Sponsored By Cutera;

Skin revitalization and resurfacing are highly popular trends in the world of aesthetics with continued growth driven by the demand for non- or minimally invasive procedures and proven results. Secret^™ from Cutera (Brisbane, Calif.) offers physicians a chance to meet this demand. Presenting a graduated approach to skin revitalization and resurfacing, the Secret family of products offer aesthetic practices the opportunity to build their armamentarium of devices.

Secret™ RF is ideal for providers that are interested in adding delegable treatments like radiofrequency microneedling (RFMN) to their practice. Secret^™ PRO brings together two gold standard treatments, RFMN and CO₂ for collagen stimulation^* and skin resurfacing. The newly introduced Secret^™ DUO is the latest platform offering dynamic facial revitalization for expanded skin types with little to no downtime via RFMN and 1540 nm non-ablative Er:Glass laser.

Nina Deep, MD, owner of Nina Deep MD Aesthetics in Columbus, Ohio, uses Secret RF for skin revitalization and considers it her go-to device to improve the appearance of surgical scars. “Secret RF offers multilayered dermal remodeling with a combination of radiofrequency and microneedling. I appreciate that it smoothly injects the needles with 100-micron precision, which really enhances patient comfort,” she reported. “We use the device to reduce acne scars, improve texture and tone, and decrease pore size. It is exceptionally effective at remodeling scar tissue.^{1, 2, 3} Secret RF is intelligently designed with customizable settings so I can tailor treatments to meet the needs of each individual patient.”

Canadian Dermatology & Plastic Surgery Centre in Toronto, Ontario, Canada was the first clinic in Canada to offer Secret PRO. “As a dermatology clinic, we use Secret PRO frequently to treat acne scars. Our patients really notice an improvement in their skin and in their quality of life,” said lead dermatologist Renita Ahluwalia, MD. “We also use it frequently for skin resurfacing.

The CO₂ technology stays more superficial, and the RF goes deeper into the skin, so we notice improvement in pore size, texture and tone. Also, many of our patients see a lifting and tightening effect, as well.” ^1,2,3

Dr. Ahluwalia reported that Secret PRO offers a degree of customization that other devices do not, with a choice of a 25- or 64-pin tip and customized penetration from 0.5 mm to 3.5 mm. The high-powered CO₂ laser features adjustable depths and scanning patterns for customized skin resurfacing. “This device is always busy in our practice because we can offer solutions for so many different patient concerns. Our patients are satisfied, we are satisfied, so we are all very happy,” she added. “Some main advantages of this device compared to other devices on the market are speed and versatility,” reported plastic surgeon Stephen Ronan, MD of Blackhawk Plastic Surgery and MedSpa (Danville, Calif.). “The RF combination of shorter pulses and fast protrusion and protraction rates of the pins results in quick treatments and localized damage in the skin, which means less downtime. Fractional CO₂ increases efficacy of the treatments. My patients are active and require little to no downtime, so they are excited about the ease of the procedures and the results achieved in a single treatment with minimal downtime.”

Nonsurgical aesthetic treatments remain in demand, making multi-treatment platforms a standard for today’s aesthetic physicians. With innovative products that have enabled physicians to provide safe and effective treatments since 1998, Cutera continues the trend with an all-in-one solution to suit aesthetic practices at any level and of all types.

* Via hemostasis and coagulation.

References:

1. Tierney, Emily P. MD; Hanke, William C. MD, MPH2. Fractionated Carbon Dioxide Laser Treatment of Photoaging: Prospective Study in 45 Patients and Review of the Literature. Dermatologic Surgery 37(9):p 1279-1290, September 2011. | DOI: 10.1111/j.1524-4725.2011.02082.x

2. Yadav, Savita, and Aashim Singh. Microneedling: Advances and Widening Horizons. Indian Dermatology Online Journal, vol. 7, no. 4, 2016, p. 244.,

3. 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.

Sponsored By BTL;

From its beginnings in medical therapy devices through its rise as a developer of gamechanging technology in aesthetic medicine, BTL Aesthetics (Boston, Mass.) has been focused on wellness. This philosophy is evident when one examines the non-invasive nature of their systems and the body of science behind each one, but more importantly, how these devices profoundly affect practices and patients. 

Roxanne Krempa is lead body sculptor and practice manager at Bay Area Body in San Francisco, Calif. – the body sculpting arm of the practice of Kathleen Welsh, MD. Ms. Krempa is involved not only in treatment planning but has also used the devices and regularly interacts with patients. Her years-long reliance on BTL technologies is a testament to this wellness approach and how it impacts practices and patients.

“BTL has understood where the market was going from the beginning, and their suite of devices reflects that,” she began. “People have been yearning for safe, effective devices that deliver as promised, and that is exactly what BTL devices do, in all areas, but especially in muscle stimulation. The quality of outcomes compels people to invest in themselves; they are willing to pay for treatment because of the effect, making them willing to go further.”

She explained that BTL’s Emsculpt and Emsculpt Neo muscle stimulation devices exploded onto the market because they were what the market wanted and more. “There is distinct aesthetic value to treatment with these devices, but also a functional improvement, and that is where the real stories come from. I have countless anecdotes about people who got back their ability to walk around the block, their golf game, and other lost activities, dramatically restoring quality of life. Patients’ physical therapists ask them what else they are doing because their healing is well beyond what would be expected otherwise. I am sure providers around the world can say the same thing.”

Those providers who believe in the products get the greatest benefit. “Every provider in our practice is enthusiastically behind every one of the BTL technologies we use,” Ms. Krempa shared. “Trust is virtually built into BTL devices. The quality and quantity of research behind each one is impressive and growing. The company’s support goes beyond just getting you to buy their stuff. They partner with you to create pathways for success from training to upgrades as they continue to develop things further. Plus, they are extremely easy to use, reliable and comfortable for patients, often hands-free, so we can focus more on the patient, making visits more enjoyable and educational. That comfortable environment more easily fosters the relationships that create trust between providers and patients in our practice. This also opens up avenues to discuss other treatment options we offer.”

BTL has always acknowledged that their therapies are well-suited to be used alongside a variety of treatments, thanks to their noninvasive nature. For example, neurotoxin is a real beneficiary of a therapy like Emface, according to Ms. Krempa. “When you add something like neurotoxin after Emface, you can use less product, which is more efficient, whether you are going for microinjections or more traditional correction.”

As such, the company’s offerings are easily categorized as “gateway” devices, especially for populations most resistant to the prospect of aesthetic treatment, in Ms. Krempa’s experience. “The results we get with BTL devices drive interest in our total suite of therapies,” she stated. “One great example is males. They are about 8% of the market now, but in our practice, it is more like 15% because of Emsculpt and Emsculpt Neo. Men have often shied away from aesthetic medicine but are very comfortable talking about muscles and fitness, which opens doors for them. It is so much easier to convert these patients to other therapeutic offerings. The same holds true for women as well. So many people want to dip their toes into the waters of aesthetic medicine, so if we can give them a great result with a great experience, they dive right into the pool.”

Often, the next steps are obvious complementary therapies that BTL offers. “BTL’s Total Tone Up or Face and Body treatment protocols are what people end up with when they try Emface or Emsculpt,” Ms. Krempa continued. “Almost inevitably, an Emsculpt NEO patient will go for Emface, or vice versa, because as they understand the one, the concept of the other becomes more accessible to them. It is vital to understand that this isn’t just about the aesthetic improvement, especially with these devices, because they make you feel physically good, even refreshed. And, for older patients who are losing muscle mass as they age, staving off that loss and even getting some back has the additional wellness benefits that feel great. The fat reduction benefits help restore that balance as well. It is a winwin for everyone when you can build muscle, lose fat and feel great all around.”

Ms. Krempa indicated that is the very reason why the revenue stream for BTL devices in her practice has never abated. “The safety, convenience, comfort and outcomes we get inspire patient satisfaction that leads to loyalty and word-of-mouth advertising,” she explained. “This is true for every BTL device in our offices, and we have many of them. They are all still in regular use, which you cannot say for every device on the market. More than that, we don’t even have to push maintenance. Patients love what they are getting and ask us how much maintenance they can do.

