There's big money in those wrinkles. How the makers of cosmetic fillers and smoothers are trying to tap into a new market.
Janet McMahan was facing her 50th birthday, a college reunion and the end of her marriage in one year. Looking in the mirror didn't make her feel any better. "I was sick of looking tired all the time," she says. That's when McMahan, now 54, became a fan of injectable wrinkle treatments. It wasn't a cheap option for the single Nashville mother of three, who lives on a piano teacher's income of $40,000 a year. But she decided to shell out about $1,500 year for Botox to smooth the lines in her forehead and dermal fillers to plump out the creases around her mouth. "I'm not glamorous," she says. "I get my hair done at the beauty school for $15 and I don't buy lattes. I choose to spend my mad money this way."
Gone are the days when ads asking, "Does she or doesn't she?" referred to hair coloring. Now, that question would come with the answer: only her dermatologist knows for sure. And if you're old enough to remember that ad, you're just the person biopharmaceutical companies have in their sights. For women who are sliding toward 40 (or 50), conversations with friends about cosmetic procedures that used to start with "I'd never do that" are often edging closer to "never say never," as wrinkle fixes become more available and acceptable. Botox and dermal fillers like Restylane are now being offered not just in doctor's offices, but at walk-in spas and private parties—even dentists are hanging out shingles offering to whiten your teeth and make you look younger all in the same easy chair.
About a million Americans regularly go under the needle to get doses of Botox, which works by temporarily paralyzing wrinkle-making muscles in the forehead, and Restylane, a hyaluronic-acid dermal filler that fills in deeper folds or unevenness in the lower part of the face (think spackle). But Allergan Inc. and Medicis Pharmaceutical Corp.—the leading U.S. makers of injectable wrinkle reducers—want to draw in a much larger market. By their estimates there are another 25 million or so American women who can afford the $1,500 to $3,000 for two to four treatments a year, but haven't yet been convinced that they want to go that route. "There are women spending significant amounts of money at hair salons and at cosmetics counter for ineffective products," says Jonah Shacknai the CEO of Scottsdale-based Medicis, which makes the leading dermal filler, Restylane, "and as far as we're concerned, they should all be patients of Medicis."
To turn those Middle American women into patients, the two manufacturers are using very different tactics. You could sum up their pitches as "healthy mom" versus "hot mom." Irvine, Calif.-based Allergan has signed up "Sideways" actress Virginia Madsen, 45, to extol the virtues of eating right, exercising and "treating" your wrinkles. It's a Bob Dole-Viagra moment for Allergan, which five years ago probably wouldn't have been able to get a celeb to confess to regular injections of Botox.
Medicis, for its part, has created a campy reality show called "Hottest Mom in America"—a cross between "Desperate Houswives" and "American Idol." Winning moms audition for a spot on the show by demonstrating that they do a great job balancing their family and work obligations while taking care of themselves. In return, they can receive cash prizes and a year's supply of Restylane. The program, which has yet to find a television outlet, will also offer tips on looking more attractive because, says producer Jeff Greenfield, "it doesn't matter what level of hotness you have, you can always improve."
Both marketing experts and critics of the industry admire the novel packaging of a familiar perfect-yourself pitch. Analysts like Ronny Gal of Bernstein Research in New York think a mass popularization of injectables is inevitable: "These guys are riding trends that are as old at the bible: vanity, aging and the globalization of wealth," he says. Deborah Sullivan, author of "Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America" (Rutgers, 2000), agrees that the companies are adopting smart marketing strategies. "You can't go wrong with business models that bet on women's insecurity," she says. "I'm wondering how women will resist these messages."
The biggest argument for these products may be that they actually work—at least temporarily, says Alexandra Kuczynski, author of "Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery" (Doubleday, 2006). "They've medicalized youth and beauty," she says. "You can literally erase wrinkles from your face and create a youthful plumpness and these campaigns will certainly bring this stuff closer to women in Kansas. The question is, how many of them can be convinced to care whether they have crows feet?"
Even among Middle American moms worried enough about lines and sags to endure the discomfort of regular injections, there are other obstacles to more widespread acceptance. Part of Allergan's challenge will be to overcome the fear factor that comes with the notion of injecting a substance officially named Botulinum Toxin Type A into the face. Reports of droopy eyebrows or expressionless faces on overdone celebs haven't helped. "It's very safe when injected properly, but there are real risks if you have it administered by an unqualified person at a spa or a party," says Bethanne Snodgrass, a plastic and reconstructive surgeon and author of "The Makeover Myth: The Real Story Behind Cosmetic Surgery, Injectables, Lasers, Gimmicks, and Hype, and What You Need to Know to Stay Safe," (Collins, 2006). "The product could be diluted or not even Botox at all, which can result in some complications including facial paralysis." Snodgrass says the adverse effects of fillers can include infection and temporary swelling. For more information on using injectables safely, click here.
Allergan says that because the product depends so heavily on word of mouth, it's in their interest to quell rogue Botox distributors. It has launched what it's calling a "health education" campaign to educate women about proper administration procedures and provide them with qualified referrals. "It's important because bad outcomes are bad for business," says Robert E. Grant, head of Allergan's Medical division.
As the market's potential grows, so does the corporate competition. Botox, the sole player in the cosmetic neurotoxin market since 2002, will soon have to fend off Medicis, which expects to get approval for a rival product called Reloxin in 2008. The companies are also in a fierce fight to dominate the hyaluronic-acid dermal-filler market. The take for fillers is still far smaller than that of Botox (about $280 million per year in the U.S. versus Botox's nearly $1 billion in revenue), but it is growing fast. Gal estimates that fillers will become a $596 million business by 2009.
Medicis's Restylane has been the dominant hyaluronic acid filler since its introdution in the U.S. in 2004. Last year it held about 90 percent of that market. But in January of this year, Allergan introduced a challenger, Juvéderm, which it has been heavily promoting among the many medical professionals who already administer Botox. Medicis doesn't release numbers for Restylane sales, but it reports that despite the new competition, the company had a strong first-quarter showing with a 27 percent year-over-year increase in revenues. That, however, could change after Allergan announced Tuesday that it had received approval from the Food and Drug Administration to relabel Juvéderm. The new label will say that the product's effects can last up to 12 months—not just the six months it currently claims. (The relabeling was based on a study the company conducted of 292 Juvéderm users.) Restylane, by contrast, will still be labeled as effective for about six months. The news will certainly help Allergan promote Juvéderm as an alternative to Restylane, but the real test will come as the products continue to face off in the marketplace this year. "Physicians will always use their own experience with a product to make their choice," says Gal, "but it certainly helps if the FDA gives you a better label. We'll know in the next six months if Allergan's research holds true."
The most daunting task for both companies in expanding their customer base may be to convince consumers, especially those on a tight budget, to take on such an expensive beauty habit. "There is a fear of addiction," says Medicis's Shacknai. "Women worry that this is a lifetime commitment." These customers might be right. Those who stop getting injections won't prune up overnight, but the wrinkles do have a habit of returning eventually. "When the effect goes away, people are very sad," says Miami dermatologist Flor Mayoral. "They go back to their doctor." Medicis is trying to counter those concerns. In the fall, it will launch its first direct-to-consumer marketing campaign aimed at addressing that question. At the same time, both companies are pushing the message that you're never too old to look younger. Some of Medicis's hot moms are already in the grandmother category—and Allergan has hired its own older woman to endorse Botox along with Madsen. The co-promoter is none other than Madsen's mother, Elaine. Her line: "This is what 74 looks like."