INJECTABLE TREATMENTS

Shriyal Sethumadhavan reaches out to 11 dermatologists from India and collates their views on the market for injectables and what they foresee as popular treatments for the year 2021-22. 

The global facial injectable market size is reportedly expected to expand at a CAGR of 8.8 per cent from 2021 to 2028. What has been driving this demand for facial injectables? While there has been a growing focus on physical appearances, this has been redefined during the pandemic year due to video conferencing taking over professional lives. When Aesthetic Medicine connected with dermatologists for this story, most of them re-affirmed that an increase in video conferencing has led to a sudden upsurge in people wanting to change their appearances, further driving demand for injectable.

The pandemic year 2020 created a lull for the aesthetic practice, with clinics remaining shut for the initial months. On reopening too, only selected treatments were attended to. At many clinics, injectables were on hold initially owing to social distancing norms and were only offered by doctors much later in the year.

With news brands being introduced in the market for injectables, what does the current market look like? Which treatments and indications are expected to gain popularity? Eleven dermatologists across India share their views and expectations for the upcoming year.

Dr Chiranjiv Chhabra

Founder Director and Consultant Dermatologist, Alive Wellness Clinics, Delhi, Gurgaon, and Chandigarh

Market for injectable treatments in India: The Global dermal fillers market size is predicted to reach US$ 6.64 billion by 2027 exhibiting a CAGR of 9.3 per cent during the forecast period 2019-2027. The global market growth is driven by the minimally invasive nature of such procedures and the increasing efficiency of these fillers. COVID-19 induced lockdown has led to reduction in demand of elective procedures. The pandemic has negatively affected the demand of fillers across the globe. Major players in the market reported a decline in their revenue for aesthetic products in the second quarter of the financial year. However, market growth is expected after the restrictions are eased as the postponed procedures will be performed.

Injectable treatments that will be most popular in 2021-2022: HA fillers and botulinum toxin are going to hold the prime position among injectables in 2021-22. Over the past decade, increasing application of the HA filler has been showcased. It is the gold standard material for filler used for various indications such as wrinkle correction, lip enhancement, scars, and restoration of volume. The demand for cosmetic surgeries and minimally invasive or non-invasive procedures such as botulinum toxin and dermal fillers have increased tremendously over the past decade.

As a product, hyaluronic acid (HA) holds the highest market share in 2019 — attributable to its status as a Gold Standard in fillers. The second largest filler injection is calcium hydroxyapatite. According to Future Market Insights, the dermal filler market is projected to exhibit 2.9 per cent CAGR between 2021 and 2031. An increasing number of manufacturers are investing heavily in R&D to develop new innovative technologies in the field of cosmeticology, resulting in higher quality fillers that will be easier to use and offer better satisfaction to patients.

Dr Falguni Shah

Dermatologist, Cosmetologist and Founder, Radiance Skin Clinic, Mumbai

Market for injectable treatments in India: The year 2020 was tough due to the pandemic. Initially, around March-April, the number of patients for injectables dipped due to the lockdown. Until May- June, I too did not start offering aesthetic procedures for reasons of social distancing. But as months passed, owing to an increase in video conferencing, there was a sudden upsurge in people wanting to change their appearances. Corporate men and women started coming in for the little difference that fillers could make. Since work from home also meant longer working hours, the demand was for procedures with no downtime and low chances of infection. And so fillers were a good option.

Two injectable treatments that will be most popular in 2021-2022: One would be mid-face-fillers. Mid-face does not mean the cheek, but the vectors that pull the cheek or contour the cheek upwards. In several instances, we must start with fixing the temples and then we come to the mid-face. A thorough consultation is required to understand the facial structure as the cheek points are different in different individuals. The second indication that makes a big difference in making the overall face look softer and more sensuous is the lip indication. Here too, a thorough consultation is a must. It is important to understand the kind of lip shape a patient desires and then assess if that lip shape would look good on them. At times, the lips need volume, or may be a lift, or even hydration so they look softer. Fixing a lip is artistic, and deeply involves both art and science.

Dr Geeta Patel

Dermatologist, Zahra Skin and Laser Clinic, Ahmedabad

Market for injectable treatments in India: Although the aesthetic practice is getting better, it is nowhere close to the pre-COVID era as people are now saving up for hard times. Considering the current scenario, the injectable market too has taken a huge hit. Initially, people were reluctant to step out for safety purposes, and the last thing they would do was to remove the mask for a cosmetic treatment. Plus, they had nowhere to go after getting the treatment done! Older patients are also primarily the people seeking anti-ageing treatments and they are not moving out unless required. Cities such as Mumbai, Delhi, Ahmedabad, and Bengaluru, which are a huge market for antiageing treatments, have been the epicenters of COVID and hence most affected. There has been a major decline in gatherings, travels, and restaurant visits, and masks are mandatory in most places. All of this make the aesthetic equations different than before.

