On February 1, 2019, the U.S. Food and Drug Administration (FDA) approved Jeuveau™ (prabotulinumtoxinA-xvfs) for the treatment of glabellar lines. Known as frown lines or the “11,” these lines can be found between the eyebrows and are a common complaint of many patients. Jeuveau™ is the first aesthetic neurotoxin to be approved by the FDA in almost 10 years, joining commonly used injectables like Botox®, Dysport®, and Xeomin®. Joshua Rosenberg, MD, Chief of the Division of Facial Plastic and Reconstructive Surgery at Mount Sinai’s Department of Otolaryngology – Head and Neck Surgery, explains the new drug, how it works, and compares the drug to its popular competitors.

What exactly is Jeuveau?

Very similar to the ubiquitous Botox, Jeuveau is a purified botulinum toxin type A complex. It is an aesthetic neurotoxin which produces results by paralyzing the muscle. Although the effect sounds scary, these injectable medications are completely safe when administered professionally.

How do neurotoxins reduce lines and wrinkles?

Repetitive movements are responsible for many of the lines and wrinkles that form as we age, especially horizontal forehead lines and crow’s feet. Cosmetically speaking, all neurotoxins do the same thing: relax muscles involved in facial expression. Through their ability to relax our underlying facial muscles, Botox, Dysport, Xeomin, and now Jeuveau are great tools to prevent these lines from forming or soften lines that are already there to give you a younger, more refreshed look.

What is the difference between the available injectables?

Although they are distinct formulations of botulinum toxin type A, there are few practical differences between Botox, Dysport, and Xeomin for the average patient. They all produce temporary results that last between three and six months, require similar injection techniques, and have similar prices. For many patients, the product decision is made by a dermatologist or facial plastic surgeon.

So, why is the industry so excited by this new drug?

The excitement centers not only on its “new kid” status but also its potentially lower price. Unlike Botox, which can also be used to treat non-aesthetic conditions, Jeuveau has only been approved for cosmetic use. Due to this, the drug is expected to be 25-30 percent cheaper than its competitors. I have yet to meet a patient, especially a New York patient, who was not excited by getting a similar product for a better price.

When will patients be able to try this drug?

Jeuveau is available in offices. If you are interested in trying this new injectable, make an appointment with a Mount Sinai facial plastic surgeon.

Diagnosing and treating patients from hundreds of miles away using online platforms is the basis of telemedicine, a new and fastgrowing trend. In dermatology, there are already numerous studies highlighting the value of teledermatology in delivering quality care to communities where dermatologists are scarce.

Herbert Goodheart, MD, oversaw the first teledermatology initiative at Elmhurst Hospital Center, a Mount Sinai Health System affiliate. This year, the Kimberly and Eric J. Waldman Department of Dermatology launched a formal teledermatology program directed by George Han, MD, PhD, at Mount Sinai Beth Israel. Under the supervision of Dr. Han, residents see patients remotely in real time at Bassett Medical Center in Cooperstown, New York.

Our doctors conduct online interviews and examinations, order tests, and prescribe medications, all from over a hundred miles away.

“Teledermatology allows us to help people in a way that other patients experience in Manhattan, where dermatologists are abundant,” says Shira Wieder, MD, a dermatology resident at Mount Sinai. “We have had the opportunity to help patients suffering from untreated psoriasis or atopic dermatitis their entire lives and have never been able to see a dermatologist. Patients are so appreciative of our help and seem to love the service, despite only getting to meet us over the computer.” Dr. Wieder said that some clinic nurses were initially skeptical about the teledermatology concept but now think it is a wonderful addition to their clinic. Ellen de Moll, MD, a dermatology resident, said she has also enjoyed her time on the rotation. “It has allowed me to help many patients with limited access and provide truly life-changing treatments for everything from acne to severe psoriasis to rare diseases, she says.” Dr. de Moll also noted some of the challenges of teledermatology, including the difficulty of obtaining clear images and the inability to touch and apply pressure to skin lesions.

Patient feedback has been very positive, with testimonials such as, “Less wait time to be seen by specialists” and “Getting care from physicians at a premier hospital.” Patients also appreciate the chance to see changes in their clinical photos and receive opinions from several physicians over the course of their care. Prior to teledermatology, the average wait time for a dermatology appointment for these patients in upstate New York was close to a year. Now they can consult with a Mount Sinai dermatologist within a couple of weeks, and sooner for urgent problems.

“Dermatology lends itself to telemedicine, given the uneven distribution of dermatologists in the U.S. and the visual nature of our field,” says Dr. de Moll.