Dysport has now received approval from the FDA for use in United States.  Dysport is a purified protein, similar to Botox, that relaxes muscles of the face.  It is not identical to Botox, but works in a similar manner.  It is administered by a physician or a registered nurse  and can provide months of improved appearance to the lines of the face.

Dr. Ebroon was honored to have dinner with Jonah Shacknai the founder and Chief Executive Officer of Medicis.  They spent an evening together this past week in Beverly Hills, California, discussing Dysport and how it will help his patients.  Dr. Ebroon wanted to learn as much as he could about the development of Dysport and the properties of this new medicine.  Mr. Shacknai indicated that Medicis, the company that makes Dysport, was extremely pleased to get approval of the medicine in the United States.  He also indicated that Medicis is working to develop other cosmetic products. 

Dysport is new, but Dr. Ebroon has a tremendous amount of experience with the similar medicine Botox.  He first started using Botox at Northwestern University in Chicago, Illinois in 1991.  He has used Botox over the last 18 years on thousand of patients. 

Botox has been a very successful medication in improving the lines of the face.  It is especially effective in the glabella, the area between the eyebrows, which tend to form deep vertical lines that give the connotation of anger.  Botox is also used commonly by Dr. Ebroon to treat crow's feet in the forehead region.  Occasionally Dr. Ebroon will use Botox in other areas as well.  Some people form vertical bands in the neck from overactive use of neck muscles and Botox can be very effective in relaxing these.  Also, occasionally, Dr. Ebroon will use Botox in very small quantities around the mouth.

It remains to be seen if Dysport is as safe and effective as Botox is.  The package insert approved by the Federal Drug Administration in the United States gave the approval Dysport for four months of use.  This is similar to the duration of Botox.  On the other hand, there are some differences between the medications.  There may be differences in how quickly Dysport starts working and how much the medication spreads.  It remains to be seen how large these differences are and if they have any clinical relevance, meaning do they really make a difference when used in a patient.

We have come a long way in nonsurgical treatments for reducing the lines and furrows of the face.  For many years, Botox has been a very important tool for aesthetic surgeons in noninvasively improving the appearance of the face.  The procedure takes only several minutes and a patient can jump back into their daily routine very quickly.

Botox is often used in conjunction with products called dermal fillers.  These products are made to fill areas of the face that one can see when the face is at rest.  Fillers can plump up these areas to make them look more smooth.  Common places to use fillers are in the smile lines around the mouth and to enhance the appearance of lips.  They are also used to contour the face in order to make the face look better.

Much like a sculptor, a physician with an artistic eye can use his or her experience and aesthetic sensibility to remove years off the appearance of the face.  Now that Dysport is available, Dr. Ebroon will watch closely to learn its characteristics and add it to the growing armamentarium of esthetic treatments for the face that are minimally invasive and have quick recoveries.

Stay tuned for more information about Dysport as it becomes available.

Dr.  Ebroon is excited to introduce Dysport (a new wrinkle remover) into his practice.   Dysport is used for both cosmetic and therapeutic use and sanctioned by the FDA. 

Dysport is made from the same active ingredient as Botox, Clostridium botulinim toxin type A. Botulinum toxins temporarily reduce the appearance of wrinkles by restricting the muscle actions that cause creasing and frown lines.

Dr. Ebroon uses Dysport for cosmetic injections to reduce wrinkles in the face such as the frown line in between the brows, the laugh lines, crow's feet and forehead.   As with Botox, Dysport temporarily minimizes the action of facial muscles, smoothing out undesirable lines between the brows, across the forehead or crow's feet to restore a more youthful, less stressed appearance.

Radiesse consists of microspheres made of calcium hydroxylapatite. These small smooth particles are suspended in a water based gel. Dr. Ebroon has been using Radiesse for hand rejuvination with fantastic results. Sometimes, as the hands age, the skin on the back of the hands starts to loosen and wrinkle. Veins and tendons can often become more prominent as the soft tissue atrophies somewhat. Radiesse filler can be used in a painless technique. It is injected into the back of the hands and carefully massaged throughout the back of the hand to give some fullness to the space between the veins and tendons. The extra fullness makes the skin somewhat more taut and therefore less creepy and wrinkled. Radiesse treatment for hand rejuvination is one of the most well received procedures that Dr. Ebroon does. If you are bothered with the appearance of your hands, please consider seeing Dr. Ebroon for hand rejuvination.

Before and After Hand Rejuvination Photo
(actual patient photo performed by Dr. Ebroon)

Before - Hand Rejuvination Photo

After - Hand Rejuvination Photo

The outstanding cosmetic enhancements that Botox offers continues to be enjoyed by millions of people around the world. Botox was developed for medical purposes in the 1970s and 1980s. Originally it was developed to help the condition called Strabismus. Strabismus is when the eyes do not both look in the same direction, causing one eye to appear as though it is turned in or turned out. Dr. Alan Scott developed Botox to temporarily weaken one of the eye muscles so that both eyes could look in the same direction. Botox was approved for this purpose in the 1980s.

Soon afterwards, further medical uses for Botox were discovered. Patients who have the condition called blepharospasm constantly and involuntarily blink their eye muscles. This disease, when it progresses far enough, can prevent people from reading or driving. It can also make work almost impossible. Its devastating physical and psychological effects lower the quality of life of many people who have it. By relaxing the eye muscles, Botox greatly helps these people. Patients who could no longer drive are able to drive again. People who had difficulty reading can read again comfortably after the use of Botox for this purpose.

