Sponsored by Ultimate Contour

Ultimate Contour from Ideal Curves LLC (Lehi, Utah) merges a uniquely delivered low-intensity, low-frequency focused ultrasound with radiofrequency (RF) to disrupt localized fat and smooth overlying tissue, giving aesthetic physicians the ability to deliver instantly visible results that bring patients back for more. This consumable-free device shifts the current standard for traditional body shaping devices to a new realm, providing substantial return on investment (ROI) as well as results.

As the brainchild of John Meadors, DC, the idea for Ultimate Contour was planted in 2003 but did not germinate until 2013. After an exhaustive search for engineers with the vision to bring the idea to fruition, and rigorous FDA trials, Ultimate Contour was born.

“This is a great device for any dermatologist who wants to enter or build a presence in the body sculpting space,” said dermatologist Wendy Roberts, MD, who practices in Rancho Mirage, Calif. “Ultimate Contour is a great entry-level machine because the unit is small and on wheels, it is painless, easy and safe to use, and works well. It does what they say it will do. We haven’t seen major complications so far. The device is affordable, treatment is affordable for patients, you get noticeable results immediately and patients want more. If you have any kind of aesthetic practice, it is almost mandatory you have something for body shaping, and this is perfect for that.”

“To me, the most important thing about Ultimate Contour is that people are losing inches quickly and safely,” reported Michael Gold, MD, the founder and medical director of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center and Tennessee Clinical Research Center in Nashville, Tenn. “In an industry where you have to be careful about claims, this device is doing what they claim it does, safely. In my many years, I have seen technologies come and go because they simply didn’t live up to the hype. The bottom line is that Ultimate Contour works well and quickly, which is important in this space because these days patients want results fast.”

“The two unique aspects of this technology that I noticed outside of safety and efficacy, which will be very appealing to physicians, are the treatment comfort and lack of consumables,” explained Barry DiBernardo, MD, founder of New Jersey Plastic Surgery in Montclair, N.J. “Early technologies based mostly on ultrasound were not as comfortable, and Ultimate Contour is very comfortable in comparison. Secondly, we have no consumables, so we don’t need to pay a substantial cost every time we treat patients. The device itself is reasonably priced, but regardless, the cost of consumables on top of any capital outlay will cut deeply into your ROI, so lack of consumables is important for tracking practice profits.”

“This is another evolution of ultrasound for fat,” emphasized plastic surgeon Jason Pozner, MD, owner of Sanctuary Plastic Surgery (Boca Raton, Fla.). Dr. Pozner has been part of numerous FDA clinical trials, some with ultrasound modalities. “The early devices for tightening and fat reduction did produce results but were often associated with significant discomfort. Ultimate Contour does not have that discomfort, it is safe and seems to work well, and there are no disposables so the financial picture will be much more favorable. Also, we have not seen paradoxical hyperplasia or other adverse events that have been an issue for existing technologies for fat.”

Another physician with longtime involvement in the space is dermatologist and cosmetic laser surgeon Mark Taylor, MD, founder and medical director of Gateway Aesthetic Institute and Laser Center (Salt Lake City, Utah). “Early ultrasound devices were extremely painful; my staff really didn’t like using them because of the discomfort to patients, the cumbersome nature of the treatment and the mixed results. They absolutely love Ultimate Contour because the patients love it, and treatment is much easier to perform. I’ve owned every device ever made and the Ultimate Contour is the only device I highly recommend for body contouring,” he explained.

Coupling the strengths of its high-intensity ultrasound and RF modalities to disrupt fat and tighten skin, Ultimate Contour delivers a one-two punch against unwanted adiposity that is painless and without consumables. The low-frequency (40 KHz) ultrasound component – unique in the space – causes immediate lipolysis of underlying fat in the treatment area by sending disruptive vibrations that devastate the structural integrity of fat cells. Voids and pockets are created to further stress adipocytes to rupture. Resultant free-floating fatty acids and cellular debris are then eliminated via the body’s natural mechanisms. According to Dr. Taylor, the power and megahertz are what separate ultrasound devices. “Ultimate Contour’s unique combination of frequency and energy work together in the right way to shake the fat cells apart.”

RF delivers uniform deep-tissue heating at the deeper, collagen-rich skin layers to induce collagen contraction as well as promote neocollagenesis and neoelastinogenesis. Treatment is likened to a gentle hot-stone massage and lasts 10 to 15 minutes per zone. Beyond the abdomen, the RF component is also commonly employed to tighten arms, thighs and knees; both modalities can be used individually, but maximum results require both ultrasound and RF components with repeated sessions. A typical course of Ultimate Contour therapy is four to six sessions at one-week intervals.

Typical treatment with Ultimate Contour begins with visualizing four abdominal quadrants, each its own treatment zone (roughly the size of a half sheet of paper, according to Dr. DiBernardo). Ultrasound lotion is applied for lubrication and contact purposes, which also contributes to optimal energy absorption.

The user applies the handpiece to the lotioned area and works across as energy is applied, requiring about 20 to 40 minutes per zone depending on total surface area, usually related to BMI. Redness is typical but not persistent past a few hours and most patients report no pain. There is no downtime associated with Ultimate Contour. “This device glides easily over the treatment area so you can do four reasonably-sized areas in a typical 40-minute session,” Dr. Taylor continued. After treatment with the ultrasound component, patients can immediately resume daily activities, including workouts.

Remarkably, patients notice immediate circumference reduction after a single session, up to a full inch. As the body recovers and its natural waste removal and metabolic processes do their work, the full result typically manifests over a period of six to eight weeks from the initial treatment. Remodeling and growth of collagen and elastin also take time; skin tightening and cellulite improvement will occur gradually over a period no less than four weeks.

Rapid results are a huge hit with the Beverly Hills crowd, according to Ava Shamban, MD, director of Ava MD (Beverly Hills, Calif.). “The typical patient in Beverly Hills is not high-BMI, but everybody must look perfect or has some high-profile event to attend. With Ultimate Contour, you get those on-the-table results plus what happens over the next several weeks, and patients are over the moon about it,” she expressed.

