Meet REX, a Longer-Lasting Alternative to Botox?

GFX may smooth wrinkles for up to 18 months — if you can find someone to do it.

Resisting the march of time
PeopleImages/Getty Images

There is a Botox alternative for people who want to reduce or eliminate frown lines. It is called Relaxed Expressions (REX for short) and its wrinkle smoothing effects last up to 18 months. Also known as GFX or NoTox, this radiofrequency based procedure is not widely available.

Unlike Botox, no poison is injected into the face. GFX, which stands for glabellar frown relaxation, uses targeted bipolar radiofrequency energy to weaken (via heat-induced injury) the motor nerves which connect to the forehead muscles responsible for frowning.

The radiofrequency (RF) used in REX differs from that used in other cosmetic treatments like Thermage in that it is a lower “dose” of the RF energy and is more targeted due to its method of delivery—a small needle-like probe delivers the energy underneath the skin rather than through the skin.

Botox vs. REX

When it comes to Botox, it's proven to be easy, effective, and pretty much safe. So if something other filler or procedure wants to topple it from its wrinkle filling perch, it has big shoes to fill. REX is trying to do that.

When compared to Botox, the results of REX last longer, an average of 12 to 18 months as compared to Botox’s average of 3 months. Fewer appointments equal lower cost, right? Not necessarily, since it tends to be more expensive than Botox.

Another thing to consider about REX's lasting results: If you don’t like the procedure's outcome, you'll have to wait for its effects wear off.

In fact, some cosmetic specialists have raised a concern over the possibility of permanent nerve damage and/or muscle atrophy, although no incidence of this has been reported so far.

Other things that REX has going for it, are that it creates a more natural look than Botox, with less risk of brow ptosis, and is effective even on patients who have developed a resistance to Botox.

Lastly, REX is more invasive and more specialized than Botox, though less so than than surgical Botox alternatives, making it appealing to those for whom Botox is not an option. 

Who Should Get REX

According to the makers of REX, the procedure can benefit anyone who wishes to lessen the appearance of the vertical frown lines between the brows without the use of an injected toxin. In addition, the procedure can provide a moderate lifting effect to the brow. It is questionable whether that FDA-approved it for treatment of frown lines, it also may be used to reduce lines in other areas, such as horizontal forehead creases and crows feet.

As with any cosmetic procedure, realistic expectations are key. The procedure should not be performed on pregnant women.

Safety Information and FDA Approval 

The technology used by the REX system is FDA-approved for medical use, and has been used safely to treat patients with cardiac and other conditions for more than a decade. Cosmetic use of the system began in the mid-2000s and whether the FDA cleared REX for cosmetic use to treat frown lines is unclear, though there are reports that it has.

To date, no significant adverse effects have been reported. However, the maker of the GFX machine, Bioform Medical, is no longer in business.

Anesthesia and Pain Management

Local anesthesia and regional nerve blocks are administered prior to the procedure to make it more comfortable. Most people find this adequate; however, some doctors may also give you oral or intravenous sedatives to help you relax before the procedure. Oral acetaminophen may be taken for the first 24 hours following the procedure to lessen any discomfort.

The REX Procedure

The procedure is completed in two phases. In the first phase, the REX needle probe is inserted underneath the skin in two specific sites on each side of the face: one near the nose, and the other near the temple. The correct nerves are then precisely located by the doctor through a painless process of electrical stimulation which causes the targeted nerves to send impulses which cause the “frown” muscles to contract.

Once the nerves have been located, a precisely controlled dose of radiofrequency energy is applied for approximately 10 seconds. This process is repeated in several spots along the targeted nerve for maximum effectiveness. Then the entire sequence is repeated at each insertion site. The entire procedure takes about 15-30 minutes.

Once the nerves are disabled, the patient is no longer able to draw the eyebrows down into a scowl. Thereby, the vertical lines between the brows are therefore significantly diminished. According to New York dermatologist and aesthetic surgeon, Neil Sadick, MD, the results he has seen in his practice are aesthetically comparable to those of Botox, and his patients appreciate the longer duration of the procedure's effects.

Recovery and Downtime

After your procedure, cool compresses are applied to the insertion sites and treated areas. Your doctor will instruct you to sleep with your head above the level of your heart for the first night after the procedure.

The most common problems in recovery are localized swelling, redness and bruising. These are usually mild and of short duration.

In most cases, you can return to work immediately after the procedure, although you may be wearing small band-aids over the puncture sites for the first 24 hours. If you don’t want to spend your day explaining the band-aids (and possible redness and swelling), it might be a good idea to take a day off.

REX Costs

Fees vary from $1,500 to $3,000 for a treatment of the frown lines. As with many other cosmetic procedures, geographic location is a factor in pricing. Treatment of additional areas may cost more. Compared to Botox, at first glance it seems quite expensive. However, the duration of the effects may make it worth the extra cash, since Botox wears off within 3 to 4 months, whereas the effects of the REX procedure have been reported to last 12 to 18 months or more.

Important Note:

It must be noted here that most of the available data on this procedure has come from two of the few doctors who are currently using this technology, as well as from Bioform Medical, the company that makes REX. Long-term studies are still in progress, so although the procedure shows promise, patients considering it should proceed with caution until more data is available.

See REX before and after photos.

Sources:

Kim JH, Jeong JW, Son D, Han K, Lee SY, Choi TH, Chang DW. Percutaneous selective radiofrequency nerve ablation for glabellar frown lines. Aesthet Surg J. 2011 Sep;31(7):747-55. doi: 10.1177/1090820X11416807.

Technology Brief, GFX Nerve Ablation System (Glabellar Furrow Relaxation), American Society of Plastic Surgeons.

Interview with Neil Sadick, MD, New York, NY, MD; conducted on September 17, 2008.

Physician Information Sheet, Bioform Medical, Inc., San Mateo, Calif., 2008.

Press Release, Bioform Medical, Inc., San Mateo, Calif., April 30, 2008.

Radiofrequency Ablation of the Nerve to the Corrugator Muscle for Elimination of Glabellar Furrowing; Utley and Goode, Archives of Facial and Plastic Surgery 1999; Volume 1, pages 46-48.

Radiofrequency Energy for Denervation of Selected Facial Muscles: Clinical Experience; James Newman, MD; San Mateo, California; (White Paper for “Relaxed Expressions” Technology), BioForm Medical, Inc., 2008.

Continue Reading