By Debra Jaliman MD
For years, dermatologists have used Botox to smooth wrinkles, especially the deep creases between the brows, forehead lines, and crow’s feet. Very skilled dermatologists also use it above the lip to soften lines caused by pursing the lips, to lift sagging necklines, and to lift the corners of the mouth. Patients usually love the results and have made Botox injections the most popular non-surgical cosmetic procedure in the United States. For the longest time, there was no good alternative to using Botox injections, because nothing worked quite as well; Dysport, which is marketed as a Botox alternative, in my opinion is not as effective. Now there are two interesting alternatives, one already on the market and one on the horizon: Xeomin and a topical botulinum toxin gel.
A surprising number of people are afraid of needles. The very thought of getting injections into the face terrifies them, even though the Botox shots are virtually painless, since in most cases a numbing cream is applied to the skin before the injections begin. These are the patients who will benefit most from the new gel, which contains the same muscle-paralyzing neurotoxin as Botox.
So far the gel has been tested on crow’s feet around the eyes, where the skin is thinnest and the gel can penetrate best. The gel is applied to the area and left on for about half an hour before being wiped off.
The results of a clinical trial are encouraging. According to a recent study, around 90% of patients saw a decrease in moderate to severe crow’s feet and the results lasted around four months, which are comparable to what Botox achieves.
This new gel is still being tested and has not yet been approved by the Food and Drug Administration. Once it becomes available, there are a couple of points to keep in mind:
- This new gel is NOT intended for home use, contrary to what some media mistakenly announced. It is a neurotoxin with all the potential side effects of Botox and should only be administered in a doctor’s office.
- It will probably not replace Botox injections entirely, especially around the mouth where precision placement of shots is very important and in areas where the skin is too thick to allow the gel to penetrate.
Xeomin, like Botox, is a botulinum-based injectable. Approved by the FDA last summer, Zeomin is rapidly gaining adherents among dermatologists. It seems to be just as effective as Botox, but because it has a lower protein load, it may be associated with fewer side effects, although the jury is still out on this. The final price has not been fixed by the manufacturer, but it looks like it may end up costing doctors and patients considerably less than Botox.
Although the FDA so far has approved it only for use in the creases between eyebrows, most doctors seem to feel that, like Botox, it can be used anywhere on the face. Besides, even Botox is officially approved only frown lines – and in real life its use is certainly not limited to that.