“When we are treating people, we have to be careful to explain how the results will look, and the timeline,” Dr. Gold explained. “It will take weeks and weeks to see the full result, and four to six treatments. This has been true for a long time. With Ultimate Contour, the full result still manifests over that length of time, but the instant results require no explanation. They encourage trust and compliance, especially when you consider that the treatment is comfortable, so the patient not only comes back to complete a course of treatment, they tell their friends – or better yet, their friends ask them what they have been doing.”

“I was hesitant to adopt previous body shaping technologies,” Dr. Roberts shared. “With my pathology background, I thought that there may be inherent challenges associated with treatment, some of which did surface. I felt the opposite when Dr. Meadors showed me Ultimate Contour because it was safe and easy to operate, and, in my opinion, it delivered well beyond the promises, which is not as common in this business as we would like it to be. It is safe and it works, what more can you ask for?”

“I must admit I was skeptical at first,” Dr. Gold related, “and we don’t fully understand why it works so well, but their proprietary ultrasound and RF combination has obvious synergy because the results are real, and the patient satisfaction is real. I have told myself it simply should not work as well as it does, but I cannot argue with the results.”

Researchers such as Dr. DiBernardo have shed some light. “We treated ten patients in a preliminary analysis of the device,” Dr. DiBernardo began, “with four sessions at one-week intervals; treatment times ranging between about 30 to 50 minutes depending on the size of the areas treated. We used FLIR infrared imaging to monitor heat and saw no excess heat, which is probably a contributing factor to the high relative comfort of treatment. Also, any major adverse events were absent at this point.”

Dr. DiBernardo said that according to ex vivo histology work done by Christopher Robb, MD (Spring Hill, Tenn.), there was a remarkable effect on the fatty tissue in the treatment zone. “Dr. Robb referred to it as the fatty tissue being ‘shredded.’ They were physically broken apart. I believe that is why we are seeing an effect right away. Speculation is that the larger ultrasonic waves are creating a physical disruption to the fat cell wall and total destruction of the fat cell. If you think about the waveform at 40 KHz, you are creating physical damage to fat cells. For more insight, we treated another specimen and looked at it at five-, ten-, and 15-minute treatment points with concomitant scanning electron microscopy at 10,000x magnification; serial images showed increasingly broken cells, providing further physical evidence of what is happening at the cellular level. We hope to do further multi-center studies to gain more insight into this promising technology.”

As-yet-unpublished FDA trials seem to agree. An investigation led by Thomas Sutton, MD (Lincoln, Neb.), treated about 50 patients for three sessions over a nine-day period; patients lost an average of 3.12 inches. A trial by Kirk Moore, MD (Midvale, Utah) revealed an average 2.0 inches lost by patients (N=50) after three once-per-week treatments, measured at 12 weeks out.

Ultimate Contour is also FDA cleared for the temporary reduction of the appearance of cellulite. Among many contributing factors to cellulite are body-fat percentage, skin thickness and quality, age, and that old culprit, genetics. “Cellulite is multifactorial, and, as everyone knows, we do not have a cure for it. However, we can treat it successfully with Ultimate Contour,” said Dr. Gold. “The keys are compliance, which you get in spades with Ultimate Contour, and maintenance, which is especially important with cellulite.” While not a permanent solution, the effects of treatment – localized fat reduction, skin tightening, improvements in elasticity and thickness, and enhanced local microcirculation – can dramatically affect the appearance of cellulite with time. “But again, the synergy between the proprietary ultrasound and RF of Ultimate Contour gives those immediate results. Theoretically, you get fat disruption from the ultrasound and some improvement in skin tightening and quality from the RF, which also helps the appearance of cellulite,” Dr. Gold added.

Adopting the device is a breeze. “As far as medical aesthetic devices go, this is one of the easiest to use, as well as very easy to teach and implement into your practice,” Dr. Pozner emphasized, “so you can delegate this treatment to staff. It depends on state and local regulations, but ultrasound devices are not as heavily regulated in most places as laser- or light-based therapies because those require much more training to use safely. Staff acceptance is quite high due to ease of use and time of the procedure.”

With any body shaping technology, ideal candidates are fairly slim and healthy, simply looking for something to help them achieve what they have not been able to from their efforts at the gym or the dinner table. However, Ultimate Contour’s low-frequency ultrasound is FDA cleared for abdominal circumference reduction in candidates with a BMI of 25 or greater, so somewhat heavier patients can benefit. “Ideal patients would be the low-hanging fruit – people with specific bulges or troublesome areas they want reduced, which have proven resistant to diet and exercise,” Dr. Pozner indicated. “It is also a valid post-liposuction adjunct to push those results to the next level.”

Dr. Taylor agreed. “Good candidates have localized pooches of fat that they just cannot get rid of at the gym or in the kitchen, and they just need a little shaping, typically around the abdomen, the love handles, perhaps the axilla or saddlebags,” he explained. “You can treat higher-BMI patients, but you have to manage expectations and get results that you are both going to be happy with, so one must be very careful treating heavier patients. That is true for any treatment, including liposuction, which is capable of treating individuals with a larger BMI.”

According to Dr. Shamban, safety and ease-of-use are key in an aesthetic climate more inclusive than ever to what are referred to as non-core physicians (not dermatologists or plastic surgeons). “As the aesthetic industry embraces the non-core physician, we are looking at two realities: the benefit of how they expand the industry, and the potential harm they can cause if patients are unsatisfied – or worse, get hurt. Claims of ‘easy to do’ can promote complacency. This device bypasses all that. Ultimate Contour is easy to use safely and will give you great results consistently with basic training. I mean, I just had my arms treated, and they look like they are airbrushed. Also, no consumables means that pricing is not complicated; it can be based entirely on what your regional market will bear above your simple overhead.”

As with all aesthetic contouring devices, Ultimate Contour is not a weight-loss solution meant to replace diet, exercise and other aspects of a healthy lifestyle. However, according to Dr. Roberts, it is the perfect stepping stone to lifestyle improvements because the results are so motivating.

