More and more people are opting for non-invasive procedures to counteract the effects of aging on their face. Of the 626,778 aesthetic medical facial treatments performed in Spain in 2021 – the latest date for which official data are available – 42% corresponded to botulinum toxin, which according to the Spanish Society of Aesthetic Medicine ( SEME ). This neuromodulator is not only the best remedy for smoothing forehead and eye wrinkles, but is also used to restore luminosity, elasticity and facial tension, as well as to treat acne, rosacea or scars.
Twenty years ago, the approval of the use of botulinum toxin in Spain marked a revolution in aesthetic medicine to relax and prevent expression lines, proclaiming botox the absolute king of the procedure. In fact, this neuromodulator has achieved the same thing that brands like Kleenex, Rimmel or Coca-Cola have done before, taking the name of the product they sell. Everyone refers to this substance as botox (botox, in Spanish), which is the name of the company that made it famous. “The use in 2004 was so impressive and effective that new references were not developed until much later,” explains surgeon and aesthetic doctor Virtudes Ruiz. The market has been dominated for many years by three brands from the laboratories Merz Pharma, Allergan and Galderma. “The three options appear similar and have a fairly similar duration. This duration not only depends on the medication, but there are also personal factors such as muscle strength, repetitive movements or the number of receptors the patient has that have an influence,” says Dr. Carmen Górriz, Deputy Director of the Department of Aesthetic Medicine at the Ricart Medical Institute. Now, however, we are entering a new era where three young botulinum toxins have entered the sector primarily because “there is a shorter duration of action. Antibodies and resistance to the options on the market have been developed. Because of this, the pharmaceutical industry has been forced to offer safer alternatives with longer duration and efficacy that have more approved indications,” explains Dr. Ruiz.
Presented last October in Spain during the II Iberoamerican Congress and V Portuguese Society of Aesthetic Medicine, Letybo (Letybotulin toxin A) is already on the market. It is of Korean origin, manufactured by the Croma-Pharma laboratory and already approved in 26 countries. The most notable advantages it offers are two: “It is indicated for use in patients up to 75 years of age – the rest are only up to 65 – and it is derived from a new strain of Clostridium botulinum, different from those which are used by all other neuromodulators that we currently use. This means that there are no resistances or antibodies and an effect of between four and six months is guaranteed,” explains María Vicente, surgeon and aesthetic doctor at Virtud Estética. The downside is that “it’s currently only approved to treat glabellar lines (between the eyebrows), but it’s hoped that there will soon be studies showing its effectiveness for the orbital (crow’s feet) region and forehead as well. ‘ adds Gorriz.
Of the 626,778 aesthetic medical facial treatments performed in Spain in 2021, 42% corresponded to botulinum toxin. Rita Puig-Serra Costa
Liquid and ready to use without the need to reconstitute – the rest of the toxins on the market are lyophilized and must be reconstituted with saline (or other reconstituents) for use -, Alluzience is the new option proposed by Galderma. “Its specific formulation, without human albumin or preservatives, or lactose or animal proteins, makes it suitable for people with allergies or intolerance to eggs or lactose, as well as vegans,” comments the expert from the Ricart Medical Institute. In addition, “its effects are felt more quickly, between 24 and 48 hours after administration, with more predictable results that last up to six months, while the previous ones last between three and four months,” he continues. The downside is that the solid dilution forces doctors to work with larger volumes, and it also causes more pain to inject.
Daxxify (Daxinotulintocin A) is expected to land in our country shortly, which is already being marketed in the US and its Revance Therapeutics technology has been approved by the Food and Drug Administration (FDA). This product “has a lower molecular weight (150 kDa) and is linked to a synthetic stabilizer peptide that allows it to dispense with human albumin protein or other animal products, allowing the molecule to easily bind to the site where it acts. This stabilizing peptide is the one that lasts the longest: six to seven months, according to the company that markets the drug, which claims to have studied 2,700 people with 4,200 treatments. Although there is still no comprehensive study in Spanish patients,” says Electa Navarrete, surgeon, aesthetic doctor and director of Clínicas Electa. Another added value is that it does not need cold for its conservation and the results are more natural due to its lower diffusion capacity. Although the doctor adds that “at the time of infiltration it causes great pain”.
Whether one or the other neuromodulator is supplied is the decision of the doctor who, knowing the characteristics of the different products and the patient, determines which option is the best in each individual case.