“It is what makes BTL devices such an incredible investment and an important piece of the foundation of our practice,” Ms. Krempa concluded. “We launch a new device, and we hope for good return on investment (ROI). BTL devices are ROI home runs because we launch them, and they stay relevant and useful, from Exilis to Emsculpt. Even years later, these devices are producing revenue and helping us convert patients to other therapies in our practice. There are no signs of slowing down. These devices are exactly what any practice needs to thrive in the market – guaranteed long-term producers that you can count on for safety and efficacy.”

Sponsored By BTL;

It is well-accepted that combination therapies are hands down the best route to exceptional outcomes. More recently, the non-invasive modalities available for these combinations have changed, raising the ceiling of outcomes and opening doors for many who want neither the knife nor the needle.

 

A recent offering, plus an emergent platform system, yield what might be the most versatile combination yet for facial applications, using devices with significant scientific support behind them.

Emface^® from BTL Aesthetics (Boston, Mass.), plus BTL’s new platform Exion^® , which features four distinct applicators, can provide never before seen facial improvement without surgery or injectables, according to dermatologist David Kent, MD, founder of Skin Care Physicians of Georgia (Macon, Ga.). Dr. Kent has been involved with clinical trials of both Emface and Exion technologies.

Together, Emface combined with Exion’s radiofrequency-plus-targeted ultrasound (RF+TUS) applicator may be the quintessential needle-free facial protocol. Termed Revitalize and Revolumize (R&R), this treatment captures both the effect of the combination and evokes the gestalt of rest and relaxation associated with an easy, hasslefree procedure. Total time per session ranges between 30 to 45 minutes. “In my experience, you get remarkable results using a course of Emface alone, which provides visible lifting across the mid- and upper face, which affects the lower face and neck,” Dr. Kent began. “Exion elevates the ceiling of what is possible by adding components to combat facial laxity and improve skin quality. This could literally transform the way we approach the treatment of facial aging.”

J.D. McCoy, NMD, medical director of Contour Medical (Gilbert, Ariz), agreed. “The simple message is that we have this powerful new protocol that changes the paradigm, and it actually delivers. As doctors, we are taught first to do no harm; it is a central tenet of medicine. As a naturopathic physician, and, as far as what my patients are looking for, that means choosing the least invasive possible options.

“As physicians, we have this bias,” Dr. McCoy continued. “It becomes almost normal to put needles in the face. To 95% of the population, the idea of needles in the face is ludicrous. People, in general, do not like needles. The idea of something that is needle-free and truly without downtime or pain is extremely exciting. Suddenly, we have a target audience that is exponentially bigger than the audience that would ever conceivably get an injection.”

“‘Needle-free’ means seeking a natural look without injectables or surgery, avoiding that ‘had work done’ appearance,” said Lesley Clark-Loeser, MD, a dermatologist in Davie, Fla. “What is more natural than energy used noninvasively? This is a multi-layered approach to getting that natural outcome. You are improving the resting tone of muscles, the quality of the connected tissue, and the quality of the skin, thus improving the appearance of aging.

“We want people to look like the best version of themselves in real life and with a face that is active and emotional,” Dr. Clark-Loeser continued. “If the face does not respond naturally to that movement, it is noticeable and unnatural looking. It is not that you cannot or should not use injectables, but rather that you do not have to if you do not want it – or you can use them sparingly, artfully. A maximum effect can be achieved from minimal to no injectables, allowing you to use your armamentarium to its fullest potential, and your expertise to express yourself, while the patient walks away looking their best.”

“Injectables are not going anywhere, but they have been around long enough that we have seen overuse that can create a problem at any age, particularly in the younger crowd that may not need as much correction,” said Paul Jarrod Frank, MD, celebrity cosmetic dermatologist in New York City, N.Y. “People want a lifted and tighter appearance without pain and downtime. There is a definite trend of patients looking for an injectable-free solution who do not need that much and do well with these devices. Older patients benefit differently because while they need more correction, this Emface+Exion combination restores the face in a way that sets the stage for more work if they need it. This is unique in the space.”

“People from all walks of life are eagerly seeking nonsurgical solutions without downtime,” said facial plastic surgeon Yael Halaas, MD (New York City, N.Y.). “There is a growing resistance to using fillers and exogenous materials, and concerns have always been about how long they last. The approach we are taking with the Emface+Exion combination is to harness the body’s natural ability to repair and rejuvenate itself, which appeals to patients. It is what the market has been asking for.”

Emface begins with BTL’s signature Synchronized RF and adds high intensity facial electromagnetic stimulation (HIFES™). While the HIFES component selectively stimulates facial elevator muscles to revitalize facial musculature and subsequent structure, Synchronized RF stimulates collagen and elastin while improving local microcirculation simultaneously. This provides a two-vector approach to combat the physical signs of facial aging without downtime or needles. “Unlike BTL’s Emsculpt Neo device, Emface uses the muscle stimulation with the added synergy of Synchronized RF to tone, more than build, muscle,” Dr. Kent explained. “You get thousands of muscle contractions, but the effect is restoration of muscle tone, thus repositioning the facial structure to what is more youthful and functional. The layers of the face do not age independently; we have skin, subcutaneous fat, muscle, and the facial skeleton with connective tissue. In the past, we would generally target the skin, plump the subcutaneous tissue and lift it, but nothing to effectively address the deeper tissues, such as the muscles and the superficial musculoaponeurotic system (SMAS). With R&R, we can nonsurgically target all the different layers. This is where Exion comes into play.”

Exion is a newcomer to the field and features four distinct and powerful applications in a single platform for treating the face and body. Typically, facial sculpting using the R&R protocol begins with Emface to strengthen and tone facial elevators and improve overlying skin quality. Exion’s RF+TUS applicator is used after to stimulate neocollagenesis and neoelastinogenesis¹ , improving skin laxity² and naturally increasing hyaluronic acid (HA).^3-5 Skin hydration and texture are also boosted.6 “It cannot be said enough: The neocollagenesis, neoelastinogenesis, and huge boost in HA are the secret sauce that Exion’s Face applicator provides,” Dr. Kent emphasized.

“Repeated studies, some of which I have taken part in, show these remarkable rises in HA,” Dr. Kent reported. “High patient satisfaction is another hallmark of this protocol. You cannot argue with those numbers on top of the more objective evaluations.” For example, Fritz and colleagues³ treated swine on the side of the abdomen (n=12, 9 RF+TUS, 3 RF only) with four weekly, 30-minute sessions. Enzyme-linked immunoassay (ELISA) testing showed an average HA increase of 80 µg/g in the RF+TUS group, with no significant changes in the RFonly group. In a similar study, Duncan et al.⁴  treated pigs (n=12) with RF+TUS (n=6) vs. RF+non-targeted US (n=6), showing an HA increase of 224% vs. no significant change in HA levels, respectively.

With a patented combination of monopolar RF and TUS, the Exion Face applicator creates therapeutic thermal and mechanical stress to fibroblasts in the deep reticular dermis, according to Dr. Kent. “This is where the improvement in collagen and elastin, and the skyrocketing HA levels, come from with the R&R protocol,” he said. “It is all about the added TUS going deeper to the fibroblasts and the unheard-of increases in HA, which works wonders for the skin.”

As Diane Duncan, MD, director of Plastic Surgical Associates in Fort Collins, Colo. pointed out, the restoration of skin quality has a visibly powerful effect on the overall result. “One thing you will notice – for example, in aging skin of the neck – is loss of the tone, texture and elasticity that gives skin its youthful glow. Instead, it looks crepey, and when you turn, you see wrinkles. The improved skin quality we see from the increases in HA with Exion has a moistening and brightening effect. Skin appears thicker and more toned so that it does not have as much tendency to fold up as aged skin does.”

“BTL started as medical and moved into the aesthetic,” said Chris Robb, MD, PhD, a dermatologist and co-owner of the Skin & Allergy Center (Nashville, Tenn.). “This explains their unique approach and familiarity with the technologies in play. Emface restores facial structure using RF and electrical stimulation to tone, not bulk, facial muscles to a more youthful-looking state. This methodology is very sound, rebuilding the foundation rather than trying to augment what is on top of a faulty foundation, as we often see with injectables. Then we use Exion RF+TUS to improve what is on top of the muscle and fascia, improving collagen and elastin and boosting HA. The RF+TUS creates a synergistic effect in the tissue with RF heating of collagen, elastin and water, combined with the cavitation effect of ultrasound on collagen and water. You see cheek topography restored as if you placed filler, but without filler, the jawline tightens and wrinkles and jowls fade. Perioral and periocular regions look more naturally youthful.”

