You win some, and well, you win some.
BOTOX Cosmetic reigns supreme in two trials one in the lab and one in the courtroom.

In what's dubbed "the frown line challenge" and may very well prove to be the wrinkle-removing heavyweight championship of the world, BOTOX Cosmetic took home the title; beating out three leading over-the-counter wrinkle cream contenders: HydroDerm, StriVectin-SD and Wrinkle Relax.

The new study, presented in September at the American Society for Dermatological Surgery and American College of Mohs Micrographic Surgery and Cutaneous Oncology combined annual meeting in San Diego, found that women who received BOTOX Cosmetic injections in the frown lines between their brows showed greater improvements, compared with women who received placebo (dummy) injections in the same area and women who used any of the three wrinkle creams.

Still smug from this victory, BOTOX Cosmetic and its manufacturer, Allergan Inc, recently scored a courtroom coup as well. A jury sided against a Hollywood producer's wife who said botox treatments caused breathing problems, fever, fatigue and severe muscle pain. The lawsuit named BOTOX Cosmetic manufacturer Allergan Inc. along with the plastic-surgeon-tothe-stars who administered the fated injections.

BOTOX Cosmetic stems from the toxin that causes botulism. It is used as an anti-wrinkle drug because it can temporarily paralyze the muscles that cause frowning. It is also approved to treat two eye muscle disorders, cervical dystonia (a neurological disorder causing severe neck and shoulder muscle contractions) and severe underarm sweating that cannot be controlled with topical treatments. But doctors can, and do, use it off-label for other conditions including chronic back pain, carpal tunnel syndrome, a pain condition called fibromyalgia, migraine, post-stroke spasticity and urinary incontinence.

In the new study, 77 women received BOTOX Cosmetic injection, placebo injection or used HydroDerm, StriVectin-SD or Wrinkle Relax daily. Every woman was evaluated before the study began and then at regular intervals during and afterward. The women using the wrinkle creams were instructed by staff members on the proper use of topical treatments, which they then applied daily.

Results speak louder than advertisements

At the end of the study, investigators looked at frown lines as well as overall change in appearance. Here's what they found:

At week four, more than 86 percent of women who got BOTOX Cosmetic showed a 50 percent or greater improvement in wrinkle severity. By contrast, the majority of women in the topical treatment and placebo injection groups had less than a 50 percent improvement in wrinkle severity. At each follow up visit, women were more likely to be satisfied if they received Botox than any of the other treatments.

What's more, the wrinkle reduction from the topical treatments did not differ from placebo at any time.

None of the women who received BOTOX Cosmetic or placebo injection, HydroDerm or Wrinkle Relax had any bad reactions. But three women using StriVectin did report side effects of flushing, redness and itching, according to lead study researcher Kenneth Beer, M.D., P.A., a dermatologist at the Palm Beach Esthetic Center and a dermatology instructor at the University of Miami, both in Florida.

While not a total KO (knock out) by BOTOX Cosmetic, "this first-ever study demonstrates that while topical cosmetic creams may diminish the appearance of some fine lines, they do not offer the same level of improvement in moderate- to-severe glabellar [frown] lines as BOTOX Cosmetic," Beer says in a press release. "A growing array of over-the-counter cosmetic creams, which are often used by consumers for fine lines and wrinkles, claim in advertisements they are as effective as BOTOX Cosmetic. But until now, no comparative data has been published to support these claims."

In fact, the study was prompted by marketing campaigns alleging that certain topical treatments are or may be "Better Than BOTOX."

Apples to oranges?

Many in the know are quick to point out that BOTOX Cosmetic works entirely differently than topical anti-aging creams. Topicals help with fine lines similarly to retinol mainly by exfoliating and thinning the skin. BOTOX Cosmetic relaxes the underlying muscle, paralyzing it and erasing the wrinkle.

Allergan, Inc. supported the study with an unrestricted educational grant. The other manufacturers were invited to support this research, but declined.

Out of the ring and into the courtroom

In Beverly Hills, where BOTOX Cosmetic is about as commonplace as wannabe starlets and maps of celebrity homes, socialite Irena Medavoy sued Arnold W. Klein, MD, alleging that he botched her BOTOX Cosmetic --big time.

Mrs. Medavoy, 45. says that she received BOTOX Cosmetic injections for both wrinkles and headaches. While most treatments went as smoothly as the she would have liked the lines on her face to be, a treatment in March 2002 for migraine headache left her incapacitated and bed-ridden for months to come with breathing problems, fever, fatigue, severe muscle pain and an even worse headache. But alas, the jury decided 9-3 in favor of Allergan and Dr. Klein. The defendants alleged that Mrs Medavoy had her symptoms years before she received the BOTOX Cosmetic injections.

DERMAdocotor Wrinkle Rx

So if you are hesitant to try BOTOX Cosmetic, but want to do something to reduce those fine lines and wrinkles, that's okay. But it's important to understand that so far, nothing applied topically can possibly be better than BOTOX Cosmetic when it comes to paralyzing muscles of expression and smoothing out wrinkle lines. DERMAdoctor suggests home rejuvenation the "old-fashioned way." Plenty of excellent antioxidants, AHAs, retinoids and sunscreen.

DERMAdoctor suggests trying DERMAdoctor Wrinkle Revenge Rescue & Protect Eye Balm or Kinerase C8 Peptide Intensive Treatment every morning and alternating Afirm 3X and MD Formulations Continuous Renewal Serum every other night. Whether or not you're aleady sold on BOTOX Cosmetic, consider enhancing its effects with MD Formulations Facial Cleanser, MD Formulations Vit-A-Plus Intensive Anti-Aging Serum and MD Formulations Vit-A-Plus Anti-Aging Eye Complex which provides all the essentials for healthier looking skin for women considering or who have had BOTOX Cosmetic.

Denise Mann
DERMAdoctor Staff Writer

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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