Monday, July 20, 2009

Better Than Botox - 2 New Treatments Now Available

Features : Memphis Commercial Appeal

Here's news to wipe the frown from your face. A new technology that uses radio-frequency waves to smooth brow wrinkles may last longer and cost less over the long run than Botox and is now available here and in a limited number of other cities.

   Dr. Phillip Langsdon  is studying a new radiofrequency technology,  called Relaxed Expressions, to treat frown lines  at The Langsdon Clinic in Germantown. The RF treatment "has the potential to be a changing force in the way we treat frown lines," he said.

Dr. Phillip Langsdon is studying a new radiofrequency technology, called Relaxed Expressions, to treat frown lines at The Langsdon Clinic in Germantown. The RF treatment "has the potential to be a changing force in the way we treat frown lines," he said.

Barbara Davis, a retired registered nurse, is shown prior to undergoing the radio-frequency  procedure called Relaxed Expressions.

Barbara Davis, a retired registered nurse, is shown prior to undergoing the radio-frequency procedure called Relaxed Expressions.

This image at right was taken one week after Davis had the treatment.

At the same time, another treatment called Dysport (pronounced DIS sport), an injectable substance similar to Botox Cosmetic, has hit the market this month giving Botox an immediate, widespread competitor.

With such developments, it appears the days of the Botox monopoly are over -- good news for consumers who have seen prices continually ratchet up over the years.

Such developments are more than mere wrinkles in the cosmetics industry. Botox is the country's most popular cosmetic procedure with almost 2.5 million treatments done last year, according to The American Society of Aesthetic Plastic Surgery, but it averages about $400 per area to diminish forehead creases and lines and crows feet, and lasts only three to six months.

For Barbara Davis, 63, the rippled pinch between her brows would let go for only two or three months, despite repeated Botox treatments. So Davis, a retired registered nurse who lives in Hernando, Miss., agreed to be a study subject for the relatively new radio-frequency technology called Relaxed Expressions. The device uses bipolar radio-frequency energy delivered with a probe to heat and temporarily incapacitate specific nerve tissue to the muscles that cause the vertical glabella wrinkles between the eyebrows.

Twenty doctors across the country, including Dr. Phillip R. Langsdon, associate professor and chief of the Division of Facial Plastic Surgery at the University of Tennessee Health Science Center, are studying the treatment, using it on 20 patients each and following the outcomes for a year.

Virginia Bledsoe of BioForm Medical Affairs, which owns the technology, said information gathered will help the company

prepare for trials for FDA approval, as well as refine the techniques used.

Bipolar RF has been used for years to treat cardiac arrhythmia. Treating frown lines is an off-label use, for which doctors are charging $1,000 to $2,000, with higher prices mainly on the coasts. (Once a product has been approved for use by the FDA, physicians may legally use it to treat other conditions for which it was not specifically approved.)

But representatives of Relaxed Expressions say effects have lasted from a year to 22 months, which, in the long run, could represent considerable savings.

And there may be other advantages. Patients typically retain a little remaining brow movement, which creates a more natural appearance than the frozen brow of Botox.

Langsdon cautions that in the hyper-charged world of cosmetic rejuvenation, "a lot of technology is pure gimmickry." But he thinks the RF treatment "has the potential to be a changing force in the way we treat frown lines," appealing to people wary of toxin injections and who want longer lasting results. He plans to offer it at The Langsdon Clinic in Germantown.

He is also still seeking more subjects for the RF treatment study. Those approved will receive doctor's services and the radio-frequency machine free, but will be charged for relaxation medications. Those interested may call 755-6465 or e-mail info@ drlangsdon.com.

The treatment is performed with numbing injections and/or relaxation medication, such as Valium, and takes about a half hour. The physician locates the target nerve with small electrical impulses from the probe, then administers radio-frequency waves, which heat the nerve and disrupt its ability to signal the muscles that cause frowns.

Davis' frown loosened almost immediately. Afterward, she said, "I went home and fed my horse." She was back at her part-time office job the next day, with a little swelling and not much bruising. The "eleven" lines between her brows are still there, she said, a few days later, "but it looks much more relaxed." She called the discomfort "tolerable. ... I'd do it again in a minute."

Dysport, formerly known as Reloxin, is, like Botox Cosmetic, a botulinum toxin type A. Made by Ipsen and marketed in this country by Medicis, it was approved in late April for glabella lines (lines between the brows), as well as cervical dystonia, a muscle contraction disorder in the neck.

Both Botox and Dysport have been in use about 20 years. While similar, there are subtle differences, said Dr. David E. Bank, founder and director of The Center for Dermatology, Cosmetic, and Laser Surgery in Mount Kisco, N.Y., who participated in the FDA trials of Dysport for frown lines.

Dysport may work a little faster, last a little longer and affect a wider area, he said.

Dysport may take effect as early as 24 to 48 hours after injection, while Botox often takes an extra day or two to kick in, he said. That's not a big deal "unless you've got a big reunion that weekend or a wedding to go to," he said.

In trials, Dysport lasted from four to six months in some patients, while Botox typically lasts for three months and begins to wear off in four, he said.

Some patients got "a pretty, smoothing out of the forehead area as well," he said.

Bank believes the two treatments will turn out to be roughly comparable in price. But he pointed out Botox Cosmetic prices have more than doubled since the product was introduced. (It was FDA approved in 2002). "While there may not be a drop in prices, (the competition) may put the brakes on the ongoing price escalation," he said.

Allergan, maker of Botox, is, in fact, greeting its rival's roll-out with a $50 rebate offer on treatments of $200 or more through Sept. 30, said Terri Healy, a registered nurse who does Botox treatments at Eden Spa & Laser here.

Healy feels Dysport may be trickier to use than Botox, because it migrates through the muscle more easily, she said. A temporary droopy eyelid is a possible side effect with both products. So, for now, the spa, which treats about 25 clients a week with Botox, is sticking with Botox.

In Memphis, $12 is a standard price for a unit of Botox, said Healy. Women with a tight furrow may require 20 to 30 units, she said, while men, who often have more muscle bulk, may require 30 to 50.

Botox is sometimes offered locally for as little as $9 a unit by competing medi-spas and doctor's offices, she said. But sometimes the deal is only for large-dose users or first-time users.

The best time to get a bargain is now before the fall party season and when parents may be spending their money more on family and kids, she said.

Perhaps moms dealing with kids out of school also see more reason to keep the frown option available.

Frown stoppers

Two new treatments for frown wrinkles offer alternatives to Botox, the country's most popular cosmetic procedure.

Botox, FDA-approved in 2002, is a botulinum toxin injected into the facial muscles that cause frowns and crow's feet to temporarily paralyze them.

Dysport, also known as Reloxin, is another botulinum toxin injectable approved in April that may work faster and perhaps last a little longer than Botox. It is hoped it will end the Botox monopoly.

Relaxed Expressions is a relatively new technology, delivered with a machine and a probe, that uses bipolar radio-frequency energy to incapacitate the nerves to the muscles that cause frowns for a result that may be considerably longer-lasting than Botox. Memphis is among 20 cities where the procedure is being studied.