As desperate as we are to have this infamous year fade into the rearview, we’re perfectly clear-eyed about 2021. A simple calendar flip can’t bridge chasmic divides or dash a pandemic. What it can do is usher in some pretty miraculous breakthroughs—the most monumental, of course, being the freshly approved COVID-19 vaccine.
While, clearly, nothing compares to this humanity-saving shot, there have been some exciting advancements in the aesthetics realm of late. Over the past several months, in between monitoring case counts and watching poll numbers, we’ve been tracking the status of hotly anticipated injectables and devices—those that have either very recently won FDA approval or are on the cusp of earning that distinction. From game-changing cellulite busters to the neurotoxin we’ve all been waiting for, we present nine bright spots on the beauty horizon.
1. Daxi (aka DaxibotulinumtoxinA): a longer-lasting neurotoxin
Daxi’s most celebrated selling point is its longevity. While all currently FDA-approved neurotoxins minimize muscle movement for about three months, “phase three studies of Daxi show clinical improvement for the frown area [glabellar lines between the brows] for up to 28 weeks—that’s seven months,” says Dr. Annie Chiu, a board-certified dermatologist in Redondo Beach, California. “That could mean only twice-a-year visits to your dermatologist, to keep your skin looking smooth”—an undeniable boon in the COVID-19 era. Does this mean that potential toxin complications, like ptosis (an uncommon drooping of the lid or brow post-treatment), may be equally persistent? No, according to Dr. Chiu, “ptosis rates [for Daxi] are actually similar to [those of] all other neuromodulators on the market and did not seem to last any longer.”
Daxi derives its power from a proprietary peptide, which seems to act as an endurance booster. “Typically, we’ve considered dosage to be the primary determinant of [a botulinum toxin’s] efficacy and durability,” says Dr. Hema Sundaram, a board-certified dermatologist in Fairfax, Virginia, and Rockville, Maryland. (Studies consistently show that larger doses beget longer-lasting effects.) However, “there’s a limit to how high we can dose without getting side effects, like ptosis or an unnatural, frozen appearance, so efficacy must be balanced with safety,” notes Dr. Sundaram. “The intriguing possibility [with Daxi] is that we might be able to achieve greater efficacy without increasing side effects.”
Another potential Daxi advantage: it’s considered “cleaner” than its rivals, because it lacks human serum albumin, a foreign stabilizing agent. (Even Xeomin, nicknamed the “naked” toxin, contains this component of human blood.) “Due to the peptide, Daxi is the first injectable botulinum toxin type A to not require human- or animal-derived additives,” Dr. Sundaram says.
While there were whispers of Daxi getting greenlit by the end of 2020, doctors are now hopeful for a winter 2021 debut. While the toxin will be indicated for frown lines, it’s also being studied for the treatment of forehead furrows and crow’s-feet.
2. Renuva: a fat-building injectable
Liposuction has always been a prerequisite for fat transfer—but a new injectable is poised to disrupt that paradigm come January. Meet Renuva: “Made from donated human tissue that’s been screened, processed, and purified, it contains the same collagens, growth factors, and proteins as human fat,” explains board-certified Dallas plastic surgeon Dr. Rod Rohrich. “When injected, it acts as a scaffold, allowing the body to recruit fat cells to attach to it, and over the course of 12 to 16 weeks, the material is gradually replaced by your own fat.” It can be injected anywhere fat lives naturally—including the cheeks, temples, chin, nasolabial folds, marionette lines, and backs of the hands. “The [cadaver] sourcing can take a bit of discussion with some patients,” notes Dr. Sundaram. “It’s essential that they feel comfortable with this.” Assuming they’re on board, she adds, “the technology offers the potential for predictable and durable volumizing results and expands the options for patients who aren’t good candidates for autologous fat grafting.” Doctors predict Renuva will cost more than traditional fillers but expect its volumizing effects to last years longer.
3. RHA I: a pliable precision filler for lip lines
If RHA rings a bell, it’s likely because three hyaluronic acid fillers from this collection—numbers II, III, IV—recently launched in select doctors’ offices across the U.S. As Dr. Sundaram explained in an earlier RealSelf story, “The RHA fillers have longer HA chains that can form a network of reversible, mobile bonds and require less BDDE crosslinking for stabilization.” In other words: the gels give a soft look and feel and really shine in highly mobile parts of the face. A low dose of the chemical BDDE makes them attractive to those wanting a “purer” filler.
Since the trials for RHA I kicked off a bit later than those for its siblings, it’s still under study and will likely get approved in 2021, for the correction of fine lines around the mouth, which are notoriously tricky to treat. “Because this perioral region is so dynamic, it can be challenging to get a natural result both at rest and in motion,” says Dr. Sundaram, who was a principal investigator on the RHA trials. “Little contour irregularities or lumps can appear when people pucker their lips that might not be apparent at rest.” Plus the “shearing forces” of our always-moving mouths tend to break down fillers rather quickly, creating yet another hurdle. In Dr. Sundaram’s experience, RHA I overcomes both obstacles, remaining undetectable and having a “reasonable longevity” when injected into lip lines, she says. “While the extent of improvement tends to decrease from six months onward with all perioral line fillers, some of my patients have still had noticeable improvements in perioral lines two years or more after receiving two to four treatments of RHA I over the course of a year.” (In the FDA trial, 66% of subjects had significant improvement in lip lines at 52 weeks, when the study ended, with the majority having had touch-ups in the weeks following initial treatment.)
