Would YOU brave the new Botox gun?
It’s been hailed as the anti-ageing saviour for needle-phobics. But...
by Alice Hart-Davis
WAITING for my latest round of Botox, I have to admit, I’m excited — and not just at the prospect of fewer wrinkles. It’s more because the Botox isn’t going to be injected. It’s going to be put in my face without needles.
Needle-free Botox is one of the Holy Grails of aesthetic medicine — the thing for which cosmetic doctors have been longing for years.
Not that there is anything wrong with needles. As a way of delivering the toxin into the muscles it is intended to weaken, needles are precise, effective and reliable and the ones used for Botox are so fine that, when used by an experienced practitioner, they give just the tiniest pinprick as they slip it into place.
However, for newbies, needles can be a big stumbling block. People might be fine with the idea of laser treatment, even if this essentially burns away the top layer of their skin. And they may be OK with radiofrequency treatments, which shrink-wrap sagging skin into a neater shape. But show them a needle and they’ll be out of the clinic faster than you can say onabotulinum toxin A.
There have been various attempts over the years to create a Botox gel or cream but, so far, none of these has been as effective. Biotulin Supreme Skin Gel (€41,
amazon.co.uk), reportedly popular with the Duchesses of Cambridge and Sussex and Michelle Obama, promises ‘similar’ effects to those of Botox. One of its key ingredients is spilanthol, a herbal extract that acts as an anaesthetic, temporarily numbing facial muscles.
But, having personally completed a head-to-head half-face trial that pitched the gel against Botox, I remain sceptical. I ended up with an uneven brow for months for my pains because the gel had no effect on me.
Revance Therapeutics, based in Silicon Valley and one of Botox’s competitor brands, attempted to create a ‘Botox cream’, but this product did not make it through industry trials.
Now, though, there is the Med-Jet device, which, instead of needles, will blast the required dose of toxin into crow’s feet via a microscopically narrow jet of pressurised carbon dioxide. The pressure of the gas forces a tiny jet of fluid, seven times finer than a Botox needle, through the skin.
Made by the Canadian company Medical International Technologies, the machine has for years been used to deliver needle-free vaccinations.
The liquid to be ‘in-jetted’ sits in the syringe at the top, which connects in with the gun part of the device.
The man wielding the device today is Dr Vincent Wong, a highly trained doctor who runs clinics in London and Birmingham. His qualifications in medical aesthetics are extensive: he has a first-class MBChB degree, which translates as Bachelor of Medicine, Bachelor of Surgery; he is registered with the General Medical Council in Britain, as all doctors have to be; and he has registered with Save Face, a voluntary register of cosmetic practitioners.
He also trains other doctors so, although he looks about 23, I’m trusting him on this.
Though it seems a bit of a leap from injecting vaccines to injecting the world’s most deadly toxin, digging around on the internet I see that Allergan, the pharmaceutical com-
pany that makes Botox, has sponsored trials before now on using this device to ‘inject’ Botox into the palms of people suffering with excessive sweating.
Needle injections in the palms can be particularly painful due to the number of nerves, so this needle-free option has had some success.
However, when I ask Allergan for a comment on administering Botox via the Med-Jet device, the reply is: ‘The proposed route is not an approved route of administration’ — the approved way to administer Botox is by injection with a needle.
So it’s not unheard of to use this device to deliver Botox — but how exactly does it work? ‘We’re replacing the needle with air pressure,’ says Dr Wong. ‘A small amount of liquid — in this case, Botox — will penetrate the skin and have a spreading effect, which helps with the absorption rate. The jet of liquid is finer than a needle.’
Still, I’m concerned, can it really be as accurate as a needle? To have the desired effect, Botox needs to be placed very precisely into the right muscle. I’m in two minds about the spreading effect.
I wouldn’t want Botox to spread from its injection site in my forehead — that could lead to some very strange expressions — and this is part of the reason I have asked Dr Wong just to treat my crow’s feet.
A bit of spreading of toxin among the crow’s feet does no harm, as they are — at least on my face — such a dense mass of small wrinkles that the more of them can be blitzed in one go, the better.
