Meet REX - A Longer-Lasting Alternative to Botox

• No toxin is used.
  
  
• According to physicians now performing the procedure, patients have reported that the effects last much longer than Botox. (an average of 12 to 18 months as compared to Botox’s average of 3 months)
  
  
• Proponents believe this procedure creates a more natural look than Botox, with less risk of brow ptosis.
  
  
• The procedure is effective even on patients who have developed a resistance to Botox.
  
  
• While REX is in fact more invasive than Botox, it is less invasive than surgical Botox alternatives, making it appealing to those for whom Botox is not an option.

• No long-term studies support REX’s safety and effectiveness over time, and it is not yet FDA-approved for cosmetic use.
  
  
• If you don’t like the outcome of the procedure, you have to wait at least 12 to 18 months before its effects wear off. In fact, some cosmetic specialists have raised a concern over the possibility of permanent nerve damage and/or muscle atrophy, although no incidence of this has been reported so far.
  
  
• Although it lasts longer, it is more expensive than Botox injections.

According to the makers of REX, the procedure can benefit anyone who wishes to lessen the appearance of the vertical frown lines between the brows without the use of an injected toxin. In addition, the procedure can provide a moderate lifting effect to the brow. Although the procedure is seeking FDA-approval only for treatment of frown lines (and will be marketed accordingly, similar to Botox), it can also be used to reduce lines in other areas, such as horizontal forehead creases and crows feet.

As with any cosmetic procedure, realistic expectations are key. The procedure should not be performed on pregnant women.

The technology used by the REX system is FDA-approved for medical use, and has been used safely to treat patients with cardiac and other conditions for more than a decade. Cosmetic use of the system began a little more than two years ago, though clinical trials are still in progress to obtain FDA clearance for cosmetic use. Use of REX to treat frown lines is currently still considered an "off-label" use and is not officially endorsed by Bioform Medical, Inc., the company that owns the technology. To date, no significant adverse effects have been reported.

Local anesthesia and regional nerve blocks are administered prior to the procedure to make it more comfortable. Most people find this adequate; however, some doctors may also give you oral or intravenous sedatives to help you relax before the procedure. Oral acetaminophen may be taken for the first 24 hours following the procedure to lessen any discomfort.

Cool compresses are applied to the insertion sites and treated areas. Your doctor will instruct you to sleep with your head above the level of your heart for the first night after the procedure.

The most common problems in recovery are localized swelling, redness and bruising. These are usually mild and of short duration.

In most cases, you can return to work immediately after the procedure, although you may be wearing small band-aids over the puncture sites for the first 24 hours. If you don’t want to spend your day explaining the band-aids (and possible redness and swelling), it might be a good idea to take a day off.

Fees vary from $1,500 to $3,000 for a treatment of the frown lines. As with many other cosmetic procedures, geographic location is a factor in pricing. Treatment of additional areas may cost more. Compared to Botox, at first glance it seems quite expensive. However, the duration of the effects may make it worth the extra cash, since Botox wears off within 3 to 4 months, whereas the effects of the REX procedure have been reported to last 12 to 18 months or more.

The procedure is completed in two phases. In the first phase, the REX needle probe is inserted underneath the skin in two specific sites on each side of the face: one near the nose, and the other near the temple. The correct nerves are then precisely located by the doctor through a painless process of electrical stimulation which causes the targeted nerves to send impulses which cause the “frown” muscles to contract.

Once the nerves have been located, a precisely controlled dose of RF energy is applied for approximately ten seconds. This process is repeated in several spots along the targeted nerve for maximum effectiveness. Then the entire sequence is repeated at each insertion site. The entire procedure takes about 15-30 minutes.

Once the nerves are disabled, the patient is no longer able to draw the eyebrows down into a scowl. Thereby, the vertical lines between the brows are therefore significantly diminished. According to New York dermatologist and aesthetic surgeon, Neil Sadick, MD, the results he has seen in his practice are aesthetically comparable to those of Botox, and his patients appreciate the longer duration of the procedure's effects.

Important Note:

It must be noted here that most of the available data on this procedure has come from two of the few doctors who are currently using this technology, as well as from Bioform Medical, the company that makes REX. Long-term studies are still in progress, so although the procedure shows promise, patients considering it should proceed with caution until more data is available.

_Sources:

Interview with Neil Sadick, MD, New York, NY, MD; conducted on September 17, 2008.

Physician Information Sheet, Bioform Medical, Inc., San Mateo, Calif., 2008.

Press Release, Bioform Medical, Inc., San Mateo, Calif., April 30, 2008.

Radiofrequency Ablation of the Nerve to the Corrugator Muscle for Elimination of Glabellar Furrowing; Utley and Goode, Archives of Facial and Plastic Surgery 1999; Volume 1, pages 46-48.

Radiofrequency Energy for Denervation of Selected Facial Muscles: Clinical Experience; James Newman, MD; San Mateo, California; (White Paper for “Relaxed Expressions” Technology), BioForm Medical, Inc., 2008.