“As a physician, I want to positively impact the health and wellbeing of my patients as much as possible, so I always suggest changes in lifestyle components such as diet and exercise. We can get results with Ultimate Contour without lifestyle changes, but as with any body contouring treatment, a closer-to-optimal lifestyle leads to closer-to-optimal outcomes that last longer,” Dr. Roberts expressed. “The immediate and longer-term results are so motivating, we would be missing an opportunity if we didn’t share that information with patients. Maintenance treatments are always important as well, of course, but Ultimate Contour motivated me to push harder with my own diet, hydration and exercise, and I am always eager to share the good news with my patients. I offer body composition scales and nutritional programs to support any patient who wants more, and with Ultimate Contour it is that much easier.”

Sponsored by RegenLab USA

Use of platelet-rich plasma (PRP) in aesthetic practices has become more widespread, safer and less wasteful thanks to innovative devices and advanced injection techniques, according to dermatologist Janine Hopkins, MD, of Hopkins Dermatology (Monroe, La., and Southlake, Texas).

Controlling PRP Application, Eliminating Waste
Dr. Hopkins uses the CuraCator^TM device (Trinnovations LLC) when applying PRP – often RegenPRP by RegenLab (Brooklyn, N.Y.) – to tissue after procedures such as microneedling or laser resurfacing.

RegenLab offers FDA-cleared devices for the autologous preparation of PRP, platelet-rich fibrin (PRF) and platelet-rich fibrin matrix (PRFM), now manufactured in the U.S. RegenLab kits offer up to 12 mL of PRP with flexible concentrations and high platelet recovery to utilize in various applications.

The CuraCator device addresses the main challenge of using PRP: Application.

“You would see people dripping from syringes with the needle, creating a high risk for needle stick. Or they would drip from an opening in the syringe, so there would be splatter,” Dr. Hopkins explained. “With CuraCator we no longer have to drip and rub PRP into the patient’s skin.”

The CuraCator was designed as a sterile, single-use applicator that attaches to luer lock syringes, making it easy to administer RegenPRP and other PRP products, shared Dr. Hopkins, who trademarked and launched CuraCator in the U.S.

“It is safer and more controlled,” Dr. Hopkins continued. “This device also lowers the risk of possible contamination of these PRP products.”

Aesthetic practitioners have also seen product run down the neck or drip around the eyes when using PRP. CuraCator’s targeted application solves this problem, too.

“Often in my practice, we will do a PRP facial to amplify results of a microneedling or laser resurfacing procedure,” Dr. Hopkins began. “Because we are not wasting as much product during the application process, we can actually offer patients a second treatment by injecting the residual PRP into their scalp or into other areas like the lower eyelid trough or nasolabial fold.”

Advanced Injection Techniques, New Uses
“PRP is beneficial for many different ages and stages of life,” noted Dr. Hopkins. She uses RegenPRP not only to enhance recovery but also to boost neocollagenesis.

“Based on data in studies, some of which came out in Europe, we can inject PRP into tissue. It is commonly done to stimulate new hair growth,” Dr. Hopkins explained. “In the past we did not have a lot of options for stimulating hair growth until products like PRP became available in the U.S.”

She also uses PRP in combination with hyaluronic gel to inject into areas of the face, such as acne scars, nasolabial folds or the lower eyelid tear troughs. She does the injections using a microcannula, which also attaches to a syringe.

“This allows us to inject without risk of needle puncture and less risk of bruising,” Dr. Hopkins said.

She shared another use for PRP: To prepare skin prior to injectable treatment into the tear trough. Injecting hyaluronic acid gel filler into the tear trough often results in transient post-procedure eye puffiness because fillers bind with water. “I prefer to inject PRP alone (before filler) to strengthen the skin and build a little more dermal collagen in that thin area of eyelid skin,” Dr. Hopkins concluded.

Sponsored by Venus Concept, Inc.

Venus Bliss MAX^TM from Venus Concept, Inc. (Toronto, Ontario, Canada) merges three technologies onto one platform for a 360° non- invasive body shaping experience. Its protocol, known as TriBody^TM, allows practitioners to harness three well-understood technologies to help patients achieve a more aesthetically ideal silhouette: the 1064 nm diode laser, FlexMAX^TM hands-free electrical muscle stimulation (EMS), and a proprietary combination of multipolar radiofrequency (RF) and pulsed electromagnetic field (PEMF) called (MP)² technology.

The modalities employed are specified for body shaping and are consistent in their effect, according to Scott Gerrish, DO, founder and director of Gerrish MedEsthetics (Scottsdale, Ariz. and Vienna, Va.). “The diode laser heats up fat and promotes apoptosis, which is programmed cell death rather than necrosis. This is important because necrosis is associated with unnecessary inflammation and is nowhere near the best mechanism for causing cell death,” he said. “FlexMAX EMS induces up to 100,000 controlled, specific muscle contractions to build and tone the musculature. (MP)² technology uses thermal and nonthermal energies to induce fibroblast and collagen production, promote angiogenesis, and improve microcirculation which promotes the skin contraction vital to any overall body contouring therapy.”

Dr. Gerrish also explained that these same factors are why Venus Bliss MAX can improve the appearance of cellulite. “Cellulite is a multifactorial condition, and the device treats most of the factors contributing to the appearance of cellulite – improved skin quality and tightness, fat bulging and better local microcirculation. With any treatment like this you are going to want regular occasional maintenance, and this is true for Venus Bliss MAX as well, especially for cellulite,” he added.

The newest component to the platform is the FlexMAX EMS, which is a more focused therapy than the MMS employed in other devices, according to Dr. Gerrish. “MMS tends to spread laterally at higher intensities, which is less specific, especially when you need to go deeper,” he explained. “EMS is easier to direct, control and keep away from areas other than what you want to stimulate, which results in a more specific treatment.”

Although each modality can be used by itself, the three technologies together yield the most profound outcomes. Surprisingly, Dr. Gerrish noted, more and more patients have been requesting treatment with (MP)². “It is becoming popular enough that I have to consider an additional unit just to accommodate people who want it,” he reported.

