We often see patients that come in and have had prior blepharoplasty or eyelid surgery, where too much fat or skin has been removed. This defeats the purpose of cosmetic surgery as it does not make you look younger. In fact it makes you look older and un-natural.

A youthful eyelid is almost always associated with fullness around the eyes. Just take a look at any current fashion magazine. Take a look at some of the famous actresses and models today. All of them, almost invariably, have fullness to their eyelids.

That being said, preservation of this fullness must be maintained whenever performing eyelid rejuvenation and blepharoplasty. This means removing just the right amount of skin from the upper eyelid, and in most cases NEVER removing fat from the lower eyelid. For this reason, I perform a fat repositioning lower eyelid blepharoplasty that moves the protruding fat downwards instead of removing it, in order to prevent that hollowed out look. This is a story for another day, but you can read more here.

So what happens if too much skin, fat, etc. has been removed? This can be a difficult problem to treat. It is restorative plastic surgery. The case below is a woman who had no extra skin or fat in her eyelids (from prior surgery), yet she looks older purely because her eyes are too hollow. Since are minds have a harder time thinking in terms of addition (adding volume), I will show you these before and after fat grafting photos to give you a better idea. Take a look at how fat grafting her periorbital region (upper and lower eyes) has given her back years of youth and restored an attractive,youthful eyelid:

There is a new kid on the block. In the next couple of months, the FDA is likely going to approve Reloxin for a cosmetic indication to treat wrinkles. Botox received its cosmetic indication by the FDA in 2002. For the past 7 year Botox has enjoyed a competition free environment. In this same time it has rapidly grown to become the MOST commonly performed non-surgical cosmetic procedure today.

Botox is a simple and painless in-office procedure that produces remarkable results. Women and men as early as in their 20’s are reaping the benefits of Botox these days. Reloxin works in the same exact fashion.

So how do Reloxin and Botox work? The short answer is that they work by weakening the wrinkle causing muscles of the face. For those of you who love physiology, these products prevent the presynaptic transmission of acetylcholine into the synaptic cleft thus preventing muscle contraction. The results last approximately 4-6 months and the injection needs to be repeated to see continued effect and enjoy the cumulative effects of the product.

So what is the difference?
In order to better understand this we need to break down the potential benefits into several categories.

1) Effect- Which will achieve the best results- Botox or Reloxin? Theoretically they both work in exactly the same fashion, so they should be about the same. Anyway you look at it, Botox is the gold standard and Reloxin needs to prove that it is at least as good as Botox. Phase 3 clinical trials usually require that the new product be at least as good as the gold standard. So receiving FDA approval tells us at least that much about Reloxin.

Reloxin is said to spread more easily then Botox. This means that it has an effect farther away from the point of injection. This could be very beneficial in some instances and not so much in others. For example, injecting the crow’s feet or the forehead may require only one injection instead of several. I see this as a moot point since I have never had a patient complain of any pain when I inject their crow’s feet. However, less injection points will lead to less bruising, in the rare instances that bruising can occur. On the other hand, there are areas where you want to minimize the spread of product, Botox may have the upper hand in these regions.

2) Longevity- As Botox lasts 4-6 months, how long will Reloxin last? Several studies have compared the two products. One study, which was NOT biased by support from either company, revealed that Reloxin actually lasted longer then Botox. I wouldn’t close the case file on this just yet because other research studies have shown the opposite.

3) Price- Allergan, the makers of Botox Cosmetic, have enjoyed a competition free environment up until now. Perhaps consumers will reap benefits from increased competition in the marketplace.

In summary, the anticipated release of Reloxin is exciting news in the world of facial cosmetics. Perhaps there will be a role for combining both of these products in order to achieve the best possible results.

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