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Medicis (the maker of Restylane and Perlane) is poised to bring a Botox competitor--Reloxin--to the U.S. market.

Plastic surgeons have increasingly employed injectable agents to ameliorate facial aging. In fact, going under the needle has become 4-5-fold more popular than submitting to the knife!

The two common classes of injectables are...

* Muscle relaxants (Only one muscle relaxant is commonly used in the U.S.A.: Botox)

* Soft-tissue fillers (such as collagen, Restylane, Perlane, Juvederm Ultra, Juvederm Ultra Plus, Radiesse, Sculptra, and Artefill)

While the list of "fillers" has grown long in the past few years, Botox has never really had any competition in the U.S. Myobloc and a variety of creams have purported to be "better than Botox." But, you know what? They aren't.

But that just might change. And change could be a very good thing.

For years, Reloxin has been used safely and effectively in Europe, where it has been marketed as Dysport. While Reloxin's FDA approval is pending, recent head-to-head tests against Botox--performed here in the U.S.A.--have already confirmed Reloxin's efficacy.

Having digested many of these research studies, I must say that I am excited, but also wary....

* In all studies, Reloxin has worked (just like Botox)!

* And I have identified no significant red flags for Reloxin. No allergies. No untoward infections. (Same is true for Botox. Both appear to be very safe medications.)

* Reloxin does tend "to spread" more; it doesn't stay put as much as Botox. This may be either a good or bad thing. When treating a large area like the forehead, increased "spread" of the muscle relaxant may enable a plastic surgeon to avoid extra "needle pokes." On the other hand, if a plastic surgeon is trying to relax only a very specific muscle without affecting its neighbors, then Reloxin's spread may be a handicap.

* In some studies, Reloxin has not lasted as long as Botox. (And the biggest downside to Botox is that it lasts only 3-4 months.)

* In defense of Reloxin, some of these length-of-efficacy comparisons might not have been fair. Dosing is different for Reloxin and Botox. If a patient has appreciated the wrinkle-removing effects of 20 units of Botox between her eyebrows, then an equivalent dose of Reloxin is almost certainly not 20 units. It may actually be more like 80 units.

Will that 80 units of Reloxin then cost 4 times as much as 20 units of Botox? Almost certainly NOT! In the United Kingdom, 100 units of Botox sells for the equivalent of US$525. However, the cost of a 500-unit vial of Dysport/Reloxin is just US$300.

I know that you are doing the math in your head right now.... When considering equivalent dosages, the British are saving 55% when purchasing Dysport/Reloxin instead of Botox!

Also, figure that most of us American Board Certified Plastic Surgeons have grown pretty comfortable with Botox. Why would we subject our patients to "greater spread" and to unfamiliar unit dosages unless Medicis offers us some pretty competitive pricing on Reloxin?

And will the manufacturers of Botox, then, have to lower their prices?

Capitalism in action! This time, the free market is on our side.