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Treatment melts double chins away

David Tedham isn’t, in the parlance of the multibillion-dollar global cosmetic industry, a “cosmetic contemplator.” He’s unfussy about appearance; his skin-care regimen is bare-bones.
Dr. Shannon Humphrey prepares Janet McRoberts for treatment with Belkyra, a drug that breaks down fat cells under the chin, at her Vancouver clinic.

David Tedham isn’t, in the parlance of the multibillion-dollar global cosmetic industry, a “cosmetic contemplator.”

He’s unfussy about appearance; his skin-care regimen is bare-bones. The only time the 58-year-old had visited a dermatologist was to get sun spots checked out.

But one thing bothered Tedham: a double chin he’s had since he was a kid. It was an annoying feature, but not so much that he’d resort to surgery, he said.

But when he learned about a new injectable drug called Belkyra that promises to melt away chin fat, he didn’t hesitate. “You go in and out and you’re done,” said Tedham, who had the procedure at Vancouver cosmetic dermatology clinic Carruthers & Humphrey in December.

“You have some swelling for the day, so what?”

Belkyra is the latest option in the growing lunchtime lift market. And Vancouver-based Dr. Jean Carruthers, whose discovery of the cosmetic use of botulinum toxin A has become legend, believes it could be the next Botox.

“It’s a question of being so convenient and so effective and safe,” said Carruthers. “That’s really what makes people want to do it.”

Belkyra, which received approvals from Health Canada and the U.S. Food and Drug Administration last year, targets submental fullness, also known as the dreaded double chin.

Its crucial ingredient is deoxycholic acid, a naturally occurring molecule identical to the ones produced in the gallbladder that aid in the digestion and absorption of fat.

Upon injection into the fat under the chin, the drug breaks fat cells open. Once destroyed, the cells can no longer accumulate fat.

“Even if (patients) go on a Ben & Jerry’s spree afterwards, it’s not going to come back,” said Carruthers.

The clinic has performed about 40 procedures since January, and both Carruthers and her colleague Dr. Shannon Humphrey expect the number to grow — especially after last week’s formal launch by pharmaceutical powerhouse Allergan, which acquired Belkyra manufacturer Kythera Biopharmaceuticals for $2.1 billion last fall.

“Fat reduction has always been one of the holy grails of cosmetic treatments,” said Humphrey, the clinic’s medical director. “Belkyra is really the first injectable that can dissolve fat in a localized way.”

Cosmetic medicine has given the world Botox for wrinkles on the upper face and fillers for the lower face. But the chin and jawline have largely been neglected — mostly because of a lack of viable treatment — even though surveys indicate people are as concerned about the chin and jaw area as they are about wrinkles and crow’s feet.

“We haven’t spent much time talking about it until we have the treatment for it,” said Humphrey, 37. “Medicine sometimes works that way. It turns a blind eye if it can’t solve the problem.”

Belkyra also puts Vancouver on the forefront of cosmetic dermatology. The 67-year-old Carruthers was involved in clinical trials for the drug, while Humphrey, as lead investigator for its phase III clinical trials, was instrumental in bringing it to market and in training physicians around the world on how to administer it.

Combined, the two doctors have completed the largest body of research on Belkyra.

Treatment starts at $1,500, depending on dosage. Most patients will need two to four treatments. Side effects include swelling, bruising, pain and numbness.

Belkyra’s relative ease of use and lack of down time are major selling points, but Humphrey stressed it should only be administered by medical professionals. Botched Belkyra could result in nerve injury, an asymmetrical smile, muscle weakness or ulcers and skin sores.

Like Botox, which has since been approved to treat other conditions such as migraines and hyperhidrosis, or excessive underarm sweating, Belkyra could have other uses in the future, said Humphrey.

Clinical studies have already found Belkyra contributes to the creation of new collagen, which correlates to tightening of the skin. And while Belkyra is currently approved only for use in the chin area, there will likely be studies looking at targeted use on other fatty sites on the body.

