The Cosmetic Toxin Pipeline

Regardless of which professional society reports its numbers, statistics suggest cosmetic botulinum toxin type A injections are among the most popular minimally invasive treatment options today, and their popularity is only growing. The latest statistics by the American Society of Plastic Surgeons pegs Botox, Dysport and Xeomin injections as number one among minimally invasive options with 7.4 million procedures performed in 2018, an increase of 3% over the previous year.

The four toxins approved for cosmetic indications offer options but not much in the way of variety. Newcomer Jeuveau (prabotulinumtoxinA-xvfs, Evolus), which the FDA approved for glabellar line treatment in February 2019, is similar to market leader Botox (onabutulinutoxinA, Allergan) and competitors Dysport (abobotulinumtoxinA, Ipsen) and Xeomin (incobotulinumtoxinA, Merz).

“In general, the market for toxins is expanding at a rapid rate due to the wider acceptance of these noninvasive procedures,” says Ava Shamban, M.D., a cosmetic dermatologist practicing in Santa Monica and Beverly Hills, Calif. “One of the downsides to the current available toxins is delayed onset of action, as well as relatively short time of persistence of effect.”

Solutions could be on the way with a variety of novel products in the cosmetic toxin pipeline. Investigational toxins include one that has a longer duration (DAXI, Revance Therapeutics), a short-acting, short-duration product (BoNTE, Allergan) and a ready-to-use liquid formulation (QM1114, Galderma).

Market Opportunity

The cosmetic toxin market is big but nowhere as big as it should be, according to Dr. Yoelin.

“Less than 10% of patients that are candidates for toxins use them on a regular basis.” she says. Longer acting toxins, where patients need to be injected less often, could help grow the market.

While the corporate marketing and consumers on social media will help to drive integration of the new product options, aesthetic providers will also fuel the market by deciding whether to incorporate the new products in their practice.

And many doctors say they’ll at least try them once they’re approved.

Houtan Chaboki, M.D., a facial plastic and reconstructive surgeon in Washington, D.C., says potential benefits of alternative neuromodulators include much of what the pipeline has to offer, including onset of action, and duration of results or reduced side effects. Dr. Chaboki says he plans to test the new aesthetic products as they become available.

“Choice is important,” Dr. Chaboki says.

NEXT: DAXI for Duration