Safety and efficacy are always important, but other key factors make Venus Bliss MAX a valuable addition to his aesthetic practice, according to Dr. Gerrish. “The device is easy to operate with a nice interface that has multiple useful features to promote the best outcomes. It has a relatively small footprint, which is always a big plus.”

“Also, thanks to the nature of the included modalities, how they are applied, and the very effective onboard cooling contained in the ergonomic handpiece, treatment is comfortable and hassle-free for patients, so compliance and patient completion of a course of therapy are highly likely,” Dr. Gerrish explained.

“TriBody therapy is something patients love, and when they experience the treatment and results, they are going to want to come back for more,” Dr. Gerrish emphasized. “It is as simple as that.”

Sponsored by Advalight

ADVATx, the dual wavelength laser system from Advalight (Copenhagen, Denmark), is both safe and effective, but these are not the only factors to consider when choosing new technology, according to Suneel Chilukuri, MD, director of Refresh Dermatology (Houston, Texas). He follows a strict, simple protocol when deciding to add to his practice’s armamentarium.

“It doesn’t matter if it is a new type of syringe that costs a few dollars or a device that costs $200,000,” Dr. Chilukuri explained. “I ask myself four simple questions: Is it safe? Is it effective? Is it easy to use? What is the return on investment?”

ADVATx checks all the boxes, making it ideal for new and expanding practices.

The device’s tandem laser modules create a 589 nm beam by passing a 1319 nm beam through a YAG crystal, combining it with a second beam and passing that through a Q-switch and a non-linear crystal, called an LBO crystal. The 589 nm wavelength treats pigmented and vascular lesions while the 1319 nm laser promotes neocollagenesis because its chromophore is water. The lasers can be used individually or in combination (called PulSync Technology). The platform weighs less than 200 lbs. and runs on a 120 V power outlet with an intuitive GUI. There are also no consumables associated with it.

In Dr. Chilukuri’s experience, “ADVATx is safe and so easy to use. We can change wavelengths and settings on the fly without changing handpieces.”

Dr. Chilukuri also noted that he determines ease of use by how quickly he can incorporate the technology into his practice. “I must qualify: what I mean by ‘easy’ is that I can actually use it myself without assistance from my team, because, if I can quickly learn a device and master it, I can teach new team members. I am ultimately responsible for the quality of our team so that is especially important,” he added.

The answer to the fourth question isn’t as vital as safety or efficacy, but it is key to running a profitable practice. “Do I have patients interested in addressing the condition the device treats? How many treatments will it take to see improvement, and how can I make it work for my patients and my practice? An easy-to-use device with no consumables and a variety of valid applications may recoup your investment in a favorable timeframe,” Dr. Chilukuri explained.

As an ADVATx user, Dr. Chilukuri has worked to get the most out of his platform. “First off, I specialize in nonsurgical, minimally invasive therapies so that is a key element for me specifically. How can I get the greatest outcome with the least amount of preparation, the least discomfort, and least amount of downtime? ADVATx fits right there,” he said. “Next, I can use it for all skin types throughout the year. In our sunny climate and multicultural region, this is essential. We like to use the 589 nm wavelength for treating blood vessels and erythema without pain or post-treatment edema, which is huge because with pulsed dye lasers we are used to seeing swelling that lasts up to four days.”

This device offers fast, effective outcomes that speak for them- selves, Dr. Chilukuri noted. “It is giving us on-the-table results that, as they continue to mani- fest, have the patients’ friends wondering what they had done, and where. It works synergistically to enhance neuromodulator and filler outcomes. There are so many ways to use a device with this kind of safety, efficacy and versatility.”

Sponsored by Cutera

Physicians who want to cover all their patients’ body shaping demands may benefit from solutions that offer combined technologies, such as the truBody^® treatment by Cutera^® (Brisbane, Calif.), which pairs the truSculpt^® iD and truSculpt^® flex devices to help patients reduce fat and build muscle.

“The combination of body fat loss and muscle toning at the same time is the most popular and sought-after aesthetic body shaping treatment in my practice,” said Arash Moradzadeh, MD, a dual board-certified ENT/ head and neck surgeon and facial plastic and reconstructive surgeon in Beverly Hills, Calif.

“truBody treatments begin with truSculpt iD, a radiofrequency (RF) device that eliminates an average of 24% body fat in a single treatment^1,2, followed by a series of treatments with truSculpt flex, a muscle sculpting device that can help firm and strengthen in 15-minute treatment sessions,” explained Dr. Moradzadeh.

The devices are designed to treat all body shapes and skin types; they can be used separately or together to provide a personalized approach for patients who are looking to lose weight but are struggling to exercise, or patients who want to maintain their muscle mass.

truSculpt iD features real-time temperature control in a monopolar RF platform that can be tailored to a patient’s individual needs for fat reduction.¹ truSculpt flex uses multidirectional stimulation (MDS) to selectively strengthen and tone muscles. Physicians can isolate and treat up to eight areas simultaneously with 54,000 contractions per session, resulting in toning and an increase in muscle mass.²

Tatyana Hamilton, MD, a board-certified dermatologist in British Columbia, Canada, takes advantage of truSculpt iD to reduce undesired body fat for her patients. “We have a lot of patients who simply cannot lose stubborn fat, despite perfect diets and regular exercise, and this can be very frustrating and discouraging,” she explained. “With truSculpt iD, we are able to help them make a meaningful difference.”

“The truSculpt flex has three different modes to prep, tone and sculpt, which allow you to simulate different types of exercise,” according to Dr. Moradzadeh. “The prep mode twists and lengthens the muscles for long, lean results. The tone and sculpt modes build strength and enhance endurance – and can possibly stimulate metabolism, much like intense interval training. Patients can build up to 30% muscle mass on a targeted area while contracting the fat layers by about 24%.”^1,2,3

“In my opinion, patients are really getting everything they want in one combination treatment,” concluded Dr. Moradzadeh.