“When you think of the facial anatomy in layers, the musculature and fascia encompass the deepest levels, and Emface works on that,” Dr. Frank began. Exion RF+TUS non-invasively builds on the next layers up to the surface, restoring tissue volume and elasticity that manifests as we go through sessions over time. It is great to see the ‘nooks and crannies’ level out as we do this without the need for healing or downtime. What you do from there depends on the individual patient’s needs.”

In short, the R&R’s moniker refers to the unique way Emface and Exion revitalize and revolumize. Dr. Halaas put it this way: “When we think of the aging face, the effects of time and gravity pull everything down. Meanwhile, we lose muscle and muscle tone as we age. Skin quality is reduced by aging and sun damage. Emface restores the facial muscle tone and revitalizes the facial scaffold at the level of muscle and bone, but only in specific ways.

“There are more than 40 facial muscles, and Emface only tones the right ones, improving density and tone,” Dr. Halaas continued. “Exion routinely and dramatically improves smoothness and texture, and Emface toning is basically equal to a few syringes of filler. If you reposition a cushion cover without replacing the filling, the sofa will still look old and tired.”   

To Dr. Kent, a massive potential benefit of the R&R protocol, and both Emface and Exion systems individually, is that you can treat younger patients. “With these devices, you can appeal to the younger population and, to varying degrees based on individual need, begin the process much sooner,” he expressed. “That would mean previously unseen graceful physical aging using nonsurgical means, and I cannot even imagine how that would look. Within this short, recent span of time, we have seen the rise of Emface and Exion, giving us a one-two punch for facial treatment that simply did not exist a year ago.” For older patients, a key aspect of R&R contributing greatly to the overall result is the treatment of the neck. “When we are doing aesthetic improvements to facial skin, ignoring the neck is a big mistake because then you look like you have a rejuvenated face and an old neck,” Dr. Clark-Loeser explained. “Exion is safe to use on the neck similarly to how we use it on the face. While you would never see a line of demarcation the way one might if we were using lasers, you do get a natural blending as you improve collagen and elastin production, even along the jawline for some immediate tightening.” On top of the excellent combination results with R&R using Emface+Exion, practitioners can further augment results with procedures using other available facial treatments they offer.

Injectables, especially injectable neurotoxins, have long been an entry point or ‘gateway’ treatment for individuals interested in cosmetic procedures. Many people start with these nonsurgical treatments before considering more invasive options, but the profit margins associated with neurotoxins can be relatively small.

“This is because the cost of the product itself and any associated supplies can account for more than 50% of the total treatment cost,” according to Terri Ross, founder and CEO of Terri Ross Consulting, and founder and co-CEO of the APX Platform (Redondo Beach, Calif.). “Some practices use neurotoxins as a ‘loss leader.’ This means they offer these treatments at a relatively low price, potentially even at a loss, to attract clients and build their client base. The hope is that these clients will return for other, more profitable treatments. Many practices are adopting a holistic approach to maximize profitability and patient satisfaction. This involves creating treatment plans combining multiple modalities that comprehensively address the patient’s aesthetic goals. In addition to injectables, practices are incorporating medical devices, such as those offered by companies like BTL, to enhance the overall treatment experience and outcomes. These devices can complement injectables by making them more efficient or effective.

“Poly-L-lactic acid (PLLA) thread lifting works well with this protocol,” Dr. Halaas said. “Threads work best when there is facial tissue and structure to work with, so the Emface+Exion combination works to this advantage specifically.”

“You can do laser-based pigmentation treatments, intense pulsed light (IPL), or even microneedling on the same day,” Dr. Clark-Loeser added. “You can even use a 1927 Thulium laser and do RF microneedling on top of that. BTL technologies play well with others for sure.”

An excellent adjunct is Exion’s own RF microneedling applicator, according to Dr. Robb. “The unique AI-controlled safety features allow this to go deeper than other devices comfortably. This can bring another dimension to the result.”

According to Dr. McCoy, the R&R protocol raises the baseline for any possible adjunctive therapy. “This has become a foundational facial treatment, meaning everything and anything can build upon it. It is appropriate for the full spectrum of patient demographics. My most elderly patient is 87 years-old and achieved a fabulous result. Male patients do amazingly with it. You see, R&R addresses a core concern that 90% of patients come in with – that they look not just aged, but tired or angry. The R&R protocol gives them that refreshed look, and it is partially because you are just addressing so much with a single treatment. Combine this with other elements of the BTL family or other tools that you have in your toolbox. It truly is a foundational treatment.”

Dr. Duncan echoed that sentiment. “What this protocol does is take your skin back years, not in the limited and superficial way we did with lasers, but with functionally restored facial structure and tissue quality that gives a naturallooking result we can build on with other tools in our armamentarium. The safety, outcomes, lack of downtime, ease of treatment, and overall convenience appeal to patients. And the sooner we can intervene, the more we will be able to help patients maintain their youthful facial appearance.”

“Most of the time patients are really coming to see us as an expert, and they want a plan, next steps, they want to know where the treatment is going to lead,” Dr. McCoy emphasized. “We tell patients that this is a marathon, not a sprint. You are never done because the aging process continues, so we want to manage it in as many ways as we can.”

“This approach allows practices to provide patients with a more complete solution to their aesthetic concerns,” Ms. Ross observed. “Patient satisfaction is a crucial aspect of any cosmetic practice. A holistic approach that delivers better results can lead to higher patient satisfaction and loyalty. The goal is to create a diversified revenue stream by offering a variety of treatments. This can help practices remain financially sustainable and competitive in the industry.”

Another aspect of financial sustainability is return on investment (ROI). Part of ROI is the efficient use of staff time, so a device or treatment becomes more profitable when it can be safely delegated to ancillary staff. “Emface and Exion are absolutely delegable procedures,” Dr. McCoy explained. “The technology is very intelligent in design with built-in safety, which is very important for any procedure I bring into the office. These are both very simple and straightforward procedures to set up and administer. The most important component is patient selection and managing expectations while ensuring no contraindications to treatment. And at the same time, it is an opportunity for those ancillary staff not just to administer the procedure, but also educate the patient about the treatment and the other opportunities within the practice, which they enjoy.”

Another important piece of the puzzle is BTL’s customer support. Starting with the rep who comes into your office, it is exceptional, said Dr. Robb. “These people understand your needs, the business and the technology. This continues at conferences where the growing body of research supporting these developing technologies is shared. The reps do not abandon you when you make the purchase; they stick with you and want you to be successful. Their trainers are outstanding, so you and your staff will be well-versed in how to use the devices safely, and if you need help, they are there.

“Marketing support starts with the company’s direct-to-consumer campaigns throughout the country, using billboards and influencer-based presentations that have impacted my business firsthand,” Dr. Robb continued. “People seeking treatment may find you through their website, and I receive regular emails from prospective patients this way. And, of course, BTL is always adding more down the pipeline – not things that make your device obsolete, but that augment and accentuate what you own.”

Dr. Frank cannot speak highly enough about the business side of BTL. “On top of the great ROI we see with these devices is the support that makes the ROI come to life,” he explained. “Direct-to-consumer marketing is essential because it reaches people that doctors simply cannot and creates recognizable branding. The training and support are superior. BTL’s long history with these technologies puts them firmly at the forefront of aesthetic medicine, with safer and effective non-invasive devices that offer easy-to-sell treatments because they live up to the hype. Patients will always choose less invasive and less hassle, but with BTL devices, they do not have to consider the old trade-off of results versus risk and downtime.”

References:

1. Kent DE. Monopolar radiofrequency and targeted ultrasound induces remodelling of fibrillar collagen and elastin fibers: histological porcine model study. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, Calif., 27 April 2022.

2. Kent DE, Mueller G. A novel technology combining radiofrequency and targeted ultrasound for improvement in skin laxity: the efficacy and safety evaluation. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, Phoenix, Ariz., April 13-16, 2023.

3. Fritz K, Bernardy J, Jarosova R, Kralova N. Radiofrequency and targeted ultrasound have shown to enhance natural hyaluronic acid production: porcine animal study. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, Calif., 27 April 2022.

