New wrinkle remover now in the dermatologists' offices

Donna Halvorsen, Star Tribune
Published February 10, 2004

As a businesswoman, Jeanette Elasky always wants to look her best, and she's game to do anything that will keep the effects of age from sneaking up on her. "You want to put your best image out there when you work with the public," said Elasky, a Minneapolis furniture store owner who gives her age as "50-plus." So she was eager to try Restylane, the upstart wrinkle remover that may give Botox a run for its money. Restylane isn't made from a toxin, as Botox is, and it isn't animal-derived, as some collagen products are. It's a Swedish synthetic reproduction of a substance that's used by the body to carry and bind water. It keeps joints lubricated, among other things. When it's injected into the face, it temporarily creates the natural fullness seen in children's skin.

A grateful reaction after a Restylane treatment
Jerry Holt
Star Tribune

Although Restylane is new to the United States -- the Food and Drug Administration (FDA) approved it in December -- it has been used in Europe, Canada and Mexico for years.

Its biggest selling point is that it lasts longer than Botox or collagen -- four to six months compared to three to four months, although any of the three treatments can last longer than the others for some people.

Dermatologists Drs. Ed Szachowicz of Edina and Charles E . Crutchfield III of Eagan, said Restylane is a safe, injectible gel that can bring immediate results that patients "ooh" and "aah" over, even after they've paid $450 to $1,200 for it.

"It's just a beautiful result," Szachowicz said. "It's so natural."

Did Elasky like her results? You bet she did.

She was comfortable in Szachowicz's chair. She'd been there before for Botox injections, and she knows the drill. Szachowicz numbs part of her face so she barely feels the tiny needle as it injects the clear Restylane gel, which plumps up facial areas where sagging has caused wrinkles.

"Oh, look at that," Elasky said when Szachowicz handed her a mirror barely 20 minutes later. "Ooh, I love it. Oh, my word."

It was easier, she said, than the dental work she had the day before.

Crutchfield and Szachowicz say they don't see Restylane as a substitute for Botox, and in some cases the treatments could be used together. Botox paralyzes muscles, temporarily eliminating wrinkles caused by facial movements, while Restylane eliminates wrinkles that are on the face when it is at rest, Crutchfield said.

Restylane is a synthetic form of hyaluronic acid, which is responsible for holding moisture in the skin, but skin loses moisture as people age. "Babies, when they're born, their skin is chock full of hyaluronic acid," Szachowicz said.

No allergy test
Collagen has been considered the gold standard of fillers for lines, wrinkles and folds, but because it's animal-derived (it's made from cow's hide), allergy tests are required. It could take three visits and a month's time to get the injection done, doctors say.

No allergy test is needed for the synthetic Restylane. Common effects are redness, swelling and bruising at the injection sites, which doctors say will go away in a few hours to a day. The patient can be in and out of the office in an hour.

"You can inject it right away when people want it, which is something that people like nowadays," said Dr. O.J. Rustad, a North Oaks rmatologist. "They want things done as soon as possible rather than having to wait a month once they've made a decision. With our lifestyles, people don't like having to make multiple trips back and forth."

With Botox and collagen, it may take a week or two to determine if the right amount of the drug has been injected and whether a touch-up is needed, Rustad said. Deep creases may take a while, he added.

Because Botox paralyzes muscles, it has been used primarily in the upper half of the face, particularly the forehead. Rustad said Botox is rarely used on the bottom half of the face, where facial expression requires movement of the skin. Patients should not expect perfection with Restylane, but they will get "significant improvement," and his patients have been pleased with the results, he said.

Crutchfield views Restylane as "probably the most exciting advancement in getting rid of unwanted facial wrinkles since Botox." He said the results are "astonishing" because Restylane almost instantly fills in grooves, wrinkles and scars that people have looked at in the mirror for years. He recalled one woman who had the remnants of acne scarring removed from her face in time for her wedding.

Hiding scars
Scarring was a lifelong problem for Judy Olausen, 58, of Minneapolis. As a girl, her face was scarred in a traffic accident that sent her through the windshield face first.

She said she hated it when people said, as they have dozens if not hundreds of times, "What happened to you?"

The scarring on the right side of her face ran from the lower lip to the chin. As Olausen grew older, the scar deepened and pulled the tissue down on that side of her face.

As a photographer, she was always making her clients look good, but there didn't seem to be anything she could do for herself. Then, in January, Szachowicz injected Restylane into and around the scar, lifting it up so it was no longer noticeable.

"Oh, my gosh, it's all filled in!" Olausen said immediately after the injection. "It's gone! Oh, my gosh!"

As she waited for her "after" picture in the doctor's office, all the hurts of the past came rushing at her, and tears welled in her eyes. Sharon Miller, Szachowicz's patient coordinator, hugged her and said, "There's a whole lot of baggage that comes with scars."

In approving Restylane, the FDA said it is "safe and effective for filling moderate to severe wrinkles around the nose and mouth," that most people needed only one injection to get a satisfactory result and that the effect lasted about six months. As with other drugs, doctors can and do use Restylane in other places on the face.

The FDA said the manufacturer's studies provided little data on Restylane's safety when used by non-Caucasians. Crutchfield's office is conducting a followup study and invites people of color who want a free treatment as part of it to sign up at http://www.crutchfielddermatology.com or call 651-209-3600.