References:
1. Taub A, Bartholomeusz J. Ultrasound Evaluation of a Single Treatment with a Temperature Controlled Multi-Frequency Monopolar Radio Frequency Device for the Improvement of Localized Adiposity on the Abdomen and Flanks. J Drugs Dermatol. 2020;19(1):28-34
2. Somenek MT, Ronan SJ, Pittman TA. A Multi-Site, Single- Blinded, Prospective Pilot Clinical Trial for Non-Invasive Fat Reduction of the Abdomen and Flanks Using a Monopolar 2 MHz Radiofrequency Device. Lasers Surg Med. 2021 Mar;53(3):337-343
3. Ronan, Stephen J. A Novel Bio-Electric Current Stimulation Device for Improvement of Muscle Tone: The truSculpt Flex. 7/2019.

Sponsored by BTL Aesthetics

Similar in concept and approach, but distinctly different in delivery, both the game-changing Emsculpt NEO and emerging Emface platforms from BTL Aesthetics (Boston, Mass.) represent a one-two punch from a marketing, as well as aesthetic outcome perspective. Harnessed properly, these novel devices have unheard-of potential to usher in new patients and expose them to your entire armamentarium.

Emsculpt NEO merges BTL’s high-intensity focused electromagnetic (HIFEM^®-brand) technology and radiofrequency (RF) energies with simultaneous delivery for peerless body shaping outcomes. While the HIFEM energy induces supramaximal contractions of target musculature for scientifically proven muscle hypertrophy and hyperplasia, Synchronized RF adds a fat-reduction effect. Results also suggest a synergy where the RF improves the muscle outcome and the HIFEM energy induces local metabolism to enhance reduction of local adiposity. There is also a powerful wellness boost from the muscle stimu- lation with improved core strength and stability that can benefit patients of all ages.

The new Emface platform also melds Synchronized RF with what is termed high intensity facial electromagnetic stimulation (HIFESTM-brand) technology in an innovative dual-modality facial treatment using a unique applicator, but there is a profound difference. The muscle improvement – also scientifically demonstrated – is directed to the facial muscles that are different from the muscles on the body. “The facial muscles are significantly smaller, and the target areas are not deep,” according to New York City-based facial plastic surgeon Yael Halaas, MD. “The more superficial HIFES allows the user to directly stimulate the target elevator musculature. With HIFES technology, we are looking for tone and function, rather than hypertrophy and muscle building, as compared to stronger and more in-depth penetrating HIFEM technology.”

Its RF component, also concurrently delivered, improves surface facial tissue in numerous ways that promote the overall result. “As with the facial HIFES energy, we want to properly diffuse the RF energy to stimulate collagen and elastin while restricting depth,” Dr. Halaas added. “We don’t want to cause fat loss.” The result is a marriage made in heaven for facial restoration that can stave off the need for injectables, or even work in conjunction with them.

“These technologies are hyper-stimulating the industry in the same way that they hyper-stimulate muscles, and they can hyper-stimulate your practice as well,” emphasized celebrity cosmetic dermatologist Paul Jarrod Frank, MD (New York City, N.Y.). “These technologies are growing in visibility and popularity. They are sim- ple, easy, painless and free of hassle or downtime. They have across-the-board appeal, from the millennials to the boomers. You can treat anyone safely and many would benefit. These devices are both an aesthetic treatment and a naturopathic skin and body fitness tool, and that dual benefit should bring people into your door.

“Nothing comes close to how well they fit the modern climate for aesthetic and well- ness medicine,” Dr. Frank continued. “They provide scientifically proven results safely. Improvement is powerful but subtle, in a variety of ways that are incredibly profound as a whole and in a way that is both visible and natural-looking. The functional improvements are a wellness benefit. There is no pain or downtime, only the sensations associated after vigorous muscle exercise.”

Plastic surgeon Brian Kinney, MD (Beverly Hills, Calif.), credits the intuitive nature of these therapies for playing a key role in their appeal. “We refer to the outcomes as ‘natural restoration’ because they do not promote an artificial result,” he said. “With Emsculpt NEO for the body, it is structure and function, reduce the fat, build the muscle, and you look and feel better. Emface helps restore more youthful function to facial muscles and promotes more youthful-looking skin, which doesn’t just look better, it functions more like it used to. It is very easy to explain this to people and they love the concepts, especially if they are averse to more invasive treatments or injectables, which many people are.”

And that’s the rub: while aesthetic medicine has become more accessible and thus more mainstream, many are still put off by various aspects of it such as the cost, stigma, value, hassle or components. “Even though injectable treatments blew the doors of aesthetic medicine wide open more than two decades ago, many people still dislike the idea of injecting foreign substances into their bodies,” Dr. Kinney stated. “Others dislike needles, and many will avoid anything invasive. BTL’s technologies make aesthetic results available to these patient groups.”

BTL technologies are a key component of the practice of facial plastic surgeon Jennifer Levine, MD (New York, N.Y.), who is not surprised at the effect Emsculpt NEO and Emface are exhibiting. “Remember that BTL is primarily a physiotherapy company focused on non-invasive treatments, which has applied and adapted their knowledge to the aesthetic realm,” she explained. “That has positioned them perfectly to present these dual aesthetic and functional therapies. The improvement of diastasis recti for moms, thanks to Emsculpt, is a notable example. The only contraindications for treatment would be metallic implants for Emsculpt/ Emsculpt NEO, and metallic facial or dental implants for Emface.”

BTL’s Emsella should also be considered a practice builder, according to Dr. Halaas, and adds an excellent third component. “It does wonders for women and men for issues such as incontinence, and it is a major component of BTL’s Core-to-Floor protocol.”

“Always, first we need to get people in the front door,” Dr. Frank emphasized. “Regardless of their resources, problems and needs, once they experience the profound benefits of Emsculpt NEO and Emface treatments, their curiosity will be piqued, and they will be a little more open-minded. Isn’t that the definition of ‘gateway treatment?’”