4. Duncan D, Bernardy J, Hodkovicova N, Masek J. Increased levels of hyaluronic acid in skin after monopolar radiofrequency and TUS treatment: porcine animal study. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, Calif., 27 April 2022.

5. Goldberg DJ. A novel technology to boost natural production of hyaluronic acid in the skin tissue: human histology study. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, Calif., 27 April 2022.

6. Chilukuri S, Boyd CM. The simultaneous application of monopolar radiofrequency and targeted ultrasound for improvement of skin hydration and skin texture. Presented at the American Society for Laser Medicine and Surgery (ASLMS) annual meeting, San Diego, Calif., 27 April 2022

 

Sponsored By Advalight;

For a device to thrive in a medical spa setting, it must meet a specific set of requirements. These requirements include the ability to be utilized safely by trained personnel with minimal medical supervision, provide real results, appeal to existing and potential patients, and be cost effective to operate. While this ideal may be adjusted by regional governmental regulation, it is essentially the same across the board. The best devices meet all these requirements but also maximize safety and efficacy.

One device – the dual-wavelength ADVATx laser system from Advalight (Copenhagen, Denmark) – prides itself on meeting these requirements. For Morgan Puckett, RN, who owns Fyre Aesthetics in Helena, Mont., ADVATx was the first major device she acquired and she relies on the platform to bring in patients and profits. “With 25 FDA/CE-cleared indications, it gives me incredible versatility,” she explained. “I can treat virtually any patient of any age with skin issues, from gentle to more aggressive treatments, whatever fits their needs. I have access to medical grade skincare, but ADVATx takes us to that next level of capability.”

ADVATx features the 1319 nm and 589 nm wavelengths, individually or concurrently (via proprietary PulSync Technology). Their 1319 nm wavelength is a known mainstay for thermally generated dermal collagen remodeling, with water as its chromophore. The 589 nm, or yellow, wavelength is well established as the gold standard for vascular lesions and has recently been shown to reduce porphyrins.^* This can, in turn, reduce inflammation, thus presenting the potential to impact a variety of inflammatory skin indications. Together they present a complementary and versatile toolset in a single platform.

A typical patient experience – after a thorough consult with expert evaluation and treatment planning – involves a relatively comfortable treatment after a simple cleanse, modified slightly, if more aggressive treatment is called for. According to Ms. Puckett, treatment times range from a ten-minute spot treatment to 45 minutes for a full face. “Having no consumables is huge here. It allows us to treat freely without reducing return on investment, which has been great for us. Some months I am bringing in two to four times what I used to before ADVATx, which is so exciting that I am still not used to it.”

In her region, use of the device can be delegated to trained ancillary staff. “We worked with Reveal Lasers to add the ADVATx and the company has really partnered with us to make sure training is thorough,” she explained. “Our training included didactic as well as the handson, and the specialists they flew out left us comfortable and prepared.

“ ‘Seamless and simple,’ are the words I would use to describe working with Reveal to integrate the ADVATx into the practice,” she continued. “All other support has been outstanding as well, from sales and marketing to ways we can make the most of the device, and ways we can better manage our business. My account manager at Reveal is like family and has been there every step of the way.”

Simply put, adding ADVATx with Reveal has catapulted her practice forward in every way. “To me, ADVATx is like having another provider in the office that is an expert on skin and a magician with the results,” said Ms. Puckett.

 

*Data on file, Advalight (Copenhagen, Denmark)

Sponsored By Sylton;

In a busy aesthetic practice, optimizing workflow can be a challenge; efficiency relies on quick, clear communication between providers, office staff and patients. Kelly Hermans, CRNA, founder of Beautiphi Aesthetic Boutique (Rochester Hills, Mich.), believes she has found a gamechanging solution: Observ^® 520x from Sylton (Ann Arbor, Mich.).

The Observ captures high-definition (HD) images from five different angles with ten different light modes to assess skin health at the epidermal and dermal layer. Available light modes include Daylight, True UV, WOODS (Wood’s Lamp), Cross and Parallel Polarized, Surface Texture, Pigmentation, Vascularity and 360 Light Mode in both daylight and greyscale.

“I use Observ 520x during all my new patient appointments and consultations, and it has really helped my business,” Ms. Hermans shared. “My background is anesthesia, so I come from the hospital world where we use these things called workstations on wheels – and that is how I use it.”

Observ 520x’s patented face positioning system and hood sit on top of a stand with wheels, allowing the device to move as needed. “When I have a busy day of seeing patients, I can go from room to room and just roll it with me,” she mentioned. “The same iPad that I chart with, I use to connect to the camera via the docking station on the back of the device, and the cloud-based app stores all the images and notes I take. I have everything I need at my fingertips.

“Once the information is in the app, anyone in the office can pull it up immediately,” Ms. Hermans added. “It is great for patients too because I can send images, recommended skincare products, treatment progress and plans, and even a cost estimate, straight to their email where it will not get lost. It keeps everyone on the same page.”

In Ms. Hermans experience, patients also benefit from being able to see their skin from an objective viewpoint. “Before using Observ 520x, I would essentially explain the patient’s skin condition based off of what I saw upon physical examination,” she explained. “But I have learned that patients often have a hard time seeing themselves objectively.

“Patients look at themselves every day,” added Ms. Hermans. “They may not see how their skin has changed because the changes are too gradual. With Observ 520x, the evidence is right there, and it is hard to argue with. It really opens the door for better conversation between providers and patients.”

By taking updated pictures with every visit, Ms. Hermans also reinforces patient trust in her expertise and treatment strategy. “My practice is very membership based because I do not believe patients can see significant changes with just one or two treatments a year,” she explained. “As a result, I have had patients come to me after two out of six treatments saying, ‘I do not see a result, but I just spent $4,000.’ My immediate response is always, ‘Let’s do a scan real quick!’ I do not try to convince the patient they look better. Observ 520x does the talking for me.”

Sponsored By MRP;

Intense Pulsed Light (IPL) therapy utilizes cutting-edge technology to address a wide range of aesthetic and dermatologic concerns with treatments that require no surgery and little to no downtime. Today, IPL devices are a staple in many aesthetic practices as they allow physicians to offer anti-aging and skin rejuvenation treatments, hair removal, and nonsurgical options to treat sun damage and other common skin problems.

The Luvo Lucent IPL from MRP (Park City, Utah) uses gold standard technology to address common skin concerns and dermatological conditions. At 3,500 W, this powerful device effectively targets pigmentation concerns such as age spots and vascular lesions, as well as hair removal and has the ability to combat acne by eliminating acne-causing bacteria. It also comes equipped with four specially designed pulse modes and seven filters that allow for expert, customized treatments.

Rishi Gandhi, MD, a double board-certified dermatologist (Dayton, Ohio) specializes in skin cancer management with Mohs and reconstructive surgery, cosmetic surgical procedures, and minimally invasive aesthetic enhancement. He regularly uses the Lucent IPL for a wide range of concerns. “The Lucent IPL is the highest-powered IPL device. It allows us to deliver phenomenal outcomes in very few treatments to improve pigmentation, redness, texture, and tone on the skin,” he reported. “And because of its power, we see results much faster than some other IPL platforms that don’t offer this range of pulse duration power.”

Through one handpiece with seven filters (430 nm to 755 nm), the Lucent IPL platform conveniently offers the ability to treat multiple indications with one system. Moreover, filter detection technology improves safety and helps reduce errors. In addition, physicians can choose from three spot sizes including 5.6 cm2 to treat larger areas in shorter treatment times.

According to Dr. Gandhi, “the performance of this IPL is really superior from other ones I have used. “The range of filters that I can use to customize unique treatments for my patients is also quite impressive and makes the device very engaging to use. One of my favorite features is the 585 filter, which is unique to this IPL and not seen in other platforms. It almost approximates what one can do with a pulsed dye laser, which has always been the gold standard for treating vascular skin conditions.”

Dr. Gandhi is impressed that he can provide treatments with speed and efficiency, with consistent and impressive outcomes. “My patients are getting very positive results in fewer treatments,” he said. “When they see quick improvement, they gain more confidence and are more inclined to return for more skin rejuvenation treatments.”

