A new offering of injectables, fillers, and treatments is kicking off 2023 in the best way possible. While the OG favs aren't about to be relegated to the backstock closet of your dermatologist's office anytime soon, some of these newly FDA-approved products — as well as others on the horizon — are sure to shake up the world of anti-aging as you currently know it.

Here's everything to expect at your doctor's office soon.

1. Daxxify

What it is: A neuromodulator

Best for: Smoothing out frown lines, a.k.a. the 11s between the eyebrows

Point of difference: The longevity factor

The juicy details: Neuromodulators such as Botox, Dysport, Xeomin, and Juveau, have earned their reputation as stellar wrinkle reducers, and a new product, Daxxify (or Daxi, for short), is making its way into the mix. 

Most neuromodulators keep the skin smooth, on average, for three to four months. But with Daxxify, the wrinkle-reducing results last twice as long–six months to upwards of nine months in some. Tara Adashev, a skincare expert and master injector at Neinstein Plastic Surgery, calls Daxxify amazing as "it works on those strong muscle groups allowing the muscle to relax for longer." 

The effects also kick in fast. "The on-set seems to be faster than Botox, which is nice," adds board-certified dermatologist Amelia Hauser, MD. Daxxify works similarly to other injectable neuromodulators. "The toxin does the heavy lifting, so the activity you get is the same; it's just packaged differently."

All injectable wrinkle reducers contain botulinum toxin type A (made from clostridium botulinum bacteria), a protein that softens facial wrinkles and lines. But the type of protein in each injectable differs. Dr. Kenneth Mark, a cosmetic dermatology expert, says Daxxify is different in that it has a unique peptide (an RTP004 peptide) attached to it. In simple terms, the peptide allows for better longevity. And, unlike the other toxins, Daxxify doesn't rely on human- or animal-derived additives as a stabilizing agent, making it a 'cleaner' option.

So, who is this new injectable best for? Most injectors say it's better suited for experienced patients who aren't injectable virgins in case they don't like the results, which take time to wear away. "I probably wouldn't start a new patient with it," adds board-certified dermatologist Kenneth R. Beer, MD. "When injected appropriately, it is very precise, so it stays put. I think the combination of precision and duration is exciting."

2. RHA Redensity

 What it is: A thinner hyaluronic acid filler

Best for: Lip lines and barcode lines around the mouth

Point of difference: It lasts longer in areas with more movement

The juicy details: RHA fillers (there are four in the family) are a type of hyaluronic acid filler that Dr. Mark says lack vycross technology (cross-linking technology used in Juvéderm products), so RHA fillers do not have the lifting capacity. "Instead, they are indicated for movement wrinkles, whereas Juvéderm and Restylane are for static wrinkles."

When using fillers close to the skin, they need to support facial movements so that the product looks natural and adapts to the face when laughing or smiling. “What sets Redensity apart from the rest is its higher ability to stretch and extend without disrupting under pressure,” says New York facial plastic surgeon Yael Halaas. "That's why it's a great choice for highly dynamic areas, like around the mouth.”

Adashev adds that Redensity, which lasts up to one year, "also gives a hydrated look around the mouth (perioral) muscles — that's one of the goals."

Barcode lines aren't the only place where doctors are injecting Redensity. Although it's an off-label use (meaning, not an FDA-approved use), Dr. Hauser says Redensity works in any fine line. "Those little cheek lines and those under the eyes are nice areas to treat. So are the horizontal lines on the neck, which is an area where I've been using it a lot because the filler is delicate and thin, so it doesn't tend to get as lumpy under the skin."

3. Juvéderm Volux XC

What it is: A thick hyaluronic acid filler

Best for: The jawline

Point of difference: It has more lifting power

The juicy details: If you're forever chasing a snatched, sharp-as-glass jawline, you'll be happy to know that Volux is a hyaluronic acid-based filler that adds definition to the jawline (the only one designed for the area; all other injectables are off-label). Unlike other fillers, Volux is intended to emulate bone in the jawline area. Dr. Hauser describes it as much stiffer, almost like an implant. "We're not trying to create soft tissue volume with it, but rather bone structure."

