By  on July 13, 2007

NEW YORK — For the aging obsessed, who have deemed the array of serums and creams at Bloomingdale's beauty counters not potent enough to zap wrinkles, there's a quick, more severe fix close by.

They now can meander half a block down the street from the Bloomingdale's flagship to Smoothmed, a walk-in Botox clinic located at 111 East 59th Street, and walk out roughly 30 minutes later sans wrinkles.

"Botox has become mainstream and this [concept] is the next step in its evolution," said Dr. Andrew Elkwood, who cofounded Smoothmed with his business partner, Dr. Michael Rose. Both Elkwood and Rose are plastic and reconstructive surgeons who practice in Manhattan and Shrewsbury, NJ. The idea for Smoothmed, Elkwood noted, was inspired by the crowded waiting room of their practice.

"Our patients were waiting for a long time for a five-minute treatment. We wanted to create an in-and-out, no-appointment-necessary [alternative]," he said, noting that all treatments are administered by general practice physicians. If all goes well at the Midtown location, Smoothmed is considering opening units in additional markets, such as Los Angeles and Chicago.

Smoothmed's "Botox-on-the-go" concept is a startling brick-and-mortar reminder of just how ubiquitous light cosmetic procedures, like Botox, have become.

But it's not the first effort to take cosmetic procedures out of the doctor's office and into bustling shopping hubs. The Manhattan-based Georgette Klinger spa chain offers light cosmetic procedures, and a company called Nuvo International set up medical spas in shopping malls in Nevada, California and Washington. The firm declared bankruptcy in 2005 after two women filed a lawsuit alleging that they had been badly burned during laser hair removal procedures.

Some cosmetic retail concepts have failed, but light cosmetic procedures have found fertile ground in medical spas and dermatologist offices. According to the American Society of Plastic Surgeons, last year minimally invasive cosmetic procedures — such as Botox, chemical peels and microdermabrasion — increased 8 percent, with more than 9 million performed.

Robert Grant, president of Allergan Medical, the maker of Botox Cosmetic and the wrinkle filler Juvederm, pointed out that, in the U.S., the injectable aesthetic treatments industry is relatively new, beginning in 2002 with the U.S. Food and Drug Administration's approval of Botox Cosmetic. He noted that Botox — a diluted form of botulinum toxin that is used to smooth wrinkles by temporarily paralyzing the muscles beneath them — has since grown into a billion-dollar brand.It currently tops the list of the most popular of light cosmetic procedures, but new forms are gaining ground.

For instance, last year hyaluronic acid-based fillers — or wrinkle fillers used to temporarily smooth moderate to severe facial wrinkles and folds, such as nasolabial folds or the "parenthesis" along the side of the nose — made the top five for the first time. The FDA approved the first hyaluronic acid-based wrinkle filler, Restylane, in 2003. Allergan's Grant noted that they are now the fastest-growing noninvasive aesthetic procedure in the U.S., according to the American Society for Aesthetic Plastic Surgery.

When it comes to avoiding the signs of aging, sticker shock is not a barrier. Dr. Joseph Eviatar, co-medical director at Chelsea Eye & Cosmetic Surgery Associates, said that, in his experience, the cost of hyaluronic acid-based fillers tends to range from $600 to $1200 per treatment.

Some of the current fillers on the market include Allergan's Juvederm, Radiesse by BioForm Medical, ArteFill by Artes Medical and Medicis' Restylane and Perlane, which is billed as a denser form of Restylane and is the newest wrinkle filler on the market. It was approved by the FDA in May.

Dr. Paul Friedman, director of the Houston-based Dermsurgery Laser Center, said fillers are designed to re-create a youthful, full face. Drawing a parallel between aging and a deflating beach ball, he continued: "As we age, we lose volume in and under the skin. In the past, doctors focused on pulling the skin to get rid of wrinkles, but now the focus is on restoring volume and youthful contours."

Dr. Friedman, who has assisted Medicis with research and training for Perlane, estimates that there are roughly 20 million to 30 million women who are interested in cosmetic injectables but have yet to try these treatments. As for whether creams can be just as effective in addressing wrinkles, he said: "Creams cannot compare to an FDA-approved filler treatment, but topical treatments with retinoids and vitamin C or E can be used to address the tone and texture of the skin."

Eviatar, who has assisted ArteFill with training, noted that topical skin treatments are essential, but added that he has yet to see any studies that indicate creams produce collagen. In the wake of the rising popularity of light cosmetic procedures, the beauty firm Elizabeth Arden aligned itself with Allergan to comarket Prevage, an antiaging serum powered by the antioxidant idebenone that is sold at Elizabeth Arden's beauty counters.When asked if he anticipates more unions between pharmaceutical giants and beauty firms, Steven Basta, chief executive officer of BioForm, the maker of the wrinkle filler Radiesse, said over-the-counter beauty is not its business. "We are in the business of enhancing cosmetic outcomes. Patients notice the result immediately and love it." He noted that Radiesse, which received FDA approval for cosmetic use last year, is designed to immediately fill wrinkles and folds, while inducing collagen production over time.

When asked if Radiesse, like Botox, may one day be available at walk-in clinics such as Smoothmed, he said: "Botox has evolved into a social phenomenon that is different than most. Our focus is on training medical professionals how to provide the filler to patients in doctors' offices."

As for Smoothmed, Elkwood commented: "The idea was a long time coming."

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