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The Next Generation of Wrinkle Reducers and Botox Alternatives

There’s a new wave of products and technology meant to reduce wrinkles.

In-office technologies for wrinkle reduction are getting a face lift.

Two decades after the introduction of Botox — the Allergan-owned injectable neuromodulator that has long held a monopoly on wrinkle reduction — a host of new alternatives promise similar results. New clinical approaches incorporate a variety of modalities, topical and injectable, to address aging skin from all vantage points.

“There’s no one way to take care of wrinkles, it’s always best approached as a multimodal approach,” says Dr. Adam Kolker, a New York-based plastic surgeon. “No one treatment should stand alone.”

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Kolker says non-surgical procedures fall into three separate categories with varying benefits: “relax, refill and resurface.” Botox and Daxxify, which just gained approval from the U.S. Food and Drug Administration for wrinkle improvement, fall into the “relax” bucket. Collagen-based dermal fillers such as Juvéderm and Sculptra count as “refill” options, while lasers, microneedling and chemical peels fall into “resurface.”

New innovations across all three categories come as social media continues to normalize procedures to mitigate signs of aging.

“There’s been a big shift to younger patients, for sure,” Kolker says. “There’s a lot more exposure to younger patients from social media, from Instagram and TikTok, making aesthetic procedures more mainstream.”

Dr. Dendy Engelman, board-certified dermatologist agrees — “Demographically, my patients are getting younger and younger. These procedures used to be stigmatized, and people were very hush-hush about it. If they did it, they wouldn’t tell anyone. Now, because of social media, people bringing you into the exam room, people are less timid to undergo these procedures.”

Emface is popular in both doctor’s offices. The non-invasive technology was developed by BTL Aesthetics and combines radio frequency, thought to boost collagen, with high-intensity facial electrical stimulation to tone and lift facial muscles.

“For the last 20 years, the industry has been very focused on the groundbreaking treatments of injectables: Botox, Restylane, Juvéderm, and all variations,” says New York dermatologist Dr. Paul Jarrod Frank. “Now, we’re coming out with technologies that are what I like to call ‘injectable-sparing.’”

BTL Aesthetics believes the EmFace will be good for business and bring in new people who haven’t dabbled in getting work done before.

“It’s a great gateway procedure,” says John Ferris, vice president of U.S. marketing at BTL, adding it’s great for “patients who are curious about fillers but have never done them, or who are needle-averse, are able to achieve a smoothened, plumped and lifted effect without having to worry about side effects.”

Morpheus8, a microneedling procedure that also harnesses radio frequency, uses a similar technology.

“Morpheus8 is the trade name for radiofrequency microneedling, and it’s a type of energy that’s delivered through microneedles directly into the skin itself,” Kolker says. “It’s spectacular for increasing or improving tone and texture in the dermis itself, it also has the ability to remodel the deeper aspects of the dermis, to some effect, immediately.…It takes several treatments, but usually in one treatment, you will see a difference.”

It can also be used on the stomach, inner thighs, and above the knee, Kolker continues.

Ultrasound therapy has also piqued the interest of Engelman’s patients for its tightening effect.

“Ultherapy has been around for a little over 10 years, but they’ve updated the science behind it. It’s Ultrasound energy,” she says. “It’s a different way to induce heat in the dermis, and whenever we get the dermis above 40 degrees centigrade, you have upregulation of collagen and elastin. The goal is to tighten the skin by heating the dermis, which is the same modality as far as radio frequency.”

On the injectables front, Daxxify, a neuromodulator in the same class as Botox, gained FDA approval for wrinkle relaxing earlier this year. Dr. Dan Belkin, a dermatologist at New York Dermatology Group, says that while it bears similarities to its predecessor, it could provide benefits for seasoned patients.

“Daxxify is exciting, we’re just up to see if the full effects last a full six months,” he says. “For patients doing [Botox] for a long time, it starts to wear off in one to two months. People on it for years and years, we’re cycling different ones to see what’s going to last.”

Lyma’s at-home laser. Photo courtesy of Lyma

In-office resurfacing technology is also making its way into products people can use at home. Lyma, the U.K.-based supplements brand, developed an at-home cold laser two years ago. With newfound FDA approval — and price tag of $2,695 — it recently launched on Violet Grey and Goop.

“It’s an investment, but it does work,” says Lucy Goff, Lyma’s founder. “Scars are a huge market for us… it can get rid of wrinkles, it can increase your skin elasticity, it can lift the muscle in your face, it can reduce pigmentation.…It’s an investment, but a consumer wants to know that it can deal with more than one benefit.”

Goff points to the laser’s origins as evidence. “It’s a medical-grade laser, it wasn’t developed as a cosmetic tool. You can go into hospitals and be treated with low-level laser therapy to rebuild cartilage, to heal tendons, to reduce inflammation,” she says. “This is the first time that the FDA have cleared a clinical-grade skin laser for use at-home. It genuinely is a clinic-grade technology.”