LONDON, United Kingdom — It's midday on the fourth floor of Harvey Nichols, a luxury department store in London's Knightsbridge. A woman makes her way to the store's Beyond MediSpa to keep her Botox appointment. Forty-five minutes later she emerges from the clinic and heads to the restaurant to meet a friend for lunch. She is just 27 years old.

Dr Firas, a doctor who practices at the department store clinic, says he is used to seeing patients of her age. “Younger people are wanting to maintain their youthful looks, so it’s more [about] prevention,” he explains. “They’re going into the treatments more as preventative measures.” How young is young? “When it comes to lips, in their 20s, really. When we’re talking about Botox and rejuvenation, especially around the eyes, late 20s, early 30s.”

“It was quite interesting that with Botox and the injectables, people were so quick off the mark,” says Daniela Rinaldi, Harvey Nichol’s group commercial director. “The [MediSpa] business really kicked off from day one. The growth over the past 10 years [since the clinic opened] has been phenomenal.” Although she declined to give specific growth numbers, Rinaldi says this year alone, there has been a “significant double-digit increase.”

Millennial Demand

Indeed, the injectables landscape has changed significantly in recent years: treatments are becoming more sophisticated; prices are falling; beauty regimes are becoming increasingly complex; and the normalisation of cosmetic procedures — largely driven by celebrity culture and social media — has given rise to a new generation of young consumers for services ranging from muscle relaxers like Botox, to lip- and cheek-plumping fillers to non-surgical rhinoplasties.

According to a report by The American Society for Aesthetic Plastic Surgery (ASAPS), the growth of non-surgical cosmetic procedures is fast outpacing that of surgical ones. Injectable treatments alone rose 10 percent last year, with over 7 million procedures performed in the US alone. And while the 35-to-50-year-old demographic was the largest consumer of injectables, use among 19-to-35-year-olds rose by 30.7 percent. Intelligence provider Research and Markets expects the global facial injectables market to continue to grow at an annual rate of 10.4 percent between 2017 and 2023.

Dr Tijion Esho, a UK-based practitioner who specialises in non-surgical rejuvenation, sees this trend reflected at his practice, where injectable procedures make up about 70 percent of his business. “[It’s] almost like two tiers of patients,” he told BoF. “Generation X and then your millennial generation. And the millennial generation… I feel like they’re more forthcoming.”

A poll conducted at Dr Esho’s clinic showed one in three patients considered injectables as complementary to makeup. “In a way it’s now become part of many women’s routines,” he explains. “It’s becoming quite common place.”

Consumers today look at it like upkeep. They look at it like: 'I get my hair cut, why wouldn't I get my Botox?'

California-based dermatologist Dr Ava Shamban agrees with this shift in consumer attitudes. “There’s movement over to the millennials,” she says. “The millennials have watched the Kardashians, have watched these treatments done on a YouTube video, on Snapchat, on Instagram. And so they’re seeing that it’s not scary to be injected, they’re seeing good results. They look at it more along the lines of, ‘Oh, well I’m going to go and have my nails polished, and I’m going to have my hair cut and coloured and going to have my teeth whitened…’ and so it just flows into the same kind of thing. Like, ‘I don’t like the shape of my lips, or my cheekbones are a little flat.’ It’s part of an everyday routine.”

Seeing opportunity, doctors are now tailoring treatments to millennials. Dr Dara Liotta, a plastic surgeon on Manhattan's Upper East Side, created the LitLift, a trademarked procedure that combines Botox and fillers to mimic the popular makeup techniques of strobing and contouring, delivering patients with a selfie-ready complexion that can last up to two years.

“It basically evolved out of what I was seeing in my practice,” explains Dr Liotta, who notes that many of her patients have a significant social media presence. “People would tell me, ‘It’s ok when I’m in overhead lighting, but if I have a picture taken of me it just doesn’t look as good.’”

“The attitude [of consumers today] is more like they come in with their friends,” she continues. “And they look at it like upkeep. They look at it like: ‘I get my hair cut, why wouldn’t I get my Botox?’”

In addition, ASAPS data indicates that while under-18s only accounted for 0.4 percent of injectable procedures in America last year, the use among that age group increased 66.8 percent.

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Luxury Fashion Fillers

Ethics aside, there’s little doubt the adoption of injectables by younger consumers presents a significant opportunity for the traditional beauty industry. According to Bernstein analyst Ronny Gal, the current injectables market value is estimated at $3 billion. He sees “no reason that it will not get to $10 billion.” But a bridge between injectable procedures and beauty treatments is yet to be realised on a product level, as the market lacks consumer-facing brands.

