The introduction of new cosmetic injectables not only offers patients more choices in facial rejuvenation, but also more competitive pricing and better results produced by better technology.

New hyaluronic acid fillers

Many of the new injectable fillers headed for the U.S. are composed of hyaluronic acid gel, including:

• Belotero (Merz), a hyaluronic acid (HA) filler similar to Juvederm offered in three concentrations—soft, basic and intense
• Restylane Vital & SubQ (Medicis), thinner and thicker formulations in the Restylane family of injectable HA fillers
• Juvederm Voluma & Hydrate (Allergan), thinner and thicker formulations in the Juvederm family of injectable HA fillers

Belotero has already been filed with the FDA and is purported to provide an improved level of tissue integration that causes fewer incidences of lumps and bumps than other hyaluronic acid fillers.

Juvederm Voluma is used throughout Europe for adding large amounts of volume to the face, such as the chin and cheeks.  SubQ is also a large volume filler reportedly used for both facial contouring and body contouring, including buttock and breast augmentation.

Restylane Vital and Juvederm Hydrate are ideal for treating areas that have been historically difficult to correct with fillers, such as the back of the hands, décolleté and neck, and both purportedly offer wrinkle prevention by boosting skin hydration and elasticity.

Unlike Juvederm Hydrate, Restylane Vital offers a specialized automatic injection pen that regulates product injection volume and speed for more precise results.

Other innovative facial fillers

Novabel is the first injectable filler composed of spherical, flexible structures called Geleons, which are formed from marine brown algae extract.  This patented Geleon technology reportedly makes Novabel injections virtually pain-free and also improves skin elasticity.

In addition, the composition of Novabel is said to make injection easier and reduce swelling, making it ideal for adding volume to facial areas with thin skin, such as the eyelids and tear troughs.

In addition to Novabel, another new non-HA filler is working its way to the U.S.  Derma Veil, a pure collagen stimulator made of polylactic and polyglycolic acids (PLGA) will compete with Sculptra for a portion of the facial volume restoration market if approved.

Better than Botox? Naked botulinum type A injectables

In addition to injectable fillers, new botulinum type A neurotoxins Xeomin and PurTox are also poised to enter the U.S. marketplace.

Unlike Botox and Dysport, the active protein structures of PurTox and Xeomin products are not complexed to other, inactive proteins, leaving the active proteins “naked.”

As a result, it is theorized that these wrinkle relaxers may work faster, last longer and decrease the possibility of allergic reaction and development of blocking antibodies in patients.

PurTox has completed clinical trials and may be close to FDA approval.

Dr. Bruce Genter, a plastic surgeon in Pennsylvania, voiced his skepticism in this ABC news segment, pointing to the lack of scientific evidence supporting acupuncture as an effective wrinkle treatment.  Yet, some are saying it works for them; are they seeing real change or is wishful thinking clouding their perception?

Julia Engstrom, who says she has used Botox and laser treatments in the past, believes facial acupuncture has improved the texture of her skin and reduced the appearance of wrinkles. Nearing the end of 10 treatments, she says her improvements have come through improved sleep and relaxation. “I’ve noticed that my skin is a lot smoother, [there’s] a lot less red pigment in there and the wrinkling seems to be a lot less,” Engstrom said. “I [also] have a lot less darkening under my eyes and I’ve been getting a lot of compliments.”

Acupuncture, a process during which tiny needles are placed strategically into the body, is said to bring improved health and well-being. In an article for Prevention magazine, licensed acupuncturist and Traditional Chinese Medicine practitioner Phyllis Olson asserts that acupuncture can indeed lessen the appearance of wrinkles. She attributes this to a core premise of acupuncture – that health is reliant upon the healthy flow of chi (energy) in the body, which can be disrupted for a myriad of reasons. Acupuncture treatments are believed to break up energy blockages that prevent optimal blood flow to certain places in the body, improving circulation.

Beata Maslanka, Philadelphia acupuncturist and author of the “Art of Wellness” acknowledges that acupuncture doesn’t yield visible results that compare to Botox or other facial fillers, but claims that beauty actually comes from within; when internal imbalances are healed, people will look better overall.

Olson agrees, noting that the treatments foster relaxation of facial muscles, thereby reducing wrinkles. “Aside from the light, momentary stings, acupuncture is really quite relaxing,” she adds.

The results Engstrom points to are hard to discern from the video, but one can wonder about the salutary effects of relaxation and optimism, not to mention the natural human tendency to see (and believe) what we want to see.

If it does have a wrinkle-relaxing effect, how long could this last? NYC dermatologic surgeon Barney Kenet, MD tells Prevention: “If acupuncture relaxes the muscles, it might reduce wrinkling temporarily. As for the increased blood flow, at most it will probably give you a temporary rosy complexion–something you don’t want if you have an inflammatory condition such as acne or rosacea,” he warns. “Otherwise, cosmetic acupuncture is relatively harmless.”

Maybe so, but then you may want to consider the cost. The average price of an acupuncture treatment for facial wrinkling could be as much as $60 to $100 per session, with 10 sessions recommended by Olson, followed by monthly maintenance procedures.

In contrast, the average Botox treatment in the US costs $472 and a single treatment will last 3-6 months. This makes acupuncture wrinkle treatments both an unproven and costly proposition.

Dr. Genter, whose patients are proof that Botox and other facial fillers visibly reduce the effects of aging on the face, says: ”If it increases your well-being that’s great, I just don’t know that it can make your face look younger.”

On November 18, Food and Drug Administration officials will meet with a panel of outside experts to discuss possible changes in the labeling of cosmetic dermal fillers like Juvederm, Restylane, Radiesse and others that continue to flood the market.  Within the last six years, the FDA has received 930 reports about complications related to injectable wrinkle-fillers.

While it may sound alarming, the complications and side effects associated with these products are still very rare.  There are known issues that occur like minor swelling, and then there are serious allergic reactions, with the latter being a subject of greater FDA interest.

Allergan spokeswoman Caroline Van Hove told MSNBC that “no serious problems were seen in clinical trials of Juvederm, and the most common complaint since its approval was swelling in 0.4 percent of patients.”

Also, Food and Drug Administration officials noted that the “reports had several limitations such as failing to say when the problems started.”

The majority of industry professionals will attribute most of the reported complications to unqualified persons administering filler injections, since consumer demand for them has recently risen so dramatically.  Safety and proper training is of the utmost importance with almost any cosmetic procedure, so we recommend that all patients seek a knowledgeable plastic surgeon with the right qualifications.

For more information on the FDA panel discussion, the briefing is located here.