Luvo Lucent incorporates a user-friendly interface and the ability for the operator to store their favorite preset settings. The device also provides robust contact cooling to help increase patient comfort and safety. Overall, users say the Lucent IPL is a versatile light-based device that offers an improved treatment experience for both physicians and their patients.

According to Global Market Insights, the energy-based aesthetic devices market was valued at $4.1 billion in 2022 and is projected to reach $13.4 billion by 2032.¹

“Energy-based devices have literally opened the door for patients seeking aesthetic improvement who previously only had traditional surgical options available to them,” said David Kent, MD, founding partner of Skincare Physicians of Georgia (Macon, Ga.). “We can craft a treatment plan of complementary technologies and procedures that can help them achieve the results they are looking for.”

A Few of My Favorite Things

According to Monica Boen, MD, a dermatologist at Cosmetic Laser Dermatology (San Diego, Calif.), energy-based devices help improve skin quality with less downtime than traditional surgeries. “A key area that can be improved with energy-based treatments is skin laxity and excess fat in the neck. I use a combination of a monopolar radiofrequency (RF) sub-surface device and liposuction to improve submental fat and skin laxity in the neck. This combination produces excellent results for neck rejuvenation without surgery,” she said.

“Laser resurfacing with CO2 and Er:YAG lasers are still the gold standard for wrinkle reduction and improvement in skin quality,” Dr. Boen continued. “There is some downtime, but the results can last for years. In my clinic, we use a unique protocol to combine pico-based and and pulsed dye lasers with CO2 and Er:YAG to reduce photodamage and wrinkles, and restore skin quality. The most recent FDA-approved lasers are 1726 nm lasers to target the sebaceous glands, which are the root cause of acne.”

While the YAG laser was the first FDAapproved device for hair removal it still has a place in aesthetics today. “Laser hair removal is one of the most requested laser treatments in dermatology,” stated DiAnne Davis, MD, a medical and cosmetic dermatologist in Dallas, Texas. “Generally speaking, the 755 wavelength is used for hair removal on patients with fair skin types, while the 1064 nm wavelength is reserved for patients with skin of color.”

Dr. Davis also treats many skin concerns with energy-based devices. “Sunspots are another form of pigmentation and can be treated with intense pulsed light therapy (IPL). I also see a lot of patients for acne scars and use a multidevice protocol with a comprehensive plan to treat them,” she shared. “I use either ablative or non-ablative fractional laser devices to address acne scars on the skin’s surface, chemical peels (20% TCA) to treat the entire face, and subcision, which addresses scar bands that are underneath the skin to give rise to rolling acne scars. All of the treatments are performed on the same day as a ‘one and done’ procedure.”

“I utilize ablative lasers when appropriate for deeper wrinkles and when patients are looking to improve years of sun damage,” reported Emily Wood, MD, a board-certified dermatologist at Westlake Dermatology in Austin, Texas. “Non-ablative lasers are a workhorse for me because they help stimulate collagen to improve overall skin texture, address fine lines and acne scars. IPL is also one of my go-to devices to address skin tone, texture and pores.”

Dr. Wood explained that she also often stacks multiple modalities for customized results. “I have a three-dimensional approach using laser or IPL to improve skin tone and texture and micro-focused ultrasound with RF to produce collagen at a deeper level to improve skin laxity,” she clarified.

According to Dr. Wood, micro-coring technology is the next big thing in energy-based treatments. “It removes tiny cores of tissue to produce tighter, more youthful skin and is a great non-invasive treatment for lower face laxity and jowls,” she said.

 Energy-based treatments are showing promising results in the challenging world of neck and facelifts, as well as body contouring. Dr. Kent said he uses Emface from BTL Aesthetics (Boston, Mass.) to help lift the face by contracting and strengthening the muscles as a baseline treatment. “We may use RF microneedling to improve skin texture, RF-based subdermal tissue coagulation for neck contouring and to lift the jowls, and EmSculpt Neo (BTL) to build muscle and eliminate fat for body sculpting.

Complementary procedures are key to customizing benefits with energy-based devices.”

Energy-Based Technologies for Today’s Busy Practices

UltraClear^® from Acclaro (Smithfield, R.I.) is clinically proven and FDA cleared for use in dermatology and plastic surgery. Uniquely powering the first-ever Mid Infrared Cold Ablative Fractional Fiber Laser (3DMiracl^™) modality, this sophisticated 3DIntelliPulse technology treats multiple skin layers from the stratum corneum and epidermis to the mid and deeper dermis. Practitioners have a range of options from lunchtime treatments to more advanced Laser-Coring^™ for deep collagen remodeling. “The UltraClear system is expected to set new standards in dermatology,” said Tina West, MD, a board-certified dermatologist and founder of the West Institute (Chevy Chase, Md. and Aspen, Colo.). “My patients enjoy a transformational effect on their skin’s appearance, texture, glow and health. This device is a game-changer in our personalized approach to total skin rejuvenation and health.”

Combining 589 nm and 1319 nm wavelengths into one handpiece, the ADVATx laser from ADVALight (Copenhagen, Denmark) is creating a gold standard for treating vascular abnormalities. According to Suneel Chilukuri, MD, a dermatologist and director of Refresh Dermatology (Houston, Texas), ADVATx has over 20 FDA clearances with a high safety profile. “I use it often for rosacea and hyperpigmentation,” he reported.

“This sophisticated laser is easy to operate with preset treatment parameters for popular indications and the nanopulse technology allows me to effectively treat my patients without the inflammatory response.” Dr. Chilukuri explained that ADVATx delivers gentle pulses of energy that the skin perceives as a single pulse.

“Overall, this is one of our most reliable devices with no consumables, no downtime and high efficacy.”

According to Janine Hopkins, MD, a boardcertified dermatologist in Monroe, La., the innovative Fotona 4D laser treatment from Fotona (Farmers Branch, Texas) has added another dimension to her dermatology practice by providing her patients with an outstanding, nonsurgical procedure to smooth and tighten their skin for beautiful results. The SP Dynamis is a versatile laser system with Nd:YAG technology for skin rejuvenation and body contouring, and the power of Er:YAG for skin resurfacing. With functions ranging from superficial to deep peels and non-ablative to fully ablative treatments, physicians can tailor treatments to any specific skin condition.

 

The Fotona4D facelift is achieved by combining these lasers for a noninvasive treatment that rejuvenates and tightens the skin from the inside out.

The Hollywood Spectra^™ from Lutronic (Billerica, Mass.) is an advanced, ultra-short 1064 nm / 532 nm laser built with nano-acoustic advantages in both full-beam and microbeam energy delivery. The Spectra Mode uniquely enables the Instagrammable Hollywood Laser Peel^® and AcnePeel^™, popular treatments for the Gen Z and Millennial generations, which are important for practice growth. According to Irina Damyanidu, chief executive officer (CEO) of The Hebe Medspa in Fishkill, N.Y., the Hollywood Spectra is an advanced laser technology with safety features like a square spot size to minimize the risk of thermal damage to the surrounding skin, and adjustable fluence settings for customization based on the patient’s specific needs and the area treated. “The advanced laser technology of Hollywood Spectra results in higher patient satisfaction and improved treatment outcomes, which has resulted in positive reviews and testimonials from satisfied patients,” she said.

As an FDA-approved laser with an advanced 532 nm system and solid-state KTP diode laser, DermaLight from NewSurg (Sellersville, Pa.) requires no disposables or expensive service contracts. According to Philip Loria, MD, a dermatologist at Oxford Dermatology (Oxford, Miss.), DermaLight has excellent utility in the treatment of facial veins, redness and pigmented lesions. “It is very quick and efficient. There is essentially no downtime and very significant results with one to two treatments,” he said. “It does not create purpura and we get great results on vascular and pigmented lesions. Overall, the DermaLight KTP laser system is a compact, reliable and effective device that safely treats vascular and pigmented lesions on all skin types.”

Sylfirm X from BENEV (Mission Viejo, Calif.), an FDA-registered pulsed wave (PW) and continuous wave (CW) RF microneedling device, features 300 micron depth for advanced skin revitalization, with proven effectiveness and safety through over 25 clinical studies. “This device has increased patient retention and referrals while allowing for more daily appointments, which has positively impacted both patient care and our bottom line,” reported Jessica Christy, PA-C, owner of Beauty Culture Spa (Bloomfield Hills, Mich.). “Incorporating the Sylfirm X has been a game-changer for us. It has broadened our range of treatments, making us a one-stop shop for skincare, and it is an investment that pays dividends in patient satisfaction, clinical outcomes, and ultimately, the success of our practice.”

