Beyond Botox

"Competition is coming.

The Injectables : Reloxin—known as Dysport in 21 countries across Europe, Asia, and South America, where it's been used since 1991—is the front-runner due to the fact that it's got the best track record and it's furthest along in trials, eagerly anticipated to debut here early next year. The buzz so far is that it has a quicker "onset of action" (i.e., while Botox can take around seven days to take effect, Reloxin takes only about three); it may last longer by a month or so (the jury is still out); and, the element producing the most derm chatter: It may diffuse more, meaning it spreads out differently than Botox upon injection, potentially covering a larger area, explains New York/Miami-based dermatologist Fredric Brandt, M.D., who is leading Reloxin's clinical trials. "Assuming your injector is good," says Manhattan dermatologist Patricia Wexler, M.D., this can be a plus, since "you can use less of the toxin and get a smoother result." In terms of integrating Reloxin into her own practice, New York dermatologist Lisa Airan, M.D., believes its increased diffusibility may make it an "area specific" treatment, ideal for covering large surfaces like the armpit (for sweating) or the periorbital area—crow's-feet. "Right now you need three to four injections of Botox for crow's-feet. If you could just do one of Reloxin, that could be a benefit," says Airan. But when precision is called for, migration can be a serious downside: "When something diffuses in the wrong place, you end up with an eyelid droop," Marsha Gordon, M.D., clinical professor and vice chairman of dermatology at Mount Sinai School of Medicine, flatly states. One thing is for sure: Since Reloxin behaves differently, it will require a refined injecting technique, and "it's going to be on the doctor to learn," she says.

The Gel-Cream : What if you could dab on Botox just like a moisturizer, and it worked—just like an injection? No needle required. That's what the brainiacs at Revance Therapeutics, a Mountain View, California, biopharmaceutical start-up founded by two Stanford cardiologists and a molecular biologist, dreamed up three years ago and have been working on ever since. (Medicis, the superpower that is developing Reloxin and is also behind the filler Restylane, has invested $20 million in Revance.)

Their brainchild, which is just going into clinical trials and has no name as yet, is a topical form of botulinum toxin type A—similar to the other injectable toxins but a much smaller molecule—that goes on as a gel-like cream and penetrates the layers of the skin, arriving at the muscle thanks to a cutting-edge, targeted delivery system.

But perhaps the most meaningful aftershocks of the topical-botulinum-toxin breakthrough are the new possibilities the transfer technology opens for other areas of aesthetics and, more important, medicine. "Once we put a molecule like Botox into a cream, it's not that big a leap to think we can do it with other things," says Beer, who cites everything from hyaluronic acid and collagen to steroids and "even chemo" as examples. "It could mean good things for drug delivery."

The Machine : GFX, which stands for "glabellar frown relaxation" (of the line between the brows), employs radiofrequency, the same heat technology used in the skin-tightening treatment Thermage, to selectively weaken nerve function. In other words, Botox-like effects without the Botox. An insulated probe is inserted beneath the skin (while the patient is either fully sedated or in a Valium/Vicodin/local-anesthesia haze), first isolating the nerve to be treated by causing a contraction and then delivering a controlled, 30-second dose of heat energy to effectively knock it out of commission.

Most nerves will regenerate their fibers "to a degree," says Newman, though they may have a permanent "relaxed effect," and the process of regeneration will take from twelve to eighteen months."

- Vogue