“These BTL technologies embody the increasing crossover between the aesthetic and functional, and overall wellness. Nowadays, we are not just about looking better, but inherently improving quality of life as we age so that we can enjoy life and its many fruits, such as relationships, as long as possible,” Dr. Halaas explained. “It is not just about looking better and younger, but feeling better for longer, both physically and psychologically. That is why patient satisfaction and expectations management are so important; the psychological component to therapy is out of our con- trol, but more than ever we can control or at least influence how we age. Show people that paradigm, give them aesthetic and functional results, and of course they will want to know what else you can do.”
  

Sponsored by Cutera

Acne is considered one of the most common dermatologic conditions affecting approximately 50 million North American teens and young adults.¹ Roughly four out of five moderate to severe acne sufferers have reported that they have missed out on major life events due to their acne.²Cutera^® (Brisbane,Calif.) is redefining traditional acne care with AviClear™, the first and only FDA-cleared energy-based device for the treatment of mild, moderate and severe acne.

The Emotional Impact of Acne on Patients

“Acne is the most common skin disease in the U.S.,” explained Jeffrey Dover,  MD, dermatologist and director of SkinCare Physicians (Chestnut Hill, Mass.). “It can cause poor self-image, anxiety, depression and have a negative psychological impact.” 

Billie Casse, DO, a board-certified dermatologist at Reno Tahoe Dermatology (Reno, Nev.), sees first hand how acne impacts her patients. “The best way to describe acne and how it affects people is ‘life-changing’,” she said. “It alters your self-esteem; it often leads to depression and can interfere with your daily routine and activities. Individuals who suffer from acne often avoid social events where photos might be taken of them, such as weddings and celebrations or situations where they might be a primary focus, like first dates. Just in the U.S. alone, the cost of acne in terms of treatment and loss of productivity is over $3 billion per year.”³

According to a survey conducted on behalf of Cutera, nearly 80% of moderate to severe acne sufferers admit that acne pre-vents them from living their lives the way they want.³ Michael Gold, MD, founder of Gold Skin Care Center (Nashville, Tenn.), shared with us that this survey aligns with what he sees in his practice. “Despite many people having a psychological impact from years  of acne, most physicians agree that compliance with current treatments is often challenging, and insurance may not always cover the required medications.”

Missed Moments Survey
Acne has both a physical and emotional impact on those who suffer from it, and the survey revealed information that matches up to what physicians hear from their patients every day.

According to the survey, 90% of moderate to severe acne sufferers said having clear skin would change the way they live their lives, including things such as²:

• Stop canceling plans
• Spend more time with friends and family
• Wear less or no makeup
• Go on dates

The survey also found that two in three sufferers wish they could relive significant events and moments they missed.

The Hurdles of Current Acne Treatments
Patients suffering from acne are often on a variety of medications and over-the-counter products throughout their acne journey. Even with new medications on the market, the treatments remain cumbersome, can have serious side effects, and do not fit into the patients’ active lifestyles. Prescription treatments may also include monthly lab tests, iPledge documentation and strict compliance, making it frustrating and burdensome for acne patients and parents of sufferers who are seeking a safe and effective treatment. Patients also experience frustration with the lack of chemical-free options and the high  probability of acne rebound when the treatment is stopped. 

David Goldberg, MD, medical director of Skin Laser & Surgery Specialists (New York, N.Y.), has experience with the issues many patients face when using prescription treatments. “Compliance is a huge issue in acne patients,”he shared. “Taking medications every day, applying topical medications twice each day, along with lab tests and iPledge documentation for isotretinoin patients can be exhausting, sometimes with little patient reward.” Indeed, it seems that current treatments had come to a standstill, until now.

Changing the Acne Treatment Paradigm
Physicians and practitioners now can help acne patients of all skin types, ethnicities and acne severities with AviClear.

“AviClear is safe to use on all skin types with minimal discomfort – and it works,” Dr. Goldberg expressed. “Moderate and severe acne patients often require years of antibiotics or isotretinoin with a risk of side effects, but now we have another treatment option with AviClear.”

“Patients can now trade all this for three simple 30-minute AviClear treatments without the risks associated with oral medications,” he stated.

Dr. Dover agrees that acne patients have a new hope. “AviClear has the potential to give durable responses after a series of three well-tolerated treatments,” he shared. “In the studies performed, 87% of patients had a > 50% reduction in inflammatory lesions at six months after the final treatment session, up from 80% at three months (primary endpoint, P<.001>2

Dr. Gold reiterated that this technology may be an important new option for many suffering from acne who want a prescription-like effect without taking a variety of medications. “It is a huge advantage; neither patients nor doctors like iPledge, and most would prefer therapies without having monthly labs done or pregnancy tests for the women who go on isotretinoin,” he shared. “And this drug-free treatment resolves active acne without a prescription.”

AviClear Technology
Overproduction of sebum by the sebaceous glands is one of the leading causes of acne.⁴ AviClear’s 1726 nm wavelength laser is designed to treat acne at the source by selectively targeting sebocytes to suppress sebum production.

“AviClear is different than anything we have ever had in treating acne,” Dr. Casse reported. “Increased sebum excretion from the sebaceous gland is a major factor in the pathophysiology of acne, but there are other sebaceous gland functions associated with the development of acne. These include sebaceous proinflammatory lipids, inflammatory cytokines produced locally, periglandular peptides and neuropeptides, such as corticotrophin-releasing hormones, produced by sebocytes and substance P⁵, all of which are involved in the acne process. So being able to inactivate the problem at the source is vital to the long-term treatment of acne.”

“I feel the most impressive part of this technology is that they have found a wavelength of light that specifically targets the sebaceous gland,” added Dr. Gold. “This has not been an easy task and with proper cooling, they have shown it to be safe and effective for our patients.”

AviClear was engineered with patient comfort in mind and has proven to be well-tolerated, comfortable and requires no pain mitigation. Together, the AviCool™ sapphire contact cooling technology and sensory controls help maintain the skin’s temperature at a cool 2° C, which enhances the treatment experience while maintaining a high safety margin.

