PH+

Beauty Link Marketing and Distribution

Silicone meets seaberry in PureHealPlus (PH+) in this new skin care product for scar reduction. Seaberry essential oil contains photomolecular compounds with anti-inflammatory, -oxidant, -viral and –microbial compounds that aid in dermal recovery. PH+ was designed to treat scars, burns, keloids and stretch marks, according to the company. The formulation, created by Dilip D. Madnani, M.D., F.A.C.S., and Konstantin Vasyukevich, M.D., is both dermatologist tested and hypoallergenic.

For more information: www.purehealplus.com

NEXT: DNAEGF Renewal

DNAEGF Renewal

It’s a science-based skin care product line designed by dermatologist Ronald Moy that includes a full DNA collection of products. According to the company, these product formulations use DNA repair enzymes to improve overall skin health with effective and clean ingredients.

Signature product DNA Defense SPF 50+ protects, heals/reverses photo damaged skin as well as damaged DNA, according to the company.

The DNA collection also includes:

• DNA Intensive Renewal
• DNA Night Renewal
• DNA Eye Renewal
• Regeneration Serum
• Foaming Gel Cleanser

For more information: www.dnaegfrenewal.com

NEXT: Redness Rehab

Redness Rehab Conceal + Correct

Dermelect Cosmeceuticals

It’s a multi-tasking, anti-aging cream formulated with multi-peptides, vitamins and hydrants for camouflaging redness and calming irritated skin, according to the cosmeceutical company. The cream is available in a universal, correcting formula and can be worn alone or under make-up.

For more information: www.dermelect.com

Dr. DayanChicago-based facial plastic surