New facial aesthetic products may pose challenge to Botox

January 1, 2010

Various hyaluronic acid-based fillers are being widely used in cosmetic dermatology, and potential competitors to established products such as Botox are being investigated in trials.

Key Points

Joel Schlessinger, M.D., F.A.A.D., F.A.A.C.S., past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), notes that although new facial aesthetic products are emerging, their success depends on their actual benefits, and on the skills of those who administer them.

"It will be a pretty high bar to get a new product to the marketplace that dislodges the HA fillers from their current perch," says Dr. Schlessinger, a board-certified dermatologist and general cosmetic surgeon, and president of http://LovelySkin.com/. "The question is if a new product is claiming certain benefits and can dislodge the current favorite in the marketplace."

Rough starts

Many of the products that enter the marketplace come with a learning curve in terms of their use, he notes.

"That (learning curve) can be a death knell to new products," Dr. Schlessinger warns. "People using the product need to be outstanding in their injection technique."

He cited the recent example of Evolence (Ortho-McNeil-Janssen). a filler developed by a division of Johnson & Johnson, which was pulled recently from the marketplace after an inauspicious start and concerns about poor results, lumps and bumps.

A recent survey on http://RealSelf.com/ showed a satisfaction rate of only 33 percent, the lowest of all fillers noted on the site, in comparison with a 64 percent satisfaction rate for Perlane (Medicis) and 59 percent for Juvéderm (Allergan).

Expert skill

Dr. Schlessinger, who was an adviser to the manufacturer about the product, told Dermatology Times that he has been concerned, since prior to his presidency of ASCDAS, about side effects occurring in patients with the injection of this filler if the injections were not performed in very skilled and experienced hands, and he has expressed this concern to multiple vendors in the cosmetic sector.

"Most companies are concerned with getting the product into the hands of everyone (including nonphysicians) who can inject the product," he says. "That practice can very quickly result in negative ratings like those that appeared on a Web site. (See: http://www.realself.com/news/johnson-and-johnson-kills-Evolence-cosmetic-filler/141485)

"The product was supposed to bruise less and produce less irritation than the HA fillers," he notes. "That was its unique selling proposition in addition to longevity. It was found to be painful on injection and was a challenge to people who want it (injection) to be a relatively painless experience as they have experienced with HA fillers."

The advantage of HA products is that they are reversible, Dr. Schlessinger says.

"The beauty about HA products is that you can inject hyaluronidase, and that totally dissolves the material," he says. "It doesn't mean that administering hyaluronidase will always work, but it can be an antidote to poorly performed treatment with Juvéderm or Restylane (Medicis)."

By contrast, Evolence did not have an antidote to reverse the effects of an injection, nor does the filler Artefill (polymethylmethacrylate, Suneva Medical), according to Dr. Schlessinger.