Soon after, roughly around 1990, related conditions were also treated with Botox. A condition similar to Blepharspasm, called Hemifacial Spasm, occurs when half of the face uncontrollably twitches. Just like Botox can be helpful in the case of Blepharspasm by relaxing the involuntary blinking muscles, Hemifacial Spasm patients can feel more comfortable in social settings because of the fact that their face is no longer twitching uncontrollably.

Other forms of so called Dystonia, where muscles involuntarily twitch throughout the body, were soon thereafter treated with Botox. Children could also benefit from this medication. Patients with spastic Dystonia who had difficulty walking or using their hands or arms were treated with Botox, and in some case could walk again.

It was recognized early on in the use of Botox that the patients who were treated for some of these conditions enjoyed reduction of wrinkles in the areas that Botox was placed. This was most noticeable in the patients who were treated on one side of their face. These patients, and their doctors, recognized that the side treated with Botox had far less wrinkles than the untreated side. When these patients repeated the use of their medications, the difference in appearance of the treated and untreated side became even more and more prominent.

Allergan, the company that makes Botox, received approval for use of Botox for cosmetic purposes in 2003. Allergan completed trials to show that the use of Botox in the glabella, the frown line between the eyebrows, could relax the frown line and improve one’s cosmetic appearance. The FDA granted approval of Botox for this purpose in 2003. Although this is the only “On-label” cosmetic use of Botox, physicians soon began to use Botox elsewhere on the face. An On-label procedure is one that is specifically approved by the FDA. However it is not only legal, but customary amd common, for doctors to use medications that are On-label for some purposes, Off-label for other purposes. Likewise, Botox was quickly used for relaxation of forehead lines, crow’s feet and occasionally on other areas in the face to reduce lines created by overactive muscle movement. There are now millions of people around the world who have been treated with Botox for these purposes.

On a chemical level, Botox is a protein derived from bacteria, Clostridium, that temporarily disrupts the signal from a nerve to a muscle. Nerves communicate with muscles, telling them to contract, using substances called neurotransmitters. These are proteins that are released from a nerve and enter a muscle telling the muscle to contract. When Botox is placed near a nerve, the nerve takes up the Botox protein and even when the nerve tries to send the signal to the muscle telling the muscle to contract, Botox overrides this signal and does not allow the muscle to squeeze. This effect is always temporary. Typically after three months or so the nerve will metabolize the Botox protein and the signal will resume as though the Botox was never there.

In the near future Botox will enjoy competition from other medications designed for the cosmetic treatment of facial lines. A medication called Dysport (also called Reloxan) is in clinical trials in United States. This medication, much like Botox, is designed to temporarily disrupt the signal from the nerve to the muscle in order to relax muscle that creates wrinkles. Nobody can say with certainty when the FDA will approve this medication. It is noteworthy that it is currently being used in Europe with consent of the European body that oversees drug approvals.

The manufacturing process for this medication is different from Botox so it is not clear if its length of action is the same as Botox. Furthermore, because its formulation is slightly different from Botox, it is not clear if it less uncomfortable or more uncomfortable to place in a patient’s facial muscles. Furthermore, the price that Medicis, the company that will have the right for distribution of Reloxan in the United States, will charge for this medication has not been revealed to the public. One must be critical when listening to estimates from the companies that develop these medications as to the timetable for FDA approval, but it is thought by the company that Reloxan will receive FDA approval in the summer of 2009 and be available for use by patients interested in cosmetic improvement shortly thereafter.

Other competitors for Botox are also in the process of developing similar medications. These competitors may not be as far in clinical studies as Reloxan, however. and may take even longer to get to the market. One such competitor is Xelmin, a Botox like product made by the German pharmaceutical company Mertz. The properties of this medication in relation to Botox have not been released to the public and we are unsure as to its advantages or disadvantages. Similarly, another product in the early to mid phases of testing is called Puretox.

Patients have enjoyed the unique and striking effects of Botox for many years. It’s mechanism of action to promote cosmetic enhancement and facial rejuvenation is a true breakthrough. It has changed how patients view surgery as many patients now have a nonsurgical alternative to improving appearance. Very soon, we will be entering a new phase of cosmetic enhancement and facial rejuvenation as these Botox competitors reach the market in the next few years. Whether they demonstrate the unparalleled safety and effectiveness that Botox has demonstrated remains to be seen. Most physicians and patients welcome the possibility of competition to the market place. It seems nothing but beneficial to have a widened array of products and prices to help patients with their choices in facial rejuvenation.

Important news came from the world of anti-wrinkle injections. Botox has been a long undisputed market leader in anti-wrinkle injections because it is the only one approved by the Federal Drug Administration (FDA). Botox is made by Allergan and they have had a monopoly in this area of the cosmetic market for over a decade.

Now news is breaking that Medicis Pharmaceutical Corporation of Scottsdale, Arizona will soon announce it has submitted an application to the FDA to obtain approval for a Botox competitor. Medicis’ drug is called Reloxin. Reloxin has been approved in Europe for non-cosmetic purposes under the brand name Dysport. They have not yet obtained permission in Europe or the United States to use Dysport for cosmetic purposes. Medicis hopes that they will obtain approval for Reloxin in 2008. This would be huge news in the treatment of anti-wrinkle therapy. If Botox has a competitor, it is thought by many observers that this can only be good for patients.

Reloxin is not identical to Botox. Reloxin may have a faster onset than Botox and may diffuse further in the muscles. This has pros and cons and good results, as usual, depend on the experience of the treating physician. Keep your eyes out for an FDA approval in 2008 for a new addition to the cosmetic anti-wrinkle market.