According to the AviClear pivotal study, 91% of patients responded to the treatment, and 87% saw at least half their acne cleared six months after three 30-minute sessions.⁶ Results continue to improve over time, with select patients showing long-term clearance two years after their treatment series.²

In a recent study, 88% of patients felt their skin looked better three months after the final treatment session, with 85% of patients reporting that their skin looks and feels smoother three months after the final treatment session.²

“Should these studies be reproduced with larger numbers, and based on my experience now that it is approved by the FDA, the AviClear technology has the potential to alter our algorithm for treating moderate to severe acne and obviating the need for some systemic therapies,” explained Dr. Dover.

Summary of AviClear Benefits
AviClear is a drug-free, prescription-free therapy that is safe for all skin types. Additionally, it requires no lab work or daily routine. Three simple, 30-minute applications fulfill the protocol making compliance much easier and the entire process more convenient than most standard acne therapy. AviClear has redefined the treat-ment of acne and gives patients an alternative option they can feel hopeful about.

“As more and more physicians understand that devices can play a role in treating acne patients, AviClear will provide them with a new option to treat patients while avoiding adverse effects,” emphasized Dr. Gold. “The clinical studies showed that with three monthly treatments, most patients cleared nicely and maintained the clearance of acne over time.”

In Dr. Casse’s experience, the results are as good or even more effective than current treatments. “People with acne are looking at months to years of acne topicals, prescriptions, or oral medications like antibiotics and sometimes isotretinoin, regardless of severity,” she began. “However, multiple factors cause acne, and the current regimens are not curing the acne, but decreasing or holding off the breakouts. In most cases, if the patient stops the regimen, the acne returns. With AviClear, there are only three treatments, done around three to four weeks apart. There is no downtime and it can be done any time of the year.”

AviClear - The Future of Acne Treatment
AviClear will change the future of acne treatment. According to Dr. Gold, AviClear will add another sound method to improve patients’ skin. “Cosmetic practices that focus only on aesthetics will have an opportunity to add a tool that will attract new patients, he noted. “When new acne patients go to an aesthetic practice for acne treatment, they may eventually convert to other procedures as they receive an amazing boost in self-confidence.”

Where other acne treatments have remained stagnant, AviClear is paving the way to treat acne by targeting sebaceous glands; a technology that has not been available in the past, as proven by the standard and current treatments. Physicians can now determine if their patients’ current treatments are still viable or if they need an update. AviClear may be used alone or in combination with other treatments, further adding to the physician’s treatment armamentarium.

Some patients may use AviClear as a supplemental or adjunct treatment to prepare for upcoming events such as weddings or vacations. Supplemental treatments can be an excellent first step for patients to become familiarized with AviClear and its benefits, making these new patients comfortable returning for subsequent treatments.

Dr. Goldberg shared that he envisions a totally new patient for physicians and their practices. “Five years from now, very few patients will use isotretinoin. The majority of those using long-term antibiotics will now have a much safer and effective alternative in AviClear,” he exclaimed. “Aesthetic practices have been treating acne scarring for years – now they can treat the cause of the scarring.”

According to Dr. Dover, the AviClear laser can be used by a variety of providers, including general dermatologists and those who treat acne regularly. Also, physicians with device-based practices can add AviClear to their practice, giving them the potential to treat significant acne with durable responses in a non-medication-based approach.

Practices and physicians will have the oppor-tunity to significantly improve patient out-comes as they help change the face of acne treatments. “We finally have a medication-free option that eliminates acne for the long-term,”announced Dr. Casse. “It is another tool we can offer patients that will save time and money. Patients no longer have to miss memorable social events because of anxiety and depression induced by the disease. This is life-changing.”

Physicians and practices can add AviClear as an energy-based treatment for acne throughout 2022.

References:
1. https://www.aad.org/media/stats-numbers#:~:text=Acne%20is%20the%20most%20common,to%2050%20million%20Americans%20annually.&text=Acne%20usually%20begins%20in%20puberty,experience%20at%20least%20minor%20acne.
2. Cutera Inc., Data on file.
3. https://www.dermatologytimes.com/view/meeting-the-challenges-of-acne-in-adults
4. O’Neill AM, Gallo RL. Host-microbiome interactions and recent progress into understanding the biology of acne vulgaris.Microbiome 2018;6: 177.
5. https://pubmed.ncbi.nlm.nih.gov/33688239/#:~:text=Stress%20is%20one%20of%20the,increases%6. Data on file, FDA clearance study. Cutera, Inc.

Sponsored by Cutera

As the market for energy-based skin revitalization continues to increase, physicians and providers have more opportunities than ever to offer a wide range of treatments to meet this demand. The Secret^TM PRO by Cutera^® (Brisbane, Calif.) combines CO₂, the gold standard of skin resurfacing, with radiofrequency (RF) microneedling to create a dynamic duo that allows aesthetic practices to rise to the challenge. This device is highly customizable and addresses a variety of patient concerns like scars, sun damage, stretch marks and the general signs of aging.¹

The versatility of the Secret PRO, paired with the convenience of a single device, is what makes this technology top of its class. “This is an all-in-one device to address multiple layers of the skin,” explained Michael Somenek, MD, facial plastic and reconstructive surgeon, and co-founder of Somenek + Pittman MD (Washington, D.C.). “Microneedling and RF treat the deeper dermal layers while the CO₂ resurfacing targets the more superficial layers, making it a very comprehensive approach to skin revitalization,” he expanded.

Dr. Somenek pointed out several factors that make the Secret PRO highly customizable. “The CO₂ laser resurfacing has been a very powerful tool because you can adjust not only the energy but the distance and spot size,” he explained. “Equally as impressive is the RF microneedling because of the number of factors that we can adjust, such as the intensity percentage, the depth of needle penetration and the treatment area size.”

The RF microneedling feature of the Secret PRO features 25-pin and 64-pin treatment tip options that can be used in one handpiece. Flexible needle penetration depths from 0.5 to 3.5 mm provide the ability to offer skin revitalization or more aggressive treatments such as scar revision. Adjustable settings for both the CO₂ and RF microneedling allow for various treatment options to address the full spectrum of anti-aging concerns with little downtime while providing both immediate and long-term results.

