Can Revance - or Reloxin - Revamp the Wrinkle War?

Dr. Hema Sundaram Health Guide
  • If you yearn for an unfurrowed brow but the thought of Botox injections leaves you cold, keep a lookout for a new, needle-free wrinkle-fighter that's currently under development.


    Last month, Scottsdale-based Medicis Pharmaceutical Corporation - whose products include Restylane, the leading dermal filler worldwide - announced a strategic collaboration with Revance Therapeutics, a company headquartered in California that is developing a new botulinum toxin type A to relax wrinkles without injections [1]. Unlike the multitude of lotions and potions already out there that make unsubstantiated claims to be Botox alternatives, Revance has sound science behind it.

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    The idea is that this new form of botulinum toxin A, the active ingredient in Botox, can be applied to your skin, through which it is absorbed to target the overactive muscles that cause unwanted frown lines and other wrinkles. I spoke recently with Jonah Shacknai, the CEO of Medicis, who told me: "While the study process for Revance is still in a relatively early stage and further work is needed to establish safety and efficacy, the clinical data so far are encouraging and I am very excited about exploring a new delivery system for botulinum toxin A".


    That makes two of us. Botox - manufactured by Irvine-based Allergan, Inc. - is currently the only botulinum toxin type A approved by the FDA for wrinkle treatment in the U.S. It's astonishingly popular: the American Society for Aesthetic Plastic Surgery reports that over 3 million procedures were performed in 2006, making Botox the number one non-surgical procedure [2]. And with good reason: There's no other rejuvenating treatment currently available to me as a cosmetic surgeon in the U.S. - or to you as a patient - that does what Botox does.


    However, many men and women who consult with me and would benefit from Botox treatment are needle-shy. I'm sure they would be extremely interested in a product that, as Shacknai puts it, could perform as an injectable but without a needle. Besides the thought of shots, the other concern that holds patients back from having Botox treatment is the fear that they'll end up with a frozen face. This should never be a problem if you're treated by an expert injector. Tiny doses of Botox in the right places will safely smooth out frown lines - and also crow's feet and neck wrinkles - while preserving your natural facial expressions.


    The best Botox treatment is undetectable; rather than drawing attention to itself, it lifts and sublimely enhances your other facial features. I advise my patients that they will probably receive compliments, post-Botox, about their hair, their eyes, their skin... in short, anything other than the Botox that has actually improved their appearance.


    As Revance is put through its paces, there's another Botox alternative looming closer on the horizon. Another Medicis product, Reloxin, has been submitted to the FDA and is awaiting approval for use in the U.S. [3]. Reloxin is an injectable form of botulinum toxin A that has been available for many years elsewhere in the world, under the name of Dysport. Like Botox, it has an established record of safety and effectiveness. Based on my experience as a Principal Investigator on the studies of Reloxin that have been submitted to the FDA, I believe that the introduction of Reloxin in the U.S. - most likely, by the end of 2008 - will benefit patients and physicians alike.


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    A competitor product could not only bring down the price of treatment, but also give patients a true alternative to Botox for the first time in this country. This is a fascinating prospect, given the debate on whether Reloxin might offer any medical advantages over Botox. Reloxin, like Botox, still requires injection but if it does, in fact, start working faster than Botox, last longer or provide aesthetically distinct results, then patients will have the luxury of being able to try both treatments and decide which they prefer. I expect that Botox will continue to increase in popularity but that greater public awareness and new options will help to grow the market , which is already worth hundreds of millions of dollars [4].


    However the Botox-Reloxin battle shakes out, and whatever time and further testing reveal about Revance, it's going to be an interesting year or two in aesthetic medicine...


    See Dr. Sundaram's Six Strategies For Safe Cosmetic Surgery.

Published On: January 17, 2008