Injectable treatments that will be most popular in 2021-2022:

• Botulinum toxin: It is a quick fix to erase the worry lines and the early signs of ageing around the eyes and forehead.

• Tear trough Filler: This is the area in focus in the COVID era. With much of the face masked, except for the eyes, brows and forehead, the focus is on highlighting the periorbital area. This area conveys how we feel – happy or sad. Treating this area can instantly add a freshness and pep to the face, giving it a pleasant appearance. Also, the selfie era makes one more critical of even insignificant flaws and seeking ways to try and make the appearance perfect.

In the COVID era, these two areas have come into focus in the injectables with the advantage being that usually one syringe is enough to achieve the result in a younger patient. These treatments are quick, effective, gratifying, long lasting and most importantly, has visible results even in masked face. The effect of COVID on injectables will be temporary, but substantial. On a happy note, the desire to look beautiful will never fade.

In the COVID era, botulinum toxin and tear trough filler have come into focus with the advantage that just one syringe is enough to achieve the desired result.

Dr Meera James

Cosmetic Dermatologist and Founder, Beau Aesthetica Cosmetic Dermatology Clinic and Academy, Cochin and Kottayam

Market for injectable treatments in India: The slowing economy and a reduced discretionary spending has been discouraging customers from undergoing expensive cosmetic treatments imposing a practical restriction in the procedural treatments. A psychological barrier and a “wait- and- see” attitude have become common in the case of aesthetic dermatology procedures during the uncertain COVID-19 times.

Injectable treatments that will be most popular in 2021-2022: Threadlifts have become affordable and an easy approach to nonsurgical facial tightening. Fillers also provide a “liquid face-lift”. Both these procedural treatments have a minimal down time and makes it possible for patients to return to their work or other daily activities almost immediately. The results are also visible instantly.

Dr Mukta Sachdev

Head of the Department of Dermatology, and Consultant Dermatologist Manipal Hospital, Bengaluru and Medical Director, MS Skin Centre, Bengaluru

Current response and market for injectable treatments in India: In India, we are still grappling with the pandemic and currently seem to be at the beginning of a second wave, which will affect the aesthetic scenario once again. Clinics were just beginning to recover with ‘revive and restart’ as being the motto for most clinical and medical aesthetic practices. With all medical and safety protocols in place, non-invasive procedures were highly preferred by aesthetic patients. Facial protective masks are going to be part of our daily ensemble and patients will choose to combine minor eye-optimising surgeries with longer lasting and, of course, natural results. There is a new focus on injectables around the upper face to lighten, brighten and enhance the area around the eyes and upper face. The new hydration injectables for skin hydration and rejuvenation are also a popular choice in these times with many people still working from home and constantly on the computer with zoom and computer meetings, making a glow and a brighter appearances, sought after wishes. Natural and refreshed appearance are the terminologies preferred by patients versus a treated and overdone look.

Injectable treatments that will be most popular in 2021-2022: The two popular injectable treatments will be:

• Botulinum toxin injections: These are not new but the fact that they are so popular says a lot about their efficacy. This is an increasingly desirable treatment and with the mask-wearing we are now doing, there is a focus on the upper face, namely the forehead lines and the frown lines and crow’s feet around the eyes. Patients are constantly requesting that the results are as natural as possible, and that visible warmth and expression are preserved in their face. We are seeing a renewed interest in these treatments with patients seeking a refreshed look for their face.

• Dermal filler injections: Two popular indications will be tear trough and hydration fillers. There is a growing demand for tear trough fillers. The delicate under-eye area is difficult to treat and with all the stress and exhaustion of the past year and with the masks hiding our lower face, we are seeing an increased demand for information about treatments for tear troughs treatments. I counsel my patients that these treatments work well for under eye volume loss, but these treatments do not get rid off nor completely alleviate dark circles caused by pigmentation. Secondly, for hydration fillers, there are several new injections in the market for hydration of the skin with injectable dermal fillers. These treatments involve the targeted injection of hyaluronic acid into the skin, leaving the skin more hydrated, refreshed, and smooth. It is a relatively new treatment modality in the world of aesthetic medicine but it is becoming more and more popular and is a definite trend for 2021-2022.

