A few years ago, a friend of mine discovered the joys of neurotoxin. “It’s as if I’ve had a really good facial,” she’d proclaimed, her forehead gleaming like freshly-Zambonied ice. At the time, I’d been a copywriter for Allergan, where I spent my days wordsmithing snazzy renditions of pre-approved, FDA-complaint language to promote Botox Cosmetic. Certain words, I quickly learned, were legal landmines—“skin” and “facial” among the most explosive.
From an FDA standpoint, Botox Cosmetic is entirely unrelated to skin (for its manufacturer to suggest otherwise could trigger compliance issues). Officially, it’s a “…prescription medicine that is injected into muscles…to temporarily improve the look of moderate to severe… lines…” It is injected, via syringe, deep beneath the skin, where it temporarily relaxes muscle contractions; contractions so tight, they’ve ‘stuck,’ if you will, after years of frowning, squinting, and knitting one’s brow. Botox Cosmetic—and others of its ilk (Xeomin, Dysport and Jeuveau)—temporarily block the nerve signals responsible for these contractions. Consequently, the muscles relax, in turn forming a smooth, unfurled canvas for the overlying skin.
When I first stumbled across the term “Skin Botox,” I’d assumed it was a misnomer; a term based on misconceptions of how neurotoxins actually work. Further research, however, exposed my own naïveté: Also known as a “Botox Facial,” “Microbotox,” or “Mesobotox,” “Skin Botox” is, in fact, its own thing—a treatment entirely separate from the FDA-approved indications with which I was so familiar. (For clarity, I’ll stick with “microtox” for the remainder of this piece.)
What Is Microtox?
According to Baton Rouge, LA dermatologist Ann Zedlitz, MD, microtox employs the FDA-approved neurotoxins we all know and love, albeit in a completely different format. Treatment goals differ, too: Whereas traditional ‘tox typically aims to soften glabellar lines, forehead furrows, and crow’s feet (by way of intramuscular injection deep beneath the skin), microtox aims to improve the skin itself. According Saddle Brook, NJ dermatologist Dr. Fredric Haberman, “Mesobotox is a new-generation technique that help[s] us deliver tiny amounts of Botox across the face and forehead.”
Microtox, Dr. Haberman explains, targets the dermis—the tissue just beneath the epidermis that comprises the visible skin. Whereas traditional neurotoxin treatments target specific, motion-rich areas, microtox is “ideal for treating large areas of the dermis,” he says.
Microtox entails injecting smaller aliquots of Botox at a higher dilution, “superficially into the skin,” Dr. Zedlitz shares. “The droplets are sprinkled very lightly all over the patient’s face,” she explains, “[which] allows the Botox to be ‘painted’ in a more even manner….[without] weaken[ing] the muscles of expression.”
How Is Microtox Administered?
While microtox may sound like Botox ‘Light,’ “This technique is very advanced,” Dr. Zedlitz cautions. The neurotoxin must be diluted appropriately, and the tiny droplets need to be administered at a consistent depth, just below the epidermis, in order to have the intended skin-centric effects. To do so typically requires a microchanneling, or microinjection, device. (Despite its phonetic proximity to “microneedling,” microchanneling is decidedly different in form and function: Whereas microneedling creates wounds in the skin to spur collagen production, microchanneling creates ultra-thin openings, i.e. ‘channels,’ as a means for delivering certain skin-care ingredients, medications, or biologics into the skin.)
Aquagold FineTouch, an FDA-cleared microchanneling device, is among the most commonly used for microtox. (The term “Aquagold Facial,” however, may or may not include neurotoxin: In addition to ‘tox, Aquagold can deliver microdoses of other substances, including hyaluronic acid fillers, vitamins, and growth factors—or a blend of ingredients—for a custom cocktail suited to specific skin goals.) Using sterile, 24K gold needles, each of which is thinner than a strand of human hair, Aquagold creates a series of evenly spaced skin openings, or channels. When used for microtox, Aquagold deposits neurotoxin into these openings at a consistent depth of 0.6 mm—just below the surface of the skin.
Covering the entire face can require thousands of tiny toxin deposits, and treatment takes approximately half an hour with minimal downtime or discomfort. Dr. Haberman says the skin undergoes a “shrink wrap effect [due to] refraction…almost immediately” post-treatment. Additional benefits may take a few days to appear, but the wait is well worth the other potential benefits.
What Are the Benefits of Microtox?
For one, microtox stifles excess sebum and sweat production—which, for oily skin types and people prone to pore congestion, could, ostensibly, mean fewer breakouts, notes Dr. Haberman. More research is needed as to how, exactly, microtox affects pore laxity and sebum production; many experts, however, believe it’s tied to blocking acetylcholine, a neurotransmitter responsible for sweat and oil production.
Secondly, microtox diminishes pore prominence, too, perhaps by affecting the teeny-tiny smooth muscles beneath the skin. (“Think of goosebumps,” Dr. Haberman analogizes.) Incidentally, microscopic pores are a key tenant of the elusive “glass skin” paradigm popularized by K-beauty. Microtox is rumored to be a go-to for many smooth-skinned Korean celebrities. Perhaps uncoincidentally, Aquagold received approval from Korea’s FDA equivalent in 2015, one year after the device hit the US markets.
Is Microtox FDA-Approved?
The FDA has not yet approved a specific neurotoxin for use with Aquagold or any other microtox delivery system. Interestingly, though, Aquavit Pharmaceuticals, the proprietor of Aquagold, has been quietly concocting its own neurotoxin (onabotulinumtoxinA), over the past few years. In March of 2022, the company officially submitted an Investigation New Drug (IND) package to the FDA for said toxin, dubbed DTX-021, which will be marketed as “Dermatox™” once it becomes available for commercial use. If approved, Dermatox will be the fifth neurotoxin with an FDA greenlight.
More interesting still: Aquavit plans to introduce yet another product—dubbed DTX-022—hot on the heels of, and in treatment-tandem with, Dermatox (DTX-011). Information on DTX-022 is currently limited—and, frankly, murky. What can be gleaned: DTX-022 is a microinjection device, it seems, designed specifically for microdosing the aforementioned toxin, Dermatox (DTX-011).
According to a press release, “DTX-022 features a novel route of administration (RoA) of DTX-021 utilizing Aquavit’s innovative microchannel delivery system.” Moreover, “With final approval of DTX-022, it will be the first-of-its-kind, world’s first FDA approved pan-facial microinjection of neurotoxins.”
The respective approval timelines for DTX-001 and DTX-002 remain unclear. Aquavit Pharmaceuticals did not reply to my emails inquiring about DTX-002 in relation to DTX-001. Inquiry with the FDA regarding potential timeline yielded the following response: “Per policy, the FDA cannot confirm, deny, or comment on any potential/pending applications.” Ergo, it seems we’ll have to wait and see whether an official, FDA-friendly rendition of so-called “Skin Botox”—er, “Skin Dermatox,”—is on the horizon. Oh—and “microtox” may itself become a misnomer, at least as it’s currently used. DTX-022 plans to snag the trademark for “Microtox™.”