Are ‘Clean’ Injectables Really A Thing?

The new buzzword in injectables is ‘clean.’ The term that’s taken the beauty world by storm has now come for fillers and neurotoxins, thanks, in part, to the queen of all things unconventional in wellness, Gwyneth Paltrow. When news recently broke that she signed on as a spokesperson for the neurotoxin Xeomin®, the headlines were all about her preference for a stripped-down injectable. In fact, she told People, “I'm obviously a more natural person and I'm not going to go crazy with anything but I also really like that [Xeomin® is] purified. It's the cleanest version."

This positioning comes on the heels of the release of the Revance RHA® Collection of fillers. Approved by the United States Food and Drug Administration (FDA) for the treatment of dynamic facial wrinkles and folds, it better mimicks natural hyaluronic acid (HA) thanks to less crosslinking and fewer additives.

The combo indicates a shift could be coming in the aesthetics space — and Adriana Lombardi, MD, a board certified dermatologist and fellowship-trained dermatologic surgeon, isn’t surprised. “Western culture is becoming more aware of what we are putting into our bodies whether it be our foods, beverages, skincare products, and, certainly, our injectables,” she explains. “People are hesitant to get injectables because the typical complaint is that they are putting a foreign product into their bodies. They are searching for a cleaner solution.”

Clean Claims

So, is there such a thing as ‘clean’ injectables? The answer depends on how you define it. For Xeomin® — which has been nicknamed “naked Botox” — what sets it apart from other neurotoxins (Botox®, Dysport®, Jeuveau®) is its formulation. “Xeomin® is not linked to a stabilizing protein [like] Botox® is,” says Melissa Doft, MD, a double board certified plastic and reconstructive surgeon in New York City. As a result, it functions a bit differently. “When Botox® is injected, the protein is cleaved from the molecule and it binds to receptors blocking the transmission of nerve signals,” she explains. Since Xeomin® skips this step, it should, in theory, act faster. It also means a patient is less likely to build up antibody resistance to it over time.

Because Xeomin® lacks the preservatives and protein complexes Dysport®, Botox®, and Jeuveau® have, Dr. Lombardi calls it “a cleaner alternative.” But Dr. Doft prefers using the term “purer” to describe it. “This neurotoxin is made in the lab and is a toxin,” she notes. Similarly, Bruce Moskowitz, MD, an oculoplastic surgeon at Specialty Aesthetic Surgery in New York City, says it’s important to maintain perspective. “All the neuromodulators have the basic botulinum toxin, but the carrying protein is substantially less in Xeomin®,” he explains. “Therefore, it’s a purer form of neurotoxin.”

When it comes to RHA®, the word “clean” also hints at a more streamlined formula. “The filler was created with hyaluronic acid that is less crosslinked and in longer strands, so that is more similar to the natural-occurring HA,” Dr. Doft shares. As such, it needs fewer chemical manipulations than other hyaluronic acid-based fillers.

Does Cleaner Mean Better?

If you are wondering if these purer injectables work better, there isn’t any real consensus among the doctors we spoke with. “Do I think that it's actually meaningful,” Dr. Moskowitz asks of Xeomin® efficacy claims. “There are no studies that I am aware of that give credence to this.” As for the claim that it kicks in quicker than other neurotoxins, Dr. Doft says she “has not found that it works faster or longer or better than Botox®.” In fact, she finds Dysport® actually “works the fastest out of all three.”

Even so, Dr. Lombardi sees an advantage. “A cleaner product can be better,” she shares. “The fewer proteins and crosslinking a product has, the less of a chance that the body may elicit a response to that product.” This idea becomes a bit clearer in the case of Revance RHA®. “Patients react less to it, as it is perceived as being ‘less foreign’ by their body,” Dr. Doft explains. “Therefore, there is less swelling, and it lasts for up to 15 months.” It also provides for better tissue integration, which makes for a natural-looking result.

The Takeaway

If the idea of a purer injectable speaks to you, your doctor can help you decide if Xeomin® and/or Revance RHA® is right for you. But Dr. Doft predicts it won’t be a major deciding factor for most people — at least for now. “My patients care most about the best results and at the end of the day,” she says.