In the cosmetic dermatology world, 2009 has been an exciting year because several new innovations were finally approved by the FDA. I have been performing the clinical research trials on these agents in my Miami Beach dermatology practice at Miami Heart Institute since 2004 and am so happy to see these products and procedures finally come to the market. To understand the role of these options, you first must know that there are three main effective ways to treat wrinkles:

• Relax the muscles to prevent wrinkles formed by muscle movement (i.e., crow’s feet). • Fill in wrinkles with injections such as hyaluronic acid. • Smooth the skin surface with creams, lasers or peels.

Relaxing the muscles Since we did the research trials that led to its approval by the FDA in 2002, Botox has been the undisputed leader in cosmetic procedures with 2,464,123 Botox Cosmetic™ procedures performed in 2008.

Having a blockbuster product like Botox is every company’s dream; consequently, many corporations are trying to develop their own “Botox.” The first copycat products that came on the market were the Better than Botox?-type creams such as Strivectin. The fact that these could not produce the results obtained with Botox injections did not stop consumers from spending millions of dollars on these creams. (By the way, the Strivectin people were able to make this statement because the question mark in “Better Than Botox?” saved them from getting in trouble for making an unproven claim. They were not technically making a claim but just asking a question. It is very interesting how all of these regulations work.)

These creams rapidly lost market share as consumers realized they did not work as well as the injections and Botox went unchallenged for seven years. Luckily, in April of this year, a competitor that could work as well as Botox was finally approved by the FDA. It is known as Dysport and has been used in Europe and Brazil for many years.

Dysport is injected with the same type of tiny needle that is used to administer Botox. They both relax muscles and smooth wrinkles for approximately four to six months and cost $250 to $1500, depending on how many muscles need to be relaxed. Having another option on the market brings healthy competition between companies that will likely result in the development of new technologies. (We are doing research on certain things that I cannot tell you about for now.)

Filling in wrinkles In July 2009, the FDA approved another injection for wrinkles called Sculptra, also known as New-Fill outside the United States. While hyaluronic acid wrinkle injections such as Restylane, Perlane and Juvederm provide instant gratification by filling in wrinkles, the results from Sculptra take longer to appear. Sculptra usually requires three to four injections spaced every month to achieve the desired results. It stimulates your cells to slowly produce collagen, which results in skin thickening and increased volume in the injected area. It is used to fill in sunken cheeks, enhance cheekbones and fill in facial wrinkles. It is very different than the hyaluronic acid injections such as Restylane and Juvederm, as shown in the accompanying table. Sculptra and hyaluronic acid injections are often used together.

In 2010 we can look forward to new hyaluronic acid products that may be coming on the market that contain an anesthetic to help decrease the pain on injection. Botox and Dysport injections are virtually painless but the hyaluronic acid injections sting and feel like a vaccination.