Annapolis, explains that one of these products, ANT-1207, is designed to address excessive axillary sweating.

Previously, there was another topical treatment under development by a biotech company called Revance, Buhrer adds. “Unfortunately, in June of 2016, they announced that they were suspending development of this product after disappointing results from their Phase Three clinical trials relating to the treatment of crow’s feet,” he says.

In terms of cost, Sandal estimates the expense of a topical treatment would be about the same as Botox injections—$250 to $700 per treatment, depending on the dose, he says. “I would guess that this product … [would] require a doctor to administer,” he adds. “This would be a remarkable achievement.”

Botox in Your 20s

There’s a theory among the younger Botox enthusiasts that undergoing treatment at an early age will prevent wrinkles from forming. The medical community, however, is mixed on how it sees and treats younger patients.

“If you can prevent wrinkles from forming deep lines, then you are less likely to need as much Botox when you are older,” says Lisa Bell, of MD Dermatology and Laser Center in Edgewater. Like any anti-aging treatment, she explains, the sooner you start, the better the results. “Once deep static lines form, then Botox doesn’t work well,” she adds.

While there isn’t much clinical data to support the theory, Sutter is keen to note that some of her patients have self-reported the need for less frequent treatments after 10 or more years of Botox. She finds they schedule appointments two times a year versus the three or four sessions previously required.

Still, some physicians emphasize the importance of maintaining a routine with treatments every three to four months. “Once stopped, the muscle functions return and over repetitive movements the lines will reform,” Zwick says.

While Buhrer agrees that weakening those muscles prior to lines forming would be ideal, he believes the cost of Botox would dissuade most younger patients from considering it a viable option.

Another factor to consider: preventing wrinkles on a younger face requires the practitioner to anticipate where the wrinkles will develop. “You would end up guessing and possibly treating them incorrectly,” says Sutter.

Looking into the Future

For those under 30, a better recommendation to Botox would be wearing sunscreen daily and practicing good skin health using medical-grade skincare, says Hardnett. “The ideal time to start [Botox] is the moment you notice a wrinkle or line that bothers you,” she says. “Once it becomes permanent, it will take a whole lot more to get rid of it.”

“Botox isn’t going anywhere,” says Bell. “It is a multi-billion dollar success with patient satisfaction in the 90th percentile.”

And its role has expanded beyond softening wrinkles, according to Zwick. “A thoughtful approach to facial shaping by targeted Botox injections is now the goal,” he says, citing an example of using Botox to achieve improvements in eyebrow positions—a procedure formerly reserved for surgery.

“Botox has spearheaded the movement toward nonsurgical cosmetic improvements and is a socially accepted treatment,” he says. “With time, there are likely to be improvements in the delivery systems of Botox to hopefully increase its length of action for both medical and cosmetic applications.”

Sutter echoes that sentiment, referencing a topical product, currently undergoing research that would destroy fat cells under the eyes while tightening the skin.

With each year, Botox moves further away from its association with frozen, expressionless faces. “We are no longer ‘chasing lines,’” says Hardnett. “But, rather, helping to reshape the face and keep away aging.”

Botox

  • An injectable neurotoxin
  • Treats frown lines between the eyebrows (glabellar lines) and crow’s feet
  • Approved for patients 21+
  • FDA-approved in 2002
  • Results in 4-5 days
  • Lasts 3-4 months

“Off-label” uses for Botox, according to Owner Laura Hardnett, of Effective MedSpa in Gambrills, include:
  • Eyebrow Lift: Botox can provide a quick and less dramatic version of the popular brow lift surgical procedure.
  • Gummy Smiles: Injecting Botox into the upper lip weakens the retractor muscles, lowering the lip line to produce a more aesthetically balanced smile.
  • Jaw Reduction: Botox can be used to transform an overly square and masculine appearing jawline into a more feminine oval or heart shape.
  • Forehead lines: Botox relaxes the lines across the forehead for a smoother appearance.

Dysport

  • An injectable neurotoxin for dynamic wrinkles
  • Approved for patients 21+
  • FDA-approved in 2009
  • Results in 1-3 days
  • Lasts up to 4 months

“It also has been shown in some patients to spread out a little more from the injection site. This results in a softer appearance of the broad muscles in the forehead and crow’s feet areas,” says Dr. Henry D. Sandel IV, of The Sandel Center in Annapolis

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