‘Oh, it is completely accurate,’ says Dr Wong. He shows me how the gun device is connected to a large machine containing the CO2 cylinder, where the pressure can be adjusted to deliver the toxin to the appropriate depth in the skin.
And is it safe? ‘Yes,’ he says. ‘It causes less trauma than a needle because of the small size of the jet.’
The cost is competitive. Prices start at €320 per session, equivalent to needle Botox at other clinics, and the dose is the same as you would receive through a needle, so the results should last just as long.
Dr Wong asks me to scrunch up my eyes to check where he needs to place the dose along my crow’s feet, then presses the round nozzle of the gun very firmly right against the side of my head and warns me there will be a noise.
I hold my breath and brace as there’s a whooshing click. Dr Wong holds the device in place for another couple of seconds, then lifts it away.
I didn’t feel anything at all, except for the pressure of the nozzle. Was that it?
I suppose I had been hoping for some drama or excitement, what with that massive gun and the warning of noise, but there was absolutely nothing to get excited about.
The only disconcerting thing was a light spray of liquid I felt from the tip of the gun after the last blast. Was that Botox? Dr Wong says it is nothing to worry about.
So, could this really take off as a new way of delivering Botox? I’m not at all sure, just because it seems such a palaver (the noisy cylinder, the huge gun device), though it’s just as quick as using a needle.
Another who doubts it is Dr Kuldeep Minocha, who has been expertly delivering cosmetic injections with needles for a dozen years. ‘Are there really large numbers of patients who simply will not entertain the idea of anti-wrinkle injections because of needlephobia?’ he asks. ‘I doubt it. Generally, a calm, unhurried manner, careful explanation of the procedure and a hand to hold during the injection is all that is needed to relieve the first-time patient’s anxiety.
‘I feel the size of the Med-Jet device alone would scare most people, especially if used around the eyes. The absorption and delivery of the drug also depends on a number of parameters, including the contact pressure applied to the skin.’
He adds: ‘There is a level of skill and artistry required when injecting toxin. I’m unsure how a device such as this will allow the practitioner to express this without changing the settings frequently.’
But others, including consultant plastic surgeon Gerard Lambe, aren’t ruling out the jet delivery of toxin. ‘For those with needle phobias, it makes a good alternative,’ he says.
‘The question about its efficacy will be judged by results at two weeks, but we know that very small amounts of toxins only need to be injected near the surface of the muscle for it to be effective. Cost and availability play a part. Only time will tell if the CO2 blast takes off widely.’
Dr Wong has been experimenting to see what the Med-Jet can do aside from Botox and is finding it helpful for treatments such as mesotherapy, where a cocktail of skin-nourishing ingredients is injected. It typically requires a lot of injections and, in an area such as the scalp, where the treatment can stimulate hair growth, it is painful. With the Med-Jet, patients tolerate it.
BUT the Med-Jet isn’t the only machine of its type in town. There is another, the new EnerJet, in the hands of consultant plastic surgeon Olivier Amar, at the Cadogan Clinic in London’s upmarket Knightsbridge.
Although the EnerJet also uses pneumatic blasts to chase liquids through the skin, it has a different mode of action. Rather than sending one piercing shot of fluid into the body, it blasts 100 microscopically small shots of liquid — perhaps a PRP mixture, perhaps a dilute form of hyaluronic acid gel, both of have skin-conditioning benefits — into the skin, to lodge a couple of millimetres below the surface more precisely than any needle could deliver it.
For now, Mr Amar is exploring what the machine can do for softening or ‘remodelling’ old scars, as well as ‘necklace lines’ on the neck, which are hard to treat with conventional fillers.
But back to my crow’s feet. They were blitzed with four quick, pain-free jets on each side and that was that. There was no pain or bruising.
The results, though, have been rather less than I was expecting. I hoped for the same softening of my crow’s feet I usually get with needle-delivered Botox, but, when I scrunch up my eyes, there seems to be only a small reduction in the muscle activity. The effects should last for three months.
Will these ‘in-jet-tions’ catch on? We’ll have to wait and see.
As for me, I’ll be sticking with the tried-and-trusted method of delivering Botox into the face, namely with a small needle.
A needle is quieter, less fuss and I know that it gives the result I’m after.