Manu Aggarwal, MD, a board-certified physician at Vein Care Center Laser Specialists, with locations in Lima, Celina and Findlay, Ohio, shared that the Secret PRO has helped her provide consistent results with improved patient outcomes. “Patients are more satisfied with the results using the fractionated CO₂ alongside RF microneedling. We can achieve greater resolution of scars, large pores, photo-aging and dermal remodeling,” Dr. Aggarwal clarified. “And we can customize results without having patients move from room to room for another laser.”

In Dr. Aggarwal’s opinion, while not all skin types can be treated with CO₂, the most impressive feature of the Secret PRO is the ability to treat Fitzpatrick I through VI skin types with the RF microneedling handpiece. “With both semi-insulated and non-insulated needles, we are able to treat all skin types and colors without raising pigmentation concerns,” Dr. Aggarwal shared. Adjustable RF intensity and laser settings allow aesthetic physicians to address each patient’s area of concern to provide truly unique and personalized results.

Furthermore, with a positive impact on patient throughput and ROI, Cutera’s Secret PRO is a safe, versatile and effective device that can benefit any aesthetic practice.

“Patient satisfaction is always our top priority, and this device has helped us achieve high levels of patient satisfaction,” Dr. Somenek emphasized.

References:

1. Based on the published findings below:

Cho, Soo Ick, et al. Evaluation of the Clinical Efficacy of Fractional Radiofrequency Microneedle Treatment in Acne Scars and Large Facial Pores. Dermatologic Surgery, vol. 38, no. 7, 2012, pp. 1017–1024., https://doi. org/10.1111/j.1524-4725.2012.02402.x.

Magnani, Lauren Rose, and Eric S. Schweiger. Fractional CO2 Lasers for the Treatment of Atrophic Acne Scars: A Review of the Literature. Journal of Cosmetic and Laser Therapy, vol. 16, no. 2, 2013, pp. 48–56., https://doi.org/10.3109/14764172.20 13.854639.

Ryu, Han-Won, et al. Clinical Improvement of Striae Distensae in Korean Patients Using a Combination of Fractionated Microneedle Radiofrequency and Fractional Carbon Dioxide Laser. Dermatologic Surgery, vol. 39, no. 10, 2013, pp. 1452–1458., https://doi.org/10.1111/dsu.12268.

Tierney, Emily P., and William C. Hanke. Fractionated Carbon Dioxide Laser Treatment of Photoaging: Prospective Study in 45 Patients and Review of the Literature. Dermatologic Surgery, vol. 37, no. 9, 2011, pp. 1279–1290., https://doi. org/10.1111/j.1524-4725.2011.02082.x.

Yadav, Savita, and Aashim Singh. Microneedling: Advances and Widening Horizons. Indian Dermatology Online Journal, vol. 7, no. 4, 2016, p. 244., https://doi.org/10.4103/2229-5178.185468.

Sponsored by Venus Concept, Inc.

With three proven technologies in one system, Venus Bliss MAX^TM from Venus Concept, Inc. (Toronto, Ont., Canada) offers 360° non-invasive body shaping with a series of single-session combination treatments, or a mix of modalities for a customized program called TriBody^TM. Bliss MAX includes the established workhorse 1064 nm diode laser technology for fat reduction and treats skin laxity and cellulite via its proprietary (MP)2 technology. (MP)2 represents a unique marriage of multipolar radiofrequency (RF) and pulsed electromagnetic fields (PEMF). However, the system’s main appeal originates in its leading-edge hands-free electrical muscle stimulation (EMS) technology, FlexMAXTM, which incorporates game-changing Adaptive Mode and delivers up to 100,000 contractions per session.

FlexMAX safely and non-invasively triggers muscle contractions via delivery of proprietary pulse configurations, specific to key muscle groups, in a controlled and accurate manner that dramatically exceeds the human capacity for manual exercise. Scott Gerrish, DO, founder and director of Gerrish MedEsthetics (Scottsdale, Ariz. and Vienna, Va.), was the first physician to adopt this powerful platform. “This technology takes the complexity out of the equation,” Dr. Gerrish began, “because our ability to recruit maximum musculature to perform movements is severely limited. Even an experienced athlete cannot hope to achieve the intensity and number of muscle contractions in an anatomical region that we can by using FlexMAX.”

Containing and controlling the flow of energy by using a unique duo electrode design, FlexMAX EMS represents an optimized approach, Dr. Gerrish noted. “EMS differs from magnetic muscle stimulation (MMS) in that it enables a more targeted delivery of energy, focused and directed at the muscle layer instead of being dispersed around the treatment area,” he explained.

Four FlexMAX applicators can be individually activated or used together for different configurations and levels of coverage over the targeted muscle groups. It also includes six velcro belts of varying sizes to accommodate different patients and body areas, providing a hands-free, hassle-free experience for both patients and providers.

Additionally, FlexMAX offers Adaptive Modes, which feature three components:

AdapTarget is designed to target seven different muscle groups (biceps, triceps, abdominals, obliques, glutes, hamstrings and quadriceps) for ultimate treatment personalization. Two areas can be treated simultaneously in one session for increased efficiency in individualized combinations.

The performance-informed AdapTrain smart training program was developed to mimic real workouts via automated and continuous fluctuations of frequency and intensity settings that maximize muscle activation.

Lastly, AdapTensity boasts breakthrough adaptive parameters with built-in intelligent algorithms to enhance customization and patient comfort. It is designed to replicate muscle memory, so the operator can adjust the intensity of treatment at any time mid-treatment cycle or during subsequent visits and the program will automatically adapt.

According to Dr. Gerrish, a typical course of treatment is four to six two-per-week sessions; it is vital to monitor progress and modify parameters accordingly. “Patients typically fall into three groups,” Dr. Gerrish stated, “some seek a more therapeutic effect. For example, strengthening your core is an established therapy for lower back pain and people tend to see reduced discomfort. Others want to improve strength and performance beyond that of a strict exercise regimen. The third group is looking for increased muscle mass and definition; increasing muscle mass is a key strategy for weight loss that you can maintain. For more global improvement, we have other incorporated modalities on Bliss MAX, which take things to the next level.”