No matter if you want more definition in the jawline or the signs of an aging lower face are becoming apparent, Volux is ideal for anyone who wants to refresh their lower face and jawline. Dr. Beer says it can be injected into the jaw using a cannula and “it has helped my patients with jowls and a saggy jaw area."  

Dr. Mark has been using Volux since it became available in November (pre-launch). "I'm still in awe of its ability to define and rejuvenate the jawline, help patients instantly, and offer more dramatic results than any other filler ever. It is literally a "facelift in a syringe."

Volux, which lasts about one year, will eventually be used off-label. “It is likely to be used to augment and build up areas where the bone structure may be weak, like the cheekbone contour,” Dr. Hauser says. 

4. Topilase

What it is: A topical hyaluronidase solution that breaks down hyaluronic acid injectables

Best for: Undoing minor imperfections or overfilled areas

Point of difference: It’s a painless, needle-free solution  

The juicy details: First things first, Topilase isn't an injectable or filler, but rather a topical hyaluronidase that undoes the effects of some fillers gone wrong, so it fits the bill for inclusion.

The doctor-developed solution works slightly differently from tried-and-true injectable hyaluronidase, which is in every dermatologist's toolbox as a quick fix for reversing the ill effects of injectables and migrated filler. While Topilase can subtly improve the appearance of irregularities and swelling resulting from fillers, it works its magic without using a needle.

Rather than pinpointing a precise area that requires dissolving, Dr. Halaas says Topilase works best to correct overfilling in thin areas such as the under eyes and lips. The thought is that the product can better penetrate areas where the skin is thin but is not as equipped in areas where the skin is thicker.

"Topilase provides a pain-free and needle-free option to customize filler results if you feel slightly too puffy or asymmetric,” she adds. “Of course, injectors will always need injectable hyaluronidase in their offices for deeper areas and emergencies.” It’s also thought to be effective for minimizing a feature or area overall.  For example, if the lips are too big everywhere post-filler, Topilase can be spread on them to reduce their size and fullness.

For Topilase to work, a layer of the solution is applied to the area and massaged into the skin. Within minutes, the signs of a bulky, overfilled feature start to reduce, albeit the reduction is more subtle than what injectable hyaluronidase achieves. You may need between one and four sessions of Topilase to minimize the volume.

Doctors don't think Topilase will work well for treating deeper nodules. When filler is injected over the bone and correction is required, applying Topilase onto the skin probably won't break down that deeper filler. "I'd suggest a stronger concentration of hyaluronidase in that area, and I think it's difficult to treat it with something topical because of its limitations," Dr. Hauser says.

What else is new:

Exciting as it is to have new options to choose from, some of the classic anti-aging stand-bys are improving, too.

• More uses for Sculptra
  

Sculptra, a bio-stimulatory filler made of poly-L-lactic acid that encourages the body to produce collagen, just got an upgrade in terms of its label. That means your injector can mix it at a higher dilution—right before the injections, too—making for an easier treatment that doesn’t compromise results. Lidocaine can also be added to Sculptra to make the treatment more comfortable. Products mixed with or containing lidocaine give an instant numbing effect with the first pull of the plunger, and many say the numbness from lidocaine is far superior to topical numbing creams.

Plenty of off-label injection points that are gaining popularity. "We are using it to tighten up saggy, droopy legs, and in some instances, the chest area," Dr. Beer says. "It is also good for treating certain types of scars." He adds that stimulating collagen growth creates a durable but natural appearance.

Dr. Halaas is injecting Sculptra in the neck, in combination with mesotherapy, to help revitalize delicate skin areas. Adashev is also using it to redefine and add structure to the neck. "Lately, we have seen tremendous interest in bio-stimulatory fillers," Dr. Halaas shares. "The concept of harnessing your body's power to rejuvenate resonates with patients and doctors."