Scarlet SRF from Aesthetic Management Partners (Cordova, Tenn.) is a next-generation short-pulse radiofrequency (SRF) microneedling treatment that produces noticeable tightening results and dermal remodeling to improve skin texture and achieve overall face and neck regeneration. Non-insulated microneedles treat the entire length of the dermis for a comprehensive procedure, while achieving independent tissue coagulation around each needle, also known as the ‘Na Effect’. With the Scarlett SRF, physicians can treat fine lines and wrinkles, large pores, hyperpigmentation and acne scarring with safe, comfortable and effective treatments. With over 500,000 treatments having been performed globally, the results achieved with Scarlet SRF provide ideal solutions for the most common aging concerns on all skin types.

Looking at traditional microneedling, the cordless Collagen P.I.N.^® from Collagen P.I.N. (Louisville, Ky.) offers a precision dial that controls depths from 0 mm to 3 mm, providing an improved treatment experience. According to the manufacturer, the device offers a 6.2% higher puncture rate with 14% more speed than many other similar devices. “Collagen P.I.N. is my goto device for the treatment of perioral rhytides, scars and striae. No other mechanical microneedling device compares,” said board-certified dermatologist Tina Alster, MD (Washington, D.C.). “Patients have noted marked improvement of perioral rhytides, stretch marks on the body and scars resulting from acne, surgery, or trauma, and are pleased with their quick recovery. This reputation has made Collagen P.I.N. one of the most common procedures in my office.”

Secret^™ DUO by Cutera (Brisbane, Calif.) offers dynamic facial revitalization for expanded skin types and little to no downtime. This device combines dual non-ablative fractional technologies: Secret RF microneedling paired with a 1540 nm erbium glass laser, in one platform. Each modality can be used individually or in combination for highly effective non-ablative facial rejuvenation. “We use it for building collagen, to reverse signs of aging, and even to help with remodeling scars,” reported Ashish Bhatia, MD, a board-certified dermatologist in Itasca, Ill. “Both modalities can be used with any skin type at any time of the year, so this device has been a great addition for providing meaningful rejuvenation with minimal downtime.”

Oligio, distributed by AMA Meditime (Brea, Calif.), uses monopolar RF to help patients achieve skin enhancement and lifting. It is an advanced, high-frequency device operating at 6.78 MHz and is designed to target the skin’s dermal layer, promote collagen production, and enhance elasticity in a treatment that is less invasive than RF microneedling and thread lifts. “Patients notice the cheeks are lifted and the jawline appears tighter,” said TJ Tsay, MD, owner of Ageless MD in Tustin, Calif. “There is an immediate effect which we show our clients after performing just one side of the face, and a delayed effect four to six weeks later when collagen is produced. Oligio offers yet another option in our toolbox to lift and tighten the skin with no downtime whatsoever.”

Plasma devices for skin revitalization continue to evolve, but the NeoGen PSR, manufactured by Energist (Swansea, U.K.) and distributed in the U.S. exclusively by Emergent MedTech (Hudson, N.H.), stands alone. Unlike coronal discharge devices, which use electrical current paired with atmospheric gases to form a plasma spark, NeoGen PSR proliferates planar and volumetric collagen and elastin, and restores hyaluronic acid (HA). “Nitrogen Plasma is a source of thermal energy that is highly conductive. The heat released from this plasma has a profound effect on the architecture of the skin,” said Shaun Spanos, NP, and co-owner of Shaun Charles MedSpa (Wakefield, Mass.). “We have treated over 3,200 clients and consider NeoGen’s results to be absolutely unrivaled in the medical aesthetic space,” added co-owner and business manager, Jeff Spanos.

Another plasma device on the market is PlaDuo^™ from SHEnB Co., Ltd. (Seoul, Korea). PlaDuo is an instrument used to coagulate tissue using RF energy. “Plasma is currently being used to treat various skin lesions based on the theory of tissue changes caused by nitrogen plasma,” said Sung Bin Cho, MD, PhD from Yosei Seran Dermatology and Laser Clinic in Seoul, Korea. “Low-level nitrogen plasma stimulates tissue changes and regeneration in the epidermis and dermis without excessive thermal coagulation or necrosis and reaches the sebaceous glands through hair follicles to trigger cellular changes. One study showed it can be a very effective treatment for excessive sebum secretion or large pores accompanying acne. Five treatment sessions are recommended for all indications. Most patients see the results quickly after one to five treatment sessions.”

Known for its highly effective PLEXR Shower, PLEXR Plus from MedResults (Glendale, Calif.) is an FDA-cleared medical plasma device approved in over 60 countries. This device allows physicians to offer both ablative and nonablative treatments with a triangle tip to cover a wide spot size, so the entire face can be treated in just five minutes. “I use PLEXR Plus for skin rejuvenation and skin tightening,” said Maryam Hekmat, MD, the founder and medical director of VIP MedSpa Clinic in San Diego, Calif. “I have used PLEXR Plus for shrinking of the large pores on the nose and cheeks and in combination with injectables like fillers to help with volume loss or PDO threads for lifting, with great results.”

Synchronous Ultrasound Parallel Beam, or SUPERB^™ Technology, drives Sofwave^™ from Sofwave (San Clemente, Calif.), a non-invasive treatment that remodels collagen and improves facial lines and wrinkles. Ultrasound technology is used to create cylindricalshaped thermal zones that penetrate 1.5 mm into the dermis for a full and effective treatment. This device is FDA cleared to lift the brow and neck tissue, lift lax skin under the chin, reduce fine lines, and the appearance of cellulite. “Because people age in a multifactorial way, I need to address it in a multifactorial way,” said board-certified dermatologist Doris Day, MD (New York City, N.Y.). “This device targets lifting without destruction and allows me to layer my other products. We notice a nice lifting effect to the brows – sometimes 2 mm to 3 mm – and the jawline is smoother because of the lifting effect to the lower face.”

EON, manufactured by Dominion Aesthetic Technologies, Inc. (Houston, Texas) and distributed by Monarch Aesthetics (Laguna Hills, Calif.) is a technological benchmark in touchless, robotic laser contouring and FDA cleared for abdominal, flank, thigh and back fat reduction. “Since COVID-19, our demand for body contouring has gone up dramatically, but not every patient wants surgery,” reported Gregory Buford, MD, a board-certified plastic surgeon in Englewood, Colo. “EON is a perfect bridge to body contouring for patients who are either not surgical candidates or not interested in surgery, and it has been a feeder to our surgical practice. There are no consumables, no pain and no risk for paradoxical adipose hyperplasia (PAH). The robotic no-touch arm helps patients feel more secure as it hovers above the treatment area and applies laser energy and jet cooling to the site. Adding EON to our body contouring menu has increased our versatility and capabilities.”

UltraSlim^® by Photonica USA (Cocoa Beach, Fla.) represents a breakthrough in noninvasive body contouring and fat reduction. Backed by clinical trials where 98% of patients lost at least two inches2, this FDA-cleared device is safe for all skin types. It utilizes advanced photonic technology that targets and stimulates fat cells, prompting them to release stored fatty acids, resulting in immediate loss without pain, discomfort or downtime. “Non-invasive fat loss and skin tightening are the future of skincare and UltraSlim is the safest, most effective of these modalities that I have seen,” said Sheila Barbarino, MD, an oculoplastic and cosmetic surgeon with practices in Austin, Texas and Redondo Beach, Calif. “My patients have a significant reduction in recovery time from having surgery and procedures like nothing else, which means they come in for more surgery and more procedures.”

The Z Wave by Zimmer MedizinSystems (Irvine, Calif.) is making waves in the aesthetic industry with applications spanning from cellulite reduction to post-procedure recovery enhancement. A Class 1 device, Z Wave is renowned for the temporary

reduction of cellulite appearance and can improve, and even resolve, capsular contracture post-breast enhancement surgery. Powerful sound waves radiate deep into the tissue, stimulating lymphatic drainage and enhancing blood circulation making it an ideal treatment for postliposuction and postcryolipolysis. Rakesh Nanda, MD, medical director of Jiva Med Spa (Columbus and Dayton, Ohio), reported that the device replaces the uncomfortable and sometimes painful postcryolipolysis massage. “With cryolipolysis alone, fat in treated areas can be reduced by 20% to 25%,” Dr. Nanda reported. “But when Z Wave is added, those results are bumped up another 8% to 10%, reducing fat by 28% to 35%.”