Since the gel doesn’t pull in much water, it gives precise, predictable results without a lot of swelling—which is why, in other parts of the world, where RHA I is already in use, it’s a go-to filler for the under-eyes. Globally speaking, “this is one of my two favorite products for the tear troughs,” Dr. Sundaram says. “The other is not coming to America anytime soon.” The under-eyes would be an off-label area for RHA I when it eventually wins Stateside approval.
4. Cytrellis microcoring: skin tightening sans scalpel
Expected to get FDA clearance in early 2021, the machine scarlessly removes up to 8% of treated skin, drilling out tiny columns and allowing them to cinch closed, for a tighter, smoother surface. The heat-free device can treat the full face and neck and has the potential to improve select areas of sagging on the body as well, says Dr. Jason Pozner, a board-certified plastic surgeon in Boca Raton, Florida. While researchers are still hammering out the ideal way to prep for the half-hour procedure—topical numbing cream versus local lidocaine shots—Dr. Pozner says the recovery is fairly minimal: “Patients are red for a day or so, with maybe some minor bleeding.” Bear in mind that, unlike a facelift, the machine does not reposition muscles or address their connective-tissue covering, so microcoring results will be less dramatic than with surgery.
5. Qwo: a first-of-its-kind shot for cellulite
After winning FDA approval in July for the treatment of moderate to severe cellulite in the buttocks, this first-ever cellulite injectable will be rolling out nationwide this spring. The shot uses collagen-degrading enzymes to break the fibrous bands (or septae) tethering skin to muscle; relieving their pull allows divots to smooth out. In recent months, the makers of the drug, Endo Aesthetics, have announced new findings, further boosting the shot’s appeal. According to cellular data, Qwo not only erodes dimpling bands but also ramps up collagen synthesis, to thicken skin over time. Moreover, a separate study, in which investigators treated subjects’ buttocks and thighs, saw improvements lasting up to four years following a series of treatments. While “the current FDA indication is for buttocks treatment only, we are getting wonderful results on the thighs,” says Dr. Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut, and investigator on the Qwo trials. Bruising can be considerable with Qwo, so plan your shots accordingly.
6. Soliton Rapid Acoustic Pulse (RAP): shockwaves for cellulite
While Qwo uses enzymes to sever septae, another coming-soon technology relies on shockwaves to painlessly release the bands responsible for dimples—in a single 20- to 30-minute treatment, with no downtime or bruising. This device is currently being paired with lasers in order to aid in tattoo removal, but according to Dr. Mathew Avram, a board-certified dermatologist in Boston, it should be receiving a cellulite indication by spring 2021. As Dr. Avram explains, it “produces very rapidly repeating, high-pressure waves that capitalize on a basic known property of sound—it moves faster through different media. This allows the technology to differentiate between structures in the body, change speeds as it moves from fat cells to stiff collagen-based septae, and create a shearing of the septae without harming the surrounding tissue.” The pivotal clinical trial, involving people with moderate to severe cellulite on their buttocks and thighs, “showed an approximate 30% mean reduction in cellulite severity for all study patients,” he says.
7. Glacial Rx: a pigment-freezing device
Those whose skin can’t take the heat of conventional lasers may be thrilled to meet Glacial Rx from R2 Technologies when it rolls into doctors’ offices early next year. Inspired by old-school liquid nitrogen, the device—which we originally reported on in our FutureBeauty series—is the first to use cold to destroy the unwanted pigment present in sunspots and melasma. “The cool thing about this device is that you can titrate [or adjust] the settings to basically have no downtime,” says board-certified San Diego dermatologist Dr. Arisa Ortiz, an investigator on the tech. While the heat-generating devices doctors commonly use to zap spots and resurface skin can sometimes backfire on sensitive skin, triggering inflammation and a subsequent darkening, Dr. Ortiz says she has not seen this with Glacial Rx. What’s more, “because the temperature and exposure times are so precisely controlled, there is much less risk of [pigmentary changes] compared to standard liquid nitrogen,” she says. Following treatment, spots and splotches are said to gradually lighten, over the course of three to four days.
8. Restylane Volyme: a flexible volumizer for cheeks
Strong, soft, supportive—it’s a desirable trifecta in both life partners and cheek fillers. Fitting the profile, we hear, is Volyme, a forthcoming hyaluronic acid gel from Restylane. The manner in which the gel’s molecules are crosslinked, or bound together, makes it flexible enough to move freely and not look awkward or obvious when our cheeks rise and fall when smiling. Dr. Sundaram believes it will be a useful addition to her tool kit, particularly for older folks, because unlike some volumizers, it doesn’t demand bone-deep placement. In patients with age-related bone loss, “if you inject all the filler deep down, it can create an unnatural, chipmunk-cheek appearance,” she explains. “To get a more natural effect, especially in animation, I would layer Volyme in the [more superficial] subcutaneous tissue, enabling the skin and underlying tissues to move as they should.” The product is purported to last up to 18 months.
9. S3Inject: a smartneedle for safer filler injections
By the end of 2021, experts hope to have in hand the industry’s first smartneedle, S3Inject, which we introduced you to here. Outfitted with a proprietary guidance technology, the needle “works by measuring the change in electrical properties as [it] passes through subcutaneous tissue,” says Dr. Avram, and this allows it to distinguish blood vessels from other structures. It can then alert injectors when they’re inside a vessel, with the goal of heading off a vascular occlusion—a filler-clogged artery, which can lead to skin death, blindness, or stroke. Assuming the needle is sensitive and specific enough to “reliably detect inadvertent intravascular entry,” says Dr. Sundaram, S3Inject “has the potential to transform the injectables landscape by virtue of being a preventive rather than corrective measure for vascular complications.”