• Renuva doubles as a post-laser skin healer

Renuva is a treatment that restores volume loss in the face, hands and body by prompting the body to make fat with the most bioidentical source to replicate volume. Lisa Goodman, PA and the founder of GoodSkin Clinics, also likes using it as a skin treatment to help laser patients heal faster beyond its intended uses.

Goodman injects Renuva under the skin right after a laser, which she says helps amplify the results and speed up healing due to the growth factors in the treatment. "I'm using it more like a wash, especially on the neck, which is difficult to treat." No one wants a fat-looking neck, which is why Goodman says overdiluting Renuva becomes more like a collagen treatment without producing a lot of fat in the area.

"It gives the skin this glowing-from-within effect, like that estrogen-y glow that happens during pregnancy, and that's something you don't see from fillers," she says. Goodman recommends 'washing' the skin with Renuva every four to six months to make the skin healthy and bright.

There are also rumblings of it being used off-label in the lips and eyes and anywhere on the body where fat needs to be replicated for additional volume.

• Skin-boosting hyaluronic acids
  

Hyaluronic acid conventionally adds volume to flat areas in injectable form. Yet, there's likely to be another way to use hyaluronic acid as an injection, and no, it's not to inflate deflated features. 

Restylane Vital and Vital Light and Volite (currently used in Europe) are non-volumizing hyaluronic acid gels, a.k.a. skin boosters, that improve skin quality rather than volume. Although these injectables are not approved in America yet, Dr. Hauser predicts Volite to be any day. "When it is, it will be the first skin-boosting hyaluronic acid available in the United States."

Volite contains a lower dose of hyaluronic acid and focuses strictly on creating smoother, more elastic, better-hydrated skin. "Volite is injected in one-centimeter grid droplets all over the cheeks for hydration and light reflection," Dr. Hauser shares. It works by changing aquaporins (they carry water across cell membranes) and the skin's architecture to hold water better. "While Volite can create glowy skin, it can also help with symptoms of dry skin. It's an alternative to layering on different topicals and gives a lush canvas." The deep-down hydration is said to last for up to nine months and won't replace the current portfolio of hyaluronic acid fillers since they serve a different purpose.

• Profhilo, a high-concentration injectable

One European injectable dermatologists would love access to in their stateside practices is Profhilo. "It's a very high concentration hyaluronic acid injectable with multiple uses," Dr. Hauser says. "It's injected differently, and because it's more liquidy, it helps with skin laxity and architecture. It's not a hydrator, like a skin booster, nor a volumizer. It's more like a contouring device made to improve the thickness of the skin and its quality." 

Ideal for correcting crepiness on the chest, above the knees and on the arms, Profhilo could potentially be used in place of radiofrequency devices or even in conjunction with them. "It falls more within the realm of how we use devices to improve skin texture, which we still don't have anything that treats that perfectly," Dr. Hauser says.

• Hybrid fillers

As more attention falls on collagen-stimulating injectables, the interest in hybrid fillers, a new category of bio-stimulatory fillers containing hyaluronic acid, continues to grow. "Allergan has one called HArmonyCA, a combination of hyaluronic and calcium hydroxyapatite filler. It's like Radiesse-meets-Voluma in one," Dr. Hauser says. "You get the immediate effect of the hyaluronic acid with the long-term stimulation of the calcium hydroxyapatite." However, hybrid fillers are a ways away from becoming a staple injectable on our shores—FDA trials haven't even started.

• Exosomes: Like PRP, but better

Injectable exosomes are a super-hot topic right now. Dr. Mark describes them as extracellular vesicles, the medical term for tiny bubbles released from stem cells. "Exosomes carry genetic information and proteins to cells throughout the body, creating paths for communication," he explains. "Exosomes contain three times the number of growth factors of stem cells." 

They also contain platelets that communicate with hair, follicles and skin cells. Lab-synthesized exosomes (pulled from donor cells or taken from plants or animals) will likely be applied to the skin topically, like PRP, and used following laser and microneedling treatments to drive the exosome's rejuvenating powers into the skin. Dr. Hallas says their primary ability is to assist with the healing and rejuvenation process for hair, skin and scars. As exciting as exosomes sound, they're not ready for approval yet.