By John Helmer, Moscow
@bears_with
When Russia’s master icon painters depicted the male and female faces which are sacred in the Russian Orthodox Church, the noses were always columnar — a long, narrow bridge without curvature – ending in a pointed tip; the lips were exactly as wide as the nostrils on either side of the nose, and the lower lip was full. The cheeks were flat without the prominence of either zygomatic (cheek) bones or flesh. The eyes were always almond-shaped, open without hood (dermatochalasis). The lacrimal caruncle, the tiny circle of flesh in the corner of the eye, did not appear in icons until the seventeenth century.*
The forehead is usually wrinkle-free except that the Mother of God of Kazan displays a vertical line between and above the eyebrows. That glabellar or frown line isn’t from nature; it symbolizes different things, depending on the school of icon painters who painted her.
Realism in icons changes with time just as the secular standard of beauty does in the face. Rank and class, with the money to make plastic change and cosmetic repair, are eternal. Today, with more cash in their pockets, time to expose their skins to the sun on holiday, and the aspiration to rise in social class and display their mobility, Russian men and women are buying more botulinum toxin drugs than ever before. In the latest report this month, consumer spending and unit sales for these drugs are currently jumping by more than a third over the levels recorded a year ago; they have more than doubled since the war began in 2022.
Popularly known by the Botox brand name, these drugs are injected in time series to erase wrinkles in the muscular movement of the face, cause lips to pout, and lift hoods over the eyes. Botox is also used to stop excessive sweating, twitching, and drooling. These can be symptoms of post-traumatic stress syndrome among soldiers returning from the war fronts, but they aren’t the drivers of the Russian Botox boom.
This is not only a boom in consumption of the drugs on the faces of men and women. It is a boom for Russian pharmaceutical companies to replace French, South Korean, Chinese and other imports of Botox-type pharmaceutical drugs which have been blocked by sanctions: growth in sales for these Russian Botox makers has been jumping – over the past year, 46% and 63% for the two leading Botox substitutes, Relatox and Miotox. Also, these products pack three to four times more punch in every shot, or so the Russian marketers, experts and clinics selling cosmetic treatments and plastic surgery are claiming.
The Russian Botox comes to the people from the people; that’s to say the state. Relatox, first started in the market in 2014, is manufactured by Microgen, a subsidiary of the state conglomerate, Rostec. Miotox is produced by the Chumakov Scientific Research Institute of the Russian Academy of Sciences, a national leader for research in medical virology, manufacturer and marketer.
When Rostec’s chief executive, Sergei Chemezov, met President Vladimir Putin this month for their annual review of Rostec’s operations, Chemezov mentioned his group’s medical technology contributions to the war, including a new histological data scanner, bioelectric prosthetic devices, and “sponsored trips to health resorts”. The Kremlin communiqué doesn’t report whether they discussed the boom in Relatox. .
The face-saving claims, not to mention the adverse side effects and the spread of counterfeit drugs, are sensitive subjects which the experts are willing to discuss in the press. There are greater sensitivities, however. Nikolai Bespalov, an author of the latest Botox market report by RNC Pharma in Moscow, and Natalia Goltyakova, chief executive of the GMT Clinic, were asked what are the social class dynamics of the Botox boom, and what oligarch groups are active in the market in combination or competition with Rostec and Chumakov, but they refused to answer.
Source: http://rncph.com/news/26_09_2024 In the aggregate, here is RNC’s tabulation of sales of the top-15 Russian brand-name drugs, based on data collected by Roszdravnadzor, the state regulator for health care. Note that Botox volume and value don’t qualify for the Top-15.
In the three years since the war began, overall Russian pharmaceutical production in volume (red line) has been stable, while ruble sales revenues (blue line) have varied up and down with a modest overall increase. In this context, the Botox growth rates are exceptional.
It seems the Botox boom had started before the war, along with other pharmaceuticals in the broader market segment of cosmetic fillers and anti-aging treatments.
Source: http://rncph.com/news/11_09_2024_2
Pharmacologically, Botox is neither a filler (black column) although it can be used to generate fuller lips by relaxing the lip muscles; nor is it a biorevitalizer (orange) which works by stimulating the skin to produce substances like collagen and elastin, and improve hydration. Botox works neurologically by relaxing the facial muscles.