 

 

 

 

References:

1. Energy-based Aesthetic Devices Market Share, Trends - 2032. Global Market Insights Inc. Published June 2023. Accessed September 8, 2023. https://www.gminsights. com/industry-analysis/energy-based-aesthetic-devicesmarket#:~:text=Energy%2Dbased%20Aesthetic%20 Devices%20Market%20size%20was%20valued%20 at%20USD  

2. NCT02867150 at Clinical Trials.gov

Why does the word ‘government’ seem to invoke mixed feelings when we hear it? In simple terms, government is supposed to be there to protect us from those negative antics that happen if we are not careful. We must have an authority that sets standards for everyone to comply with rules and regulations, but interestingly there are many different rules all within our own government which vary from state to state, commonwealth to commonwealth and locality to locality. Let’s take a look at what the federal and state/ commonwealth governmental regulations consist of in our industry:

Labor Laws

These laws include, but are not limited to:

• Minimum wage and hour standards as well as paid time off (PTO) set by both federal and state regulations.
• Workers’ compensation standards (set by states).
• Health insurance (rates are set and approved by state insurance commissions).
• Occupational safety and health (OSHA) set by federal guidelines.

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA encompasses the federal government laws set to protect the rights and privacy of individual’s protected health information (PHI). Specific standards have been in place since its inception in 1996 and are not optional. Failure to follow these guidelines can create severe monetary civil penalties from the federal government in addition to the lawsuits than can evolve from the patients whose PHI was violated.

State Regulations Regarding Who May Perform Services

There are different regulations from state to state on who may perform medical services even under the direction of a medical director. While in many states a registered nurse (RN) may inject dermal fillers, neurotoxins and perform laser treatments, nonetheless they may not in other states. A good faith exam must still be performed by a non-RN licensed medical professional such as a physician assistant (PA), nurse practitioner (NP), or medical doctor (MD or DO).

Example: In Fla., only a PA, NP, MD or DO may perform these services with the exception of laser hair removal. An aesthetician with an electrologist certification may perform laser hair removal treatment, but only under the guidance of a good faith exam performed d by the above licensed medical professionals.

State Regulations Regarding Who May Own a Medical Practice

The rules vary from state to state. Corporate Practice of Medicine (CPOM) law defines that persons without a medical license are prohibited from employing physicians or owning a medical practice with a physician to provide medical services.

Example: In Texas, a physician must own 100% of the medical practice while in Calif. a physician must own 51% and another licensed medical professional may own the remaining shares.

In Fla., a corporation or non-licensed medical professional may own a medical practice as long as it is not registered as a Professional Association, Professional Corporation or Professional LLC.

In conclusion, always be sure to check with your state and federal authorities to see how your practice is affected by regulatory guidelines. Being judicious in the beginning can save you time and headaches on the back end.

Sponsored By BENEV;

Radiofrequency (RF) is a mainstay in medical aesthetics thanks to its thermic effect on skin. RF-based treatments lead to the improvement of the appearance of aging skin with collagen stimulation and elastin production deep in the dermal layers for ongoing results. Popularity of RF is only increasing due to its effectiveness as well as the lack of downtime that today’s busy patients demand. Persistent efforts from aesthetic physicians to provide greater treatment results with fewer complications and little to no downtime have contributed to the overall rise of energy-based devices.

According to the latest market research, RF-based aesthetic devices are a leading category, with a market size that is expected to grow at an estimated compound annual growth rate (CAGR) of 12.11% between 2023 – 3031, to reach over $3.7 million by 2031^.1 Today, RF microneedling devices are a staple in many cosmetic offices thanks to their versatility and ability to rejuvenate the appearance of aging skin.

Sylfirm X RF Microneedling System

Rising to meet consumer demand, the proprietary Sylfirm X device by BENEV (Mission Viejo, Calif.) is an FDA-registered pulse wave (PW) and continuous wave (CW) RF device that targets skin laxity and pigmentation for ultimate skin rejuvenation. With over 25 clinical studies, the Sylfirm X has adopted a system using bipolar, non-insulated microneedle electrodes to target the dermal layers with a uniform electric field to maximize treatment results. According to Suneel Chilukuri, MD, dermatologist and director of cosmetic surgery at Refresh Dermatology, there are 20 different RF microneedling devices in the U.S. that are approved by the FDA. All of them are slightly different, but Sylfirm X is the only RF device with two very unique features. “It allows for a penetration of 300 microns, which is ideal for treating pigment issues or erythema, and penetration that reaches up to 4 mm to promote color correction and collagen remodeling,” he explained. “Most RF microneedling devices offer continuous waves rather than a pulsed wave, but Sylfirm X offers both.”

With these exclusive features, physicians can treat more patient concerns on a wider range of skin types. But the Sylfirm X offers even more. “Each needle tip has a polarity to it, allowing it to go between positive and negative energy,” Dr. Chilukuri continued. “The effect is that we can lift the skin and reset it. With the Sylfirm X, I can lift where the cheek sits, lift the skin of the neck and even lift the fascia of the frontalis to provide an appearance similar to an eyebrow lift.”

TJ Tsay, MD, medical director and owner of Ageless MD (Tustin, Calif.) pointed out that Sylfirm X uses non-insulated tapered needles that deliver efficient energy to each individual needle, creating a teardrop coagulation zone around the needle. “This offers the best skin tightening and collagen stimulation possible,” he said.

The ‘Na Effect’

Sylfirm X was the result of research by leading Korean dermatologist Jongiu Na, MD, who found that tapered needles deliver more energy to the needle tip, while limiting the energy to the skin’s surface.

As Dr. Tsay explained, “The ‘Na Effect’ is the result of focused, independent tissue coagulation around each microneedle electrode. While other RF systems produce a widespread area of coagulation – leading to an ineffective treatment – the ‘Na Effect’ of Sylfirm X allows for more efficient RF energy to be utilized to its full potential.”

Gretchen Frieling, MD, owner of GFace MD (Wellesley, Mass.) described the importance of the ‘Na Effect’ for dermatologists and their patients. “The ‘Na Effect’ identified by Dr. Na describes the independent electrothermal coagulation around each electrode of bipolar RF,” she explained. “With the non-insulated microneedles, you have complete coagulation in the dermal layer, immediate contraction of old collagen fibers and long term neocollagenesis. There is no thermal damage in the epidermis, no bleeding and no downtime. And because of its ability to penetrate 300 microns deep, SylfirmX is the only device that can treat the epidermis, basement membrane and papillary dermis at the same time.”

Science and Technology of Sylfirm X

According to H. William Song, MD, founder and medical director of Omni Aesthetics (Oakland, N.J.), there are several features that allow Sylfirm X to achieve targeted results with little risk and little to no downtime. “The energy delivered by this device is very precise, so the risk of complications is much lower than with the competition,” he clarified. “The non-insulated needles, coupled with the precise distribution of energy, deliver lower heat through the length of the needle instead of just the tip. This allows for linear vectoring, which is not possible with insulated needles that deliver a lot of energy.” Dr. Song also mentioned that the needles stay sharp and are thinner and stronger, allowing smooth insertion and a treatment that is less painful than the staple-like stamping movement of some devices.

 Sylfirm X is equipped with four CW modes and four PW modes, each supported by numerous clinical studies that show the efficacy and safety of the device.² CW modes result in a greater delivery of stable RF energy for wide, independent coagulation around each electrode, from the deeper dermis to the upper dermis. The result is optimal skin revitalization for firmer, more youthful looking skin. PW modes target fibroblasts to strengthen the base membrane and reduce abnormal blood vessels with no noticeable effect on surrounding tissue. Physicians are also noticing the technology of the device. “The actual physical platform of the device is aesthetically pleasing, and the screen is very user friendly,” Dr. Tsay began. Whether you want to deliver a CW with a shorter pulse width, or address more vascular lesions, or inflammatory acne with the CW mode, the parameters can be easily adjusted.

