Dr. Bruce Katz, a board-certified dermatologist and founder of Juva Skin and Laser Center in New York, was first introduced to Botox by the "Mother of Botox"—Dr. Jean Carruthers. "I was at a [dermatology] meeting in the mid-'90s with Dr. Jean Carruthers where she was telling me about this new product that she was injecting into people's foreheads to take away wrinkles, and I immediately wanted to know more," he says. "We had a few of my staff members who wanted to try it, and back then we were using an electromyogram, which is an electrical device that measures nerve conduction. We would use the device to find the nerve that would control the corrugator muscles that control the frown lines, and then we would inject the Botox."
But in those early days, there was still some (understandable) trepidation from people concerned about Botox's toxic nature. After seeing the results on his staff, Dr. Katz immediately began to offer it to his patients, but it wasn't an instant slam dunk for his practice. "At first, people were rather hesitant—no one had heard about it before, and they were a little concerned because it was from botulinum toxin," he says. "So I would show patients before-and-after photos of the dramatic results because I knew that would convince them right away, and that's exactly what happened. They couldn't believe that the difference in the frown lines was from one injection. After they saw the photos, it wasn't that difficult to convince them to try it."
Another on-the-horizon innovation, according to Dr. Shafer and Dr. Katz, is needleless Botox that can be applied topically by a physician to achieve comparable results to injectable neuromodulators. Don't get too excited, though—both doctors think we've got a few years before that particular treatment becomes a reality.
Dr. Wexler and Dr. Katz think the next frontier for injectables will be in the category of skin tightening, something that currently is only achievable with radiofrequency and ultrasound devices like Thermage, Ultherapy, and Vivace. "It would be an injectable that replaces damaged collagen with fresh, new collagen to tighten skin," says Dr. Katz. "There are chemicals out there that do that, and it's about getting the right dilutions and quantities to inject so that you get the maximal tightening effect. It's an area that's being studied as we speak, and if it's successful, it's going to be huge."