Demand in the U.S., where it’s marketed as Kybella and has been available since June, has been high, with media reports of wait lists.

The arrival of Belkyra is expected to boost overall demand for minimally invasive cosmetic procedures.

Canada does not track figures for cosmetic procedures, but Canadian trends generally mirror those in the U.S., where there has been a clear shift in the type of cosmetic procedures in demand over the last decade.

Figures from the American Society of Plastic Surgeons, which represents more than 7,000 surgeons in the U.S. and Canada, found the number of face lifts performed last year dropped six per cent. It was also the first time since 2000 that the cosmetic surgery mainstay dropped out of the top five.

Overall, data shows surgical procedures have decreased by 10 per cent between 2000 and 2015 — but minimally invasive procedures soared by 158 per cent over the same time period.

Andrea Polonijo, a PhD candidate and sociology instructor at the University of B.C., said the stigma surrounding cosmetic enhancements has faded over the years as procedures have become more widespread.

“It’s presented as an acceptable choice for women,” she said. “It’s no longer this person with high body dissatisfaction that surgery promises to help. It’s also for people who want to enhance their appearance to its highest potential.”

There’s no question, however, that cosmetic surgery and images in mass media redefine our notions of beauty.

“When you’re looking at magazines and advertisements, all these models are airbrushed and photoshopped,” said Polonijo.

“These are things women are looking to achieve in themselves that are often unattainable. You can’t walk around being airbrushed all the time, so these procedures take the place of that.”


How a Vancouver doctor began the Botox revolution

Vancouver’s Dr. Jean Carruthers, a pediatric ophthalmologist, discovered the cosmetic use of botulinum toxin A — now known as Botox — while searching for a way to treat patients suffering from blepharospasm, uncontrollable and often painful muscle spasms around the eyes.

She first became interested in the substance, then called oculinum, after learning about the work of Dr. Allan Scott, a California-based doctor who had conducted a seminal study on blepharospasm treatments. Scott’s research involved injecting macaque monkeys with four poisonous substances: alcohol, cobra venom, nerve gas and botulinum toxin A. Most of the monkeys died or suffered infections. The exceptions were the monkeys injected with small amounts of botulinum toxin. Those monkeys simply experienced a change in their eye alignment.

In 1982, Carruthers applied to bring oculinum to Canada to treat patients suffering from blepharospasms. She received the green light from Health Canada in 1983.

One day, one of her blepharospasm patients became angry with her, saying, “You didn’t treat me here,” pointing to the furrow between her brows. Carruthers explained that she hadn’t injected the patient in that spot because she wasn’t experiencing spasms there.

“But whenever you do it there,” said the patient, “I get this beautiful, untroubled expression.”

That night, during dinner, Carruthers told the story to her husband, dermatologist Alistair Carruthers, who had been trying to treat patients with deep frown lines. He had been using fillers and collagen, with little success.

“You know that frown-line problem you have? I think I got the answer,” she told him.

The discovery didn’t make the Carrutherses rich. They didn’t patent the treatment and are unable to reap the financial rewards of its widespread use.

They consulted law firms in Vancouver and Toronto but were told Botox was unpatentable because it’s not much different from blespharospasm treatment.

“Knowing what I do now, I would have gone to a law firm in a large city in the States and I would have insisted,” said Carruthers.

Today, Botox treatment, which was patented by pharma giant Allergan, is the most popular cosmetic procedure performed, with more than 6.7 million procedures worldwide in 2015.

Any regrets? Sure, Carruthers regrets not being a “multi-gazillonnaire,” she said with a laugh, but the what-ifs don’t keep her up at night.

The discovery shifted the couple’s focus to cosmetic medicine. Carruthers went on to patent the use of Botox for lines around the mouth and sold it to Allergan. Alistair Carruthers has officially retired from their practice, but remains active in research.

“We’ve had so much positivity and great results and a wonderful, full practice as a result of starting this revolution,” said Carruthers.

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