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The growth of injectable aesthetic treatments is largely fueled by the number of products that are available to use. Between neuromuscular paralyzing agents, volumizing fillers and sclerotherapy agents, there are over fifteen products currently available. That is about to grow by two new products and on-label indications.

Moving alongside Botox and Dysport will be Xeomin offered by Merz Aesthetics with its recent approval earlier this year. Like its predecessors, it has been approved by the FDA for temporary improvement in the appearance of moderate to severe glabellar (between the eyebrow) lines in adults. (between ages 21 to 65) What its advantages may be, if any, over Botox and Dysport remain to be forthcoming. As a different molecular structure of botulinum toxin, incobotulinumtoxin A, it is likely to have most of the working properties of the botulinum toxins such as delayed onset of action, limited zone of diffusion and a lifespan of three to four months. Its unit dosage and its pricing point will be interesting to see what the company offers and how it compares to its competitors.

While Restylane and many other injectable fillers have been around for awhile, it would surprise many that they have never been approved by the FDA for lip augmentation. This is interesting given that lip injections make up a significant percentage of the product’s use in most practices. This means that lip enhancement by fillers has been used off-label for more than a decade. Restylane, introduced initially in the U.S. in 2004 by Medicis Aesthetics, has been recommended recently by an FDA advisory panel to expand its approved indications to that of the lips. While this does not formally mean the FDA will do so, it is more likely than not. While this doesn’t provide any new benefits to injectable lip augmentation per se, it is comforting to know that its well known safety and effectiveness is scientifically recognized.

Sclerotherapy has used injectable products such as hypertonic saline and sodium sotradecol for decades without any new technology innovations. In the past year, a new sclerotherapy solution has been introduced that is widely used around the world. Asclera, pilodocanol, has been FDA-approved and released by Merz Aesthetics. This is for sclerosing uncomplicated spider veins (very small varicose veins less than 1mm in diameter) and small varicose veins (1 to 3mms) known as reticular veins. Asclera works similarly to other sclerosing agents by damaging the endothelium which is the lining inside of blood vessels. This causes blood platelets to attach to the lining of the vessels, causing the blood vessel to clot. Over time, the clotted vein will be replaced with scar tissue. Without blood flow, the spider veins ‘disappear’. With a similar mechanism of action, the question is how Acsclera may be superior to existing products. It is believed that it works more effectively and with less injection discomfort than its predecessors.

The infusion of new products like Xeomin and Asclera and expanding indications of existing products, like Restylane for lips, will continue to fuel the growing field of office-based injectable cosmetic treatments.

Dr. Barry Eppley

Indianapolis, Indiana

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