A BOTOX party held in Frisco, Texas, and hosted by the Big Rich, because that’s apparently a thing. (Oceanview Med Spa/FLICKR)
Last month, Evolus – a competitor to pharmaceutical giant Allergan’s botox market – was FDA approved for its version of the face-lifting drug, Jeuveau, which some experts claim to be a “better” botox. Allergan, owner of BOTOX Cosmetic, has seen its stock dip since Evolus’ approval, while some say this will serve to bolster the growth of the botox cosmetic market by providing cheaper alternative treatments.
But Evolus has just done far more than undercutting Allergan’s market. It’s broken Allergan’s monopoly. Now because botox is a competitive market, it may lead to the greatest explosion of its use, ever, along with an enormous potential for abuse. And the reasons why doesn’t start with face-lifting.
Botox – or Botulinum Toxin Type A – is a drug commonly known for its facial wrinkle smoothing. It’s also uncommonly known to be an extremely deadly toxin that can treat a variety of other ailments. One could say it’s the world’s best alternative to the fountain of youth, while others have called it unethical. Regardless, underneath the most acutely lethal toxin known to man – even deadlier anthrax or smallpox – is a $2.8 billion dollar niche of the cosmetic industry. That number is expected to rise above four billion by 2020, according to Allergan’s own estimates. But with Evolus in the picture, now that market is getting bigger.
Up until now, Allergan has had a tight monopoly over the botox drug, and they have even restricted its commercial advertisement since they lacked any viable competition. Despite that, the number of cosmetic botox patients reported by The American Society of Aesthetic Plastic Surgery is as high as seven million now. With this tri-annual treatment being regularly around $600 dollars a pop (not including the doctor’s cut for administering the deadly drug), botox has been linked to affluent areas and suburbs, such as in Orange County.
An important reason why botox is at risk for abuse is that it’s becoming more and more unregulated. In recent years, botulinum treatments have entered a whole new field of unregulated, off-label uses. According to the FDA, the drug is approved for nine separate medical uses, but that isn’t stopping doctors from pushing the boundaries even further.
Min Dong, Ph.D at Harvard Medical School who researches botulinum toxins, said in 2017 that “It’s the doctors at the front line who start using Botox off-label, and then we see the treatment of things we never expected the toxin to work for. I meet with physicians who are using the toxin everywhere – for diseases you would never know about.”
Doctors now believe botox can treat anything from overactive bladders to crossed eyes, cerebral palsy, excessive sweating, migraines or even depression. With prices of botox treatments set to go down in competition with each other, and competitive branding campaigns between Evolus and Allergan already starting, these medical treatments involving botox might even become alternatives to their mainstream counterparts relatively soon.
The botox demographic may also become a huge source of the drug’s abuse, as the underlying problem with botox is the social pressure around it. “The pressure is tremendous,” said Mrs. Heinrich, an Orange County mother who is active in her church community. “You go to Bible study and nearly everyone has it. I’m not told I should do it, but it’s treated like a standard in order to be presentable.” Her and others may not be told to take the injection, but what they are asked to is this: Botox parties.
For those who are unfamiliar with the concept, according to the American Med Spa Association, “These are events hosted by a med spa or a provider, either at the med spa or another location, where people get together to socialize, learn about treatments, and try new treatments. Often the med spa provides discounts on product so that they can get new patients in the door. Often alcohol is served. These are highly social events that mix pleasure with aesthetics, which makes the idea of getting injected with a needle a little more palatable.”
With the tide of the botox market changing, the reality is this: botox products are about to be more accessible – monetarily and geographically – than they have ever been before. Botox’s other medical treatments will also become more accessible alternatives to mainstream drugs that treat the same ailments. With advertising of botox now an opening market thanks to competition between Allergan and Evolus, innovative means of bringing in more patients such as botox parties will be highly effective, as well as profitable for doctors. Without new regulations designed towards a greater population using this very dangerous drug, the incentive for unprofessional yet profitable abuse of the drug by doctors is thus greater than it has ever been.