According to an RNC report of September 2024, “in the first half of 2024, the Russian retail market of beauty fillers and biorevitalization products was 10.9 billion rubles (retail prices, VAT included [equivalent to $117 million]), up 21% from January–June 2023. In physical terms, it was 2.2 million minimum dosage units (MDU), up 12% from the same period last year. At the same time, the total sales in 2023 were 18.5 billion rubles [$215 million], or 3.9 million MDUs, up 20% in monetary and up 27% in physical terms.”
“Fillers accounted for 62.6% of the sales in monetary terms, and biorevitalization and polylactic acid products accounted for the remaining 37.4%. In physical terms, it was slightly different; due to their high cost, fillers accounted for only 37% of the sales. The average price for a filler in the analyzed period was over 8,000 rubles [$86], three times that of a biorevitalization product, 2,600 rubles [$30]. The most expensive products are polylactic acid injections, with over 25,000 rubles [$2,690].”
Botox works differently on the face from dermal fillers and it is not a polylactic acid. So it is unclear whether the market for these other cosmetic products has boomed with the same growth acceleration as Botox. Sales volume in units and value in rubles for Botox and equivalent botulinum toxin drugs are incomplete: for the 10-month period sales doubled from Rb1.7 billion ($23 million) in 2021 to Rb3.4 billion rubles ($49 million] in 2022; in just the first three months of 2024 the sales totaled Rb2.2 billion ($24 million); in the same period of this year, the total was just over Rb3 billion ($36 million).
The concentration of the market in the wealthiest cities, Moscow and St Petersburg, is the same. “The sales differed greatly from region to region. For example, Moscow accounted for 35.8% of the sales of fillers and biorevitalization products, which is 3.8 billion rubles, or nearly 745,000 MDUs (33.6%). St. Petersburg ranked second with 9.4% (over 1 billion rubles in sales). Other regions were far behind; even Krasnodar Krai, which ranked third, accounted for only 4.2% of the sales (452.5 million rubles). In Moscow Oblast [excluding the city] the sales were 412.7 million rubles (3.8%). However, the sales in this region grew the fastest among the other top-10 regions; they went up 67% in monetary terms, while the sales in physical terms grew five times against January–June 2023.”
The principal supplier of Botox to the Russian market has been the Irish company Allergan which was taken over by AbbVie of the US in May 2020. Two years later, the American management announced it was pulling AbbVie out of Russia because of the war. In its annual report for 2022, AbbVie reported that its “operations in Russia, Belarus, and Ukraine are not significant.” This was not quite accurate.
The company’s financial reports indicate that its sales of cosmetic Botox to the international markets, including Europe and Asia, amount to 36% of its total sales. No breakdown for the international sales figure by country is reported. In 2021 sales of Botox (cosmetic) to the international market came to $808 million; in 2021, $961 million; in 2023, $1,012 million; and in 2024, $1,038 million. Inside these Europe-wide aggregates sales to Russia amounted to between 3% and 5%.
March 19, 2022 -- source: https://www.cbsnews.com/news/russia-ukraine-botox-maker-abbvie-suspends-operations/
Source: https://investors.abbvie.com/static-files/e3047152-75b3-44b3-95a8-18e4fa991768
After initial development at the Ufa branch of the Microgen company in 2001, and trials over the next decade, commercial marketing of Relatox began in 2014. By 2015 its Russian market share was 6%. Chumakov’s Miotox followed into the market in 2019. By 2020 nine competing brand-name botulinum toxin type A-hemagglutinin (BTA) products had been certified by Russian regulators for sale. By then Miotox had lost a $600 million patent licensing dispute with Allergan over medical application of Botox.