The injectables landscape is relatively uncrowded when it comes to big players. Allergan — the original Botox manufacturer which also produces a range of popular hyaluronic acid dermal fillers under its Juvederm umbrella — dominates the global facial injectables market with more than a 45 percent share. Smaller players in the market include Ipsen, which produces Dysport, and Merz Pharma, which makes Xeomin.

Beauty conglomerates like L'Oréal, Coty, LVMH and Estée Lauder are yet to tap the potential opportunity in the multi-billion dollar injectables market. But they already hold beauty licences for some of fashion's biggest brand names, including YSL, Burberry and Tom Ford. Given that these organisations boast some of the most influential branding expertise in the consumer goods industry, they are arguably primed to instigate a branding revolution within the injectables market.

But can giants like Estée Lauder and Coty get in on the game? Can LVMH or L’Oréal add a consumer-friendly sheen to the growing injectables market?

There's a big difference between producing something that's legitimately safe over the counter from something legitimately safe as a medical device.

It would be lucrative move: Botox is a huge income driver for Allergan, making up almost 20 percent of the company's net revenue income in 2016; according to Bloomberg, Wall Street analysts forecast the drug to reach sales of $4.3 billion in 2022.

However, the evolution of injectables from pharmaceutical products to beauty products is not simple. One of the biggest barriers to market penetration is the complicated and costly nature of manufacturing a product from scratch that will be safe or reliable enough to rival the reputation of existing formulas.

“I’m sceptical of many new entrants to this market since the products are complex and regulatory trials to gain approval are expensive,” Morningstar analyst Michael Waterhouse told BoF, noting that Allergan’s market stronghold has proved hard to challenge in the past. “Competing products like Dysport and Xeomin have been on the market for a while, but Botox continues to hold high market share. More recent entrants have had a hard time gaining market share.”

“Many of these products will have to go through the ethical approval and through the research, and the scientific process to get the safety data,” agrees Harvey Nichols’ Dr Firas. “And that is usually not something that can be easily done unless as a manufacturer, as a company, you have that scientific background and that heritage.”

This is a hurdle to product manufacturing that Dr Esho encountered very recently after partnering with independent beauty company Deciem to launch a namesake product range. “Something we talked about was whether or not we look into the development of fillers, ” he explained. “There’s a big difference between producing something that’s legitimately safe over the counter [from something that is] legitimately safe as a medical device.”

The logistics of injectables are problematic though. As Botox and dermal fillers are medical products, they require a prescription and must be administered by a medical practitioner. “It gets tricky when we talk about line fillers, the hyaluronic acid products,” says Gal. “Those acquire a lot more finesse, and therefore a bit more training, a lot more experience.” In other words, the training and expertise of the practitioner administering a treatment is as important as the quality of the product itself.

“My feeling is that probably as a rule, aesthetic injections will remain tied to medical practices as opposed to broader consumer goods,” concludes Gal. “What you might end up seeing though is an availability of people who have medical training in this through high-end cosmetic outlets.”

Botox at the Beauty Spa

A branded service is something Dr Shamban is currently exploring. SKINxFIVE operates separately from her two existing practices in Los Angeles, offering a curated menu of five non-surgical procedures: specialised facials, peels, laser, radio frequency, and, of course, injectables. The setup is reminiscent of getting a blow-out at blow-dry bar.

“I started [SKINxFIVE] with the idea of providing curated dermatological services,” she says, noting that she is looking to partner with hotels and shopping centres to expand the venture.

Certainly, the use of a spa environment rather than a clinical one for non-surgical procedures helps bridge the gap between injectables and beauty, and necessitates the need for consumer-friendly branding. It is an aspect of the Harvey Nichols’ Beyond MediSpa that Dr Firas believes makes it as attractive to consumers as the procedures’ short recovery times. “They can come in, have their procedure done, have lunch, do a bit of shopping and then go back to work,” he says.

Customers can come to Harvey Nichols, have their procedure done, have lunch, do a bit of shopping and then go back to work.

Integrating Botox and dermal filler services into branded spa environments alongside massages and facials could provide luxury players with a more seamless segue into the injectables market. Already, leading fashion businesses have entered the spa market, albeit in a limited fashion: Chanel recently opened its very first spa at the Ritz Paris, while Dior has its Institut at the Hôtel Plaza Athénée. And while treatments currently adhere to a more traditional offering, consumer trends indicate that the gap between the spa and dermatologist's practice is closing fast.

Licensing also presents a route into the injectables space. Given the common practice of big name fashion brands licensing out the manufacture of sunglasses, fragrances and cosmetics, perhaps the most accessible opportunity lies in a partnership with Allergan, and not a rival product.

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