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Fine-tuning fillers: Look for expanding array of injectables


Physicians will soon have an expanded array of injectables, as manufacturers fine-tune fillers and bring new neurotoxins to the market.


Perhaps the biggest development in 2009 in terms of injectable options will be the debut of Reloxin, made by Ipsen and marketed by Medicis, to the U.S. market, bringing some competition to the U.S. neurotoxin field for Allergan's Botox.


A key issue with Reloxin that physicians need to be aware of is that there is no direct scale to compare Reloxin dosages to Botox, and, therefore, direct comparisons in dosing should be avoided, says Tina Alster, M.D., director, Washington Institute of Dermatologic Laser Surgery in Washington, and clinical professor of dermatology at Georgetown University Medical Center.

"Reloxin has a very different dosing application, and so you can't assume that a certain amount of Botox translates to an equal proportion of Reloxin," Dr. Alster says.

"Its unique dosing will likely lead practitioners to develop specific recipes that work for them," she says.

The product may have a bit of a learning curve, but Dr. Alster says experienced injectors should not have a problem. Furthermore, she says, the time is right to give Botox some competition.

"I think it's about time that another neurotoxin came to market to give Botox a run for its money," she says.

"It is typical for injectors to mix and match various fillers and other injectables in the same individual depending on the body part and the magnitude of the skin defect.

"Practitioners who perform a lot of neurotoxin injections will probably end up having Botox, as well as Reloxin, in their offices and may choose one over the other for various reasons," Dr. Alster tells Dermatology Times.


Another botulinum toxin product, Puretox (Mentor), has completed phase 3 clinical trials involving 400 subjects and showing substantial efficacy.

"They finished a multicenter trial with 400 patients with Puretox and found efficacy in reducing frown lines. The onset for Puretox seems to be similar to Reloxin, and the activity is similar to Botox," says Gary Monheit, M.D., at the annual meeting of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

New dermal fillers are, meanwhile, being developed in bold new ways to offer deeper volumizing and thicker products.

Belotero (Merz), currently used in Europe, is in phase 3 clinical trials in the United States.

The hyaluronic acid filler is said to be similar to Juvéderm (Allergan), and is designed for deep dermal injection with a 27-gauge or 30-gauge needle.

The filler is said to be particularly beneficial in the nasolabial folds and marionette lines.

"Belotero is robust and gives some lift," Dr. Monheit says. "It seems to flow similarly to Juvéderm and has a stiff look to it."

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