What’s New?

There are always some exciting new products coming out and being heralded as advances in the aesthetic world.

How do you feel when you hear about a new medical treatment or product?

Innovation is necessary for scientific advance and improvement but often new products are viewed with suspicion. Some of us jump straight to trying them but others do not want to try them until they have been in use for a long time and therefore studied for long term side effects and outcomes.

Some new products represent an evolution of something that we are already familiar with and, as such, may be less daunting than a brand new type of treatment. Nonetheless, anything new can carry with it new risks and outcomes.

With regards to Botulinum toxin and dermal fillers there are some new products you may hear about:

New Wrinkle Relaxing Injections

There is a new type of botulinum toxin preparation called Daxxify™ (daxibotulinumtoxinA-lanm) . It works quicker (often within a couple of days rather than within a week or so) and the effect against wrinkle causing movements lasts for longer than the usual formulations (about 6 months average time rather than the usual 3 to 4 months). The longer duration of action will be particularly desirable for busy patients who have trouble fitting in appointments and have already ascertained a reliable pattern of treatment and response.

A longer duration of action may not always be ideal for the new patient if the effects are uncertain or there is the possibility that they do not like the result (they will be stuck with waiting for it to wear off for longer).

My patients will know – as I discuss with them – that commonly used botulinum preparations contain Human Albumin as a stabiliser. Although this is purified, there is the hypothetical risk of an unknown disease being transmitted. Daxxify™ contains no human albumin or any animal products. It might therefore be safer and have a broader appeal.

The FDA approved Daxxify™ in Sept 2022 but it is slowly being rolled out with an education and training programme in the US and it is not widely available yet. I do not know what the cost will be when it becomes available in the UK but, as it requires no cold storage, it should be more convenient than some others to transport and store.

We already have a longer acting botulinum toxin available to us in the UK (manufactured by the established brand Galderma). It is called Alluzience® and works up to 6 months rather than the usual 3 to 4 months. It also has a quicker onset of action than the usual products. However, it comes already reconstituted with water rather than saline so I have heard that it can be more painful when injected and, although it was approved by the MRHA in September 2022, it is not widely in use yet.

A New Hybrid Filler

The fillers that I use are Hyaluronic Acid (HA) fillers and there are different formulations that I select depending on the various parts of the face and the individual patient to obtain the best results. The range that I use are temporary and usually lasts 9 to 18 months but can last longer sometimes. It is possible to reverse them in case of a complication.

There are many other types of fillers on the market, including semi – permanent fillers like Calcium Hydroxyapatite. This semi-permanent filler last longer (up to 3 years) and due to a stimulatory effect cause the body to produce and lay down new collagen.

HArmonyCa® is a new dermal filler manufactured by Allergan (who also make the Juvederm® filler range VYCROSS™ that I usually use). It is a hybrid product that gives the immediate HA (Hyaluronic Acid) filling and hydrating effect along with the long-lasting lifting effect when the semi-permanent CaHA (Calcium Hydroxyapatite) microspheres stimulate fibroblasts to lay down new collagen.

Each type of these fillers has been used independently for many years and now this new hybrid product has been praised for combining these features of each type of product.

However, a potential problem with using the CaHA (Calcium Hydroxyapatite) filler or the new hybrid is that we do not yet have an agent that can dissolve semi-permanent or permanent fillers. This means that a serious complication such as an artery blockage (this can lead to loss of an area of skin or even blindness) could be irreversible.

In summary, with cosmetic treatments there is a balance of risk versus benefit. When considering a purely aesthetic treatment an individual might be less likely to take any perceived risk than if they were trialling a potentially life saving cancer drug or a vaccine to prevent a deadly disease. However, we need to avoid being so risk adverse that we ignore any changes if they represent an improvement or could even have a safety advantage.