Explaining the Popularity of Botox and Hyaluronic Acid Fillers

Nonsurgical procedures account for the vast majority of cosmetic procedures practiced in the US each year. Of the 11.7 million procedures, over three quarters are nonsurgical procedures, and the vast majority of the nonsurgical procedures are Botox (as many as 4.5 million procedures each and every year). However, the fastest-growing nonsurgical cosmetic procedure is the injection of hyaluronic-acid-based fillers like Restylane or Juvéderm, which now, according to some figures, comprise as much as a third of the nonsurgical procedures market.

What is responsible for the popularity of Botox and now these new fillers? In short, the procedures are done so often for two reasons. First, they are temporary, which means they must be done every 4-6 months to maintain results. Second, they work, which keeps people coming back for more. To really understand the popularity of these procedures, you have to understand what these compounds are, how they work, and why they are only temporary.

Beau Tox: The beautiful toxin
Botox is short for botulinum toxin A, the toxin produced by bacteria, and the chemical responsible for the deadly disease botulinism, which comes from the German for “sausage poison.” Botulinum toxin A is a neurotoxin, affecting the nervous system, which was considered as a bioweapon around World War I and II, but was found to be unsuitable because it required too much refrigeration. However, it was found to be a very effective medicine in treating some conditions. In particular, it was found to be effective in treating eye spasms. As doctors used botulinum toxin A to treat eye spasms, they noticed that it had a peculiar effect of smoothing wrinkles in the forehead area. They conducted research into the mechanism of function, applied for a patent, and in 2001 the Food and Drug Administration (FDA) approved Botox (the short, catchy trade name for botulinum toxin A) for cosmetic use.

Botox works by blocking signals from nerves to muscles. Some wrinkles, known as “dynamic wrinkles” are the result of habitual muscle actions. During our lifetimes, we command our brow muscles to contract hundreds of thousands of times. As a result, the nerves begin to habitually order the muscles to contract. This forms many of the permanent wrinkles in the forehead and elsewhere that make a person look not only old, but perpetually grumpy and tired. When Botox is injected into these muscles, it blocks the nerve signals, making the muscles relax, and smoothing the wrinkles. Unfortunately, the botulinum toxin is relatively short-lived, which not only made it unsuitable as a bioweapon, but limits its effectiveness as a cosmetic treatment. Botox injections only provide wrinkle correction for about four to six months.

High-Tech Hyaluronic Acid
Hyaluronic acid is a compound naturally found in the body. It is found in the joints and in the skin, where it acts as a lubricant and moisturizer. The first hyaluronic acid compounds used cosmetically were derived from rooster combs and cow eyes (Hylaform), but this had serious problems with allergic reactions in patients, so it didn’t become any more popular than the bovine collagen it was competing against. Hyaluronic acid compounds really took off in popularity when a Swedish company by the name of Q-Med developed a process for obtaining it from a non-animal source, a process called the non-animal stabilization of hyaluronic acid (NASHA, for which it filed a patent in 1995). In this process, a form of streptococcus bacteria which naturally produces a hyaluronic acid mucous capsule is grown in a tank, then the hyaluronic acid is harvested. Restylane was the company’s first product to utilize this technology, and it was explicitly designed as a cosmetic product. It was designed for use both as a wrinkle filler and for lip augmentation.

Restylane and all other hyaluronic acid compounds work by basically filling in a wrinkle. Injected into the skin under the wrinkle, they push the skin out, smoothing it. Unfortunately, they have a short lifespan because they are naturally absorbed by the body over time, since they are organic chemicals the body recognizes and can metabolize. In this they are like collagen, but where they have an advantage over collagen is in their hydrophilic properties. That is, they gather water. So, as molecules of hyaluronic acid are absorbed, the remaining molecules pull in water to maintain their volume, leading to relatively long lifespans as fillers. Where collagen injections lasted for 2-4 months, hyaluronic acid filler injections tend to last 4-6 months, making their lifespan comparable with Botox injections, which can be done at the same time.

The Right Tool for the Right Job
Now that you understand where these compounds come from and how they work, you can see where they might be used and what their advantages might be. For example, Botox works really well on the forehead area and on crow’s feet, wrinkles mostly caused by the habitual action of muscles. On the other hand, Restylane , Juvéderm and their related compounds work best on wrinkles around the nose and mouth, which are caused by tissue loss, and in lip augmentation, especially for fixing the flat lips of older people who have lost lip tissue to aging.