A survey of cosmetologists across the country in 2020-21 reported Russian consumers were already opting for the domestic brand-names in preference to imported Botox. The survey also confirmed the efficacy and safety of the homemade products. “The maximum effect of Miotox® administration in participants with interbrow wrinkles was observed after 14–21 days for all parameters (total size, depth and width); the total size of wrinkles in the interbrow decreased by 65%, on the forehead – by 79%, wrinkle depth – by 58% and 69%, respectively. Despite the decrease in the effect after 150 days after the drug application, the effect of the drug administration remained: the total size of wrinkles in the interbrow decreased by 25%, on the forehead – by 19%, wrinkle depth – by 25% and 26%, respectively, wrinkle width – by 3% and 1%, respectively. Conclusion. The findings confirm the good tolerability, efficacy, and a high safety profile of Miotox® in patients with hyperkinetic (facial) wrinkles.”
Allergan (AbbVie) held on to its Russian market share for Botox until its March 2022 announcement of war sanctions pull-out. “Naturally, consumers started looking for alternatives, and fortunately there were enough such alternatives on the market, including Russian–made ones,” explained a Moscow newspaper report. “This led to a gradual shift of consumers to domestic products. Although the French drug Dysport is still the leader of the Russian market in terms of sales, its peculiarity must be taken into account: to achieve an effect comparable to Botox, it requires the introduction of more units of the drug (3-4 units of Dysport versus one unit of Botox), which makes its use less convenient and more expensive. Russian pharmaceutical companies are developing this area by investing not only in the marketing promotion of their products, but also in conducting full-fledged clinical trials confirming the claimed characteristics of the drugs. The combination of these factors – competitive prices, guaranteed quality and a comprehensive marketing strategy – contributes to a steady increase in demand for domestic BTA drugs.”
A US cosmetic surgeon discusses the evidence for Botox use by President Putin in March 2022. Analysis of the faces of many heads of state and of government have reported Botox use by US House Speaker Pelosi, Italian Prime Minister Berlusconi, Brazilian President Rousseff, Argentine President Kirchner, and North Korean head of state Kim Jong Un. In President Trump’s circle, here is a list of Mar-a-Lago faces.
Until the war, the dominant Botox-type drugs in the Russian market were Dysport of France, Botox of the US, and Xeomin of Germany. China then introduced its Lantox and South Korea, Novacutan. Domestic Russian pharmaceutical groups promoted these foreign brands through patent-licensing and distribution agreements until these were halted by sanctions.
“Traditionally, foreign drugs – Botox, Dysport, and Xeomin – have been considered the standard of quality and safety which has been facilitated by numerous clinical trials,” Vedomosti reported industry sources saying earlier this month. “The Chinese Lantox and Russian analogues Relatox and Miotox are more affordable with constantly improving quality. The choice of a specialist depends on personal experience with a particular drug, data on its effectiveness and safety, the cost of treatment, as well as the availability of the necessary certificates and licenses…Patients are more often guided by the price factor and the recommendations of a cosmetologist. Recently, domestic drugs have become increasingly in demand, but foreign drugs retain the status of the ‘gold standard’ due to their long-standing reputation and extensive evidence base.”
THE MAIN BOTOX-TYPE BRANDS IN THE RUSSIAN COSMETIC MARKET
“Lantox has long been known on the Russian market, but it has never occupied a significant market share due to ‘a number of shortcomings,’ reports Yulia Frangulova, co-founder of the National Association of Aesthetic Medicine Clinics self-regulatory organization and chief executive of the Linline clinic network. She has not specified what disadvantages she was talking about. According to Frangulova, the drug can take a significant share in Russia ‘only through dumping.’” This research report by Chinese researchers covering most trials of the drug was published in 2021.
As they undercut the foreign imports for price and match them for quality and safety, the profitability of Relatox and Miotox has also spawned a grey market in counterfeit foreign imports and domestic knock-offs. “The grey market is in ecstasy”, reported a health industry publication already in 2022. “The growth of the illegal cosmetology market was there before, but in the new economic conditions it has literally got a ‘second wind’. While the professional clinics have had to raise prices, and the solvency of the population has decreased, self-taught cosmetologists get cheap (and non-certified) drugs and they work from home, and therefore save on rent.”
[*] On July 13, it will be two years since the sudden death of Tatiana Vasilievna Turitsyna, my beloved wife. Her face was perfect. Born and raised under the Siberian sun, she survived the darkness of the Yeltsin time, and then the sun which has burned since then. Her face refused to grow old.
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