Dr Narmada Matang Khatri

Dermatologist, Neo Skin Arsthrtics, Mumbai

Current response and market for injectable treatments in India: The pandemic has been a shocking reality. I have observed intense reactions from patients in terms of how injectables will be performed. They are seeking more in-depth information on the kind of injectable used along with details of the procedure. They need to be counselled with details on the product and the procedure. The market for injectables is going to grow. Patients are seeking one time visit procedures and are looking for long lasting results. This will drive the growth for injectables. Also, increasing options in injectables is a welcome change. The introduction of several players in the injectable product portfolio is giving us aesthetic physicians a great opportunity to customise the results for patients precisely. Patients have always been seeking a natural outcome from the procedures, especially with injectables.

Injectable treatments that will be most popular in 2021-2022: The two injectable treatments will be dermal fillers and PRP. Dermal fillers have come a long way in terms being injected for facial enhancement, volume loss and rejuvenation. The awareness and instant results of the procedure have made an impact on patients desires for seeking a youthful appearance. Today we have a range of dermal fillers to choose from, and so for the physicians too, this is a great opportunity to offer the best possible results for various kind of concerns. We can choose a dermal filler according to the type of skin we are dealing with. There is a choice for injecting superficial or deep, from countouring to volumising, and the products with a range of properties of HUA help us deliver the best results. The safety of these products has also been intensely researched. Further, PRP is becoming popular since it is your own biological product, and the results are satisfying for the patients. PRP for skin rejuvenation is preferred and more acceptable. PRP for hair is a service procedure that will grow in the coming years. Patients appreciate the results for fine lines open pores and talk about the glow they get as a result for face rejuvenation.

Dr Neetu Rajdeo

Cosmetic Dermatologist, Skinhance Clinic

Current response and market for injectable treatments in India: In the initial pandemic months, the market was slow. But this has picked up December 2020 onwards.

Injectable treatments that will be most popular in 2021-2022: The most popular indications will be tear trough – an eye filler required due to the increased use of gadgets – and fillers for hydration owing to increased stress and dehydration that has been caused due to the mask in areas of lips and chin.

There is a continuing rise in awareness and increasing acceptance of injectables in India due to the exposure to these treatments on social media.

Dr Rickson Pereira

Consultant Dermatologist and Head, Dr Rickson's Dermatherapie Clinic, Mumbai

Current response and market for injectable treatments in India: The injectables market is expected to grow rapidly following the lull due to the pandemic and its consequent restrictions on aesthetic procedures last year. There is a continuing rise in awareness of injectables and increasing acceptance in India due to the exposure of young Indians to these treatments on social media. Innovation and new launches of hyaluronic acid and botulinum toxin products in India will generate further interest among physicians and subsequently in patients to try these treatments.

Injectable treatments that will be most popular in 2021-2022: The introduction of two new HA filler brands Profhilo and Restylane Defyne has created curiosity among aesthetic physicians and could become popular this year. Profhilo is a non-cross-linked HA designed to improve skin texture, elasticity, hydration and tightness in the skin. Two sessions of treatment give long lasting results. Restylane Defyne is a new addition to the Restylane portfolio and is an HA dermal filler that is meant to restore volume and support tissue in areas of movement such as nasolabial folds and marionette lines. Aesthetic patients want natural looking and long-lasting results without surgery or downtime; both will deliver just that.

Dr Rinky Kapoor

Consultant Dermatologist, Cosmetic Dermatologist, The Esthetic Clinics - Mumbai, New Delhi, Kolkata, Bengaluru, Hyderabad, and Fortis Hospitals, Mumbai

Current response and market for injectable treatments in India: It has not been the year that we thought it would be and the new normal is now all about holistic wellness, a stronger immune system and beauty. Injectables such as botulinum toxin and dermal fillers have become increasingly popular alongside other non-surgical treatments such as laser skin resurfacing, microneedling, and RF methods for various reasons. The results of the stressful year are showing in our faces in different ways such as deepening groove lines, downward smiles, breakouts, maskne and a changed skin tone. There was a slump in the demand for these treatments in the initial phases of the lockdown, however, once work and interactions restarted virtually, the demand increased again. Procedures and treatments that address double chins, the wrinkles around eyes, mouth and neck and dark bags under the eyes are most in demand. A huge number of professionals are in meetings and communicate online, where the entire focus is on the face. Also, since most people are now at home, the work from home schedules allow them to manage the downtime, postprocedure, with ease, which was otherwise not possible for them with regular office schedules.