“I also like that there is not a shot count limit for each tip as in other RF microneedling devices I have used in the past,” Dr. Tsay continued. “So I can deliver as many shots as I want for each patient without worrying about reaching a limit, which then forces you to purchase another tip by a certain number of shot counts.”

Sylfirm X Treatment Protocols

Dr. Tsay shared that the Sylfirm X is a staple treatment in his office because it benefits patients of all age groups and skin types. “I can treat the 20-year-old patient with acne scars or inflammatory acne, 30-year-old patients with rosacea and large pores on their T-zone and 40-year-old patients with mild to moderate laxity,” he explained. “The 50- to 60-year-old patients that have deeper static rhytides can also see improvement with minimal downtime.”

Renato Saltz, MD, a board-certified plastic surgeon, and Michelle Young, a licensed master aesthetician at Saltz Spa Vitoria (Salt Lake City, Utah) use the Sylfirm X because of its versatility in treating a wide variety of patient concerns. They also appreciate that the device is comfortable and easy to use. “This device allows us to treat eyelids, which can be difficult, and has given us a scar treatment option,” Dr. Saltz shared. “We also have protocols and treatment plans that combine Sylfirm X and exosomes for my facelift patients. It improves my surgical outcomes and adds longevity to my results. Overall, this is a great addition in modern facial rejuvenation surgery.”

“We recommend one to three treatments per year for a deep, firming treatment,” Ms. Young noted. “Patients will see the effects of firmer skin with clearer skin tone and reduced redness in two weeks following the treatment. Scars will be softer, smaller and lighter in color. In addition, we use BENEV exosomes to shorten healing time, reduce inflammation and for a greater tissue build response due to the growth factor in the product. I put them in the refrigerator, so they are cold when applying, which feels nice, as well. I use half the bottle and send the other half home with them.”

Dr. Frieling shared that she has several specific protocols using Sylfirm X. “I recommend it with exosomes one week after poly-l-lactic acid (PLLA) treatments,” she mentioned. “For patients under 45, we recommend a threeweek interval between treatments. Over the age of 45, we recommend a minimum of four weeks, specifically to allow the fibroblasts to receive the signals to appropriately respond to the treatment. We apply exosomes after every treatment. BENEV exosomes are paramount in scar remodeling, skin rejuvenation, pigmentation regulation and hair growth. We also recommend intense hydration and repair serums after the treatment.”

“I often use Sylfirm X for patients with skin type V with icepick scars,” said Dr. Tsay. “In a typical treatment protocol, we would recommend four to six sessions using the CW mode with three passes spaced four to six weeks apart. We automatically bundle BENEV’s Exosome Regenerative Complex + (ERC+) exosomes as part of their treatment because it significantly reduces recovery time and calms down the skin’s inflammation after the treatment is done.”

Exosome Regenerative Complex and Exosome Regenerative Complex +

Exosomes are vesicles, rich in proteins and bioactive molecules that are responsible for cell-to-cell communication and facilitating the exchange of important proteins like ribonucleic acid (RNA) between cells. They have been studied in a wide range of skin conditions, including skin remodeling and wound healing, contributing to their advancement in medical aesthetic applications.

Exosome Regenerative Complex (ERC) and (ERC+) are unique in that the exosomes are powered by Exo-SCRT™ technology to separate and refine pure exosomes from stem cells. The result is a topical treatment that can be safely used to improve post-treatment healing or as a standalone and powerful regenerative treatment. These clinically proven, dual action complexes are post-care cosmetic solutions for topical use to promote a more youthful appearance.

Containing isolated and purified exosomes, both ERC and ERC+ are reportedly the only cosmetic exosomes that have been accepted by the Personal Care Products Council (PCPC), and International Cosmetic Ingredient Nomenclature Committee (INC). Also, the name ‘Human Adipose Stromal Cell Exosomes’ was given and published in the International Cosmetic Ingredient Dictionary and Handbook (INCI book). With a shelf life of two years, these highly absorbable exosomes contain the necessary vital components such as growth factors, peptides and amino acids to improve the quality of skin cells.

According to the company, BENEV exosome products promote skin cell proliferation by up to 80% in a dose-dependent manner. ERC+ can be used to hydrate skin and promote a more radiant complexion but is also effective for hair regeneration as it noticeably reduces hair shedding while promoting a healthy hair growth cycle.

As Dr. Frieling mentioned above, she uses ERC after every treatment. “We apply them in quadrants after the area has been treated,” she said. “We prefer to use a SteriTip® to apply them, which allows even distribution in a clean manner.”

Dr. Chilukuri incorporates both Sylfirm X and ERC+ into his hair regeneration treatments. “BENEV exosomes are the only exosome technology that we have seen with shortterm and long-term healing effects. I utilize the exosomes for hair regrowth,” he reported. “Platelet-rich plasma (PRP) is an effective treatment for hair restoration. In the past, I relied on PRP, but the problem is that some patients may not be ideal candidates. For example, if somebody previously used an anti-inflammatory, if they recently used aspirin or anything else that is going to affect platelet activity, they may not get as spectacular results if we use it immediately after a Sylfirm X treatment. But the ERC+ exosomes are consistent.”

“In my hair regeneration protocol, I apply the Sylfirm X at low energy settings into the scalp,” Dr. Chilukuri continued. “I then apply the ERC or ERC+ and with that we are getting incredible hair growth within a very short period of time; within about two, sometimes three treatments. This protocol has shown spectacular results for our patients.”

Patient Results

Sylfirm X standalone treatment results and patient reactions are truly impressive. “With treatments we are seeing the entire skin looks like it has been lifted up. It looks healthier with an improvement in skin luminosity,” said Dr. Chilukuri. “These treatments are very versatile, and I can effectively treat fine lines, even for patients with very fair skin types. We are also seeing an improvement in acne scars as well as lifting and improvement of the skin of the neck, so it does not look saggy. We see some change right after the first treatment, but the results do improve over time, especially about a month after the first treatment.”

Dr. Song has also noticed his patients’ reactions to Syfirm X treatment results. “Patients notice improvement in texture, pigment and pore size as well as tightening and lifting. It is important to let the patient know before the treatment that the full results take time and will continue to improve with each subsequent treatment. We also let them know that maintenance is required to keep up with the results,” he noted. “Results get better over time but sometimes patients can see lifting and tightening immediately after the treatment. For the first treatment, it is helpful to do one side of the face first and then have them sit up and see the difference between the treated and untreated sides.”

In Dr. Song’s opinion, patients should consider maintenance treatments in accordance with their lifestyle and rate of aging. “A younger patient who takes good care of their skin may want to do one treatment every year to maintain results, whereas the older patient who does not really do anything else may want to get a maintenance treatment every three months,” he added.

“We are seeing phenomenal results from resurfacing, tightening and dermal rebuilding aspects. We see brightening of melasma and lentigines,” reported Dr. Frieling. “By treating the entire thickness of the skin, you fortify the skin structure and integrity while also inducing neocollagenesis and dermal remodeling. With the addition of exosomes, we believe this is the strongest and most impactful anti-aging treatment available in the U.S. We also see significant improvement in scars, dermatitis and wound healing. Patients love this treatment! They are thrilled that it is not painful and that there is essentially zero downtime.”

Conclusion

Incorporating Sylfirm X into an aesthetic practice improves the patient experience and can extend benefits to an aesthetic business. According to Dr. Song, it provides his practice with an extra source of revenue which does not require the physician’s time. “Sylfirm X has been the best way for me to scale my practice using physician extenders,” he clarified.

Dr. Frieling concurs and added her take on the benefits. “It has allowed us to maximize the skin health of our patients, and as a dermatopathologist, this is of utmost importance to me and my team. It has demonstrated a powerful anti-aging technology that has improved our patient results and satisfaction.”

With the versatility of Sylfirm X, along with ERC and ERC+ topicals, BENEV continues to demonstrate its commitment to delivering technologies that exceed expectations and empower aesthetic physicians to offer patients the best in skin rejuvenation. With BENEV the future of aesthetics is happening now.

References:
1. Research, S. (n.d.). Radiofrequency-Based Aesthetic Devices Market Size, Share and Forecast to 2031. Straits Research. https://straitsresearch.com/report/radiofrequency-basedaesthetic-devices-market#:~:text=How%20big%20is%20 the%20radiofrequency,period%20(2023%E2%80%932031).
2. Data on file at benev.com