Injectable treatments that will be most popular in 2021-2022: Undoubtedly, they will be botulinum toxin and injectable dermal fillers. These two have been trending in the year 2020-21 and we expect to see the same trend to carry on with more gusto in 2021-22. Botulinum toxin is a popular neurotoxin that prevents the frown lines, crow’s feet, wrinkles, and lines of face from forming. Dermal fillers on the other hand are preferred for treating fine lines, and wrinkles and to restore volume to areas of the face such as forehead, cheeks, jaws, eyes, and lips. The most popular ones are hyaluronic acid dermal fillers. HA fillers rehydrate the skin and give an instant younger, rejuvenated and refreshed look on the face. Fillers and Botox are also popularly used for cheek and chin augmentation and add the perfect volume to the pout. Another modern use of fillers is in nonsurgical rhinoplasty, i.e., fillers are used to reshape the tip, size, and shape of the nose without having to go under the knife for nose surgery. Together these two injectables can be used to give a complete face lift for the perfect zoom face. In the days of adaptive video conferencing the demand of injectable fillers and botulinum toxin has increased.

Dr Shefali Trasi-Nerurkar

MD Skin, Consultant Dermatologist, Dr Trasi's Clinic & La Piel, Mumbai

Current response and market for injectable treatments in India: While the pandemic did impact the market response towards anti-ageing treatments such as injectables, as compared to what was expected, the enthusiasm about injectables has not vanished. There have been a group of patients who did not want to do injectables as they were not socialising much. Also, the masks were constantly being used covering most of their face. Financial constraints played a big role too. But the lockdown did give some patients time to learn about these injectables and they opted to doing it themselves. They understood the concept of self-care and skin care.

Injectable treatments that will be most popular in 2021-2022: The year 2021-2022 have bought in a new set of injectables with it. The Restylane brand has launched a new injectable named Restylane Defyne. This injectable will be used mainly to create a more youthful, natural looking appearance while helping one maintain natural expressions. It contains the innovative cross-linking hyaluronic acid technology to smooth out the deep laugh lines like the nasolabial and marionette folds. It can also be used to create a sharp jawline. The second injectable will gain popularity is Profhilo. Although launched in 2020, the lockdown prevented the use of this molecule in the Indian market. Profhilo is an injectable with bioremodelling properties. It contains a unique hyaluronic acid gel with prolonged stimulating activity on the dermal cells. This helps to counter the laxity and improve and restore the firmness of the skin. It stimulates collagen and elastin and attracts water in the deeper layers of the skin. Hence, this stimulation results in a significant tissue improvement with tightening and lifting effect. The most common areas of treatment are face, neck, decolletage, hands, arms, knees, and abdomen. The third injectable that has been gaining popularity since 2019 are the skinboosters such as Restylane Vital and Juvederm Volite. These two skinboosters though injectables are proving to be a hit amongst patients wanting a beautiful glowing, hydrated skin. They contain a unique form of stabilised hyaluronic acid to plump up the skin without any evident swelling. They can be used on the face, neck, decolletage and hands.

Dr Shubha M Kesari

Dermatologist and Cosmetic Dermatologist, Medical Director, Nypunya Aesthetic Clinic, Bengaluru

Current response and market for injectable treatments in India: In the pandemic scenario, though the demand for injectable treatments was initially low, it has now slowly started increasing. People who had initially withheld their regular top up of injectables are now returning eagerly.

Injectable treatments that will be most popular in 2021-2022: Wearing the mask is the new normal and this draws a lot of attention to the upper face. Our eyes and eyebrows are the defining features of our face. Unfortunately, the increased screen time has caused us all to look tired and lacking in sleep. Injecting into the lateral and mid-cheek area also helps in giving a smooth transition to the lid cheek junction in addition to lifting contouring and projecting the mid face. The tear trough and under eye hollowing can be effectively tackled by injecting fillers directly into this area. This is a challenging area to inject and must be done with the utmost caution and preferably with the cannula as it is a safer option. Tear trough is an anatomical feature encountered in many young people too and not essentially only a sign of ageing. Fillers injected for rejuvenation of the under-eye area have been and will continue to remain a popular treatment. Botulinum toxin treatment to smoothen the lines and wrinkles around eyes, on the forehead and the frown lines will continue to be popular. The chemical brow lift helps to achieve a nice perfectly arched brows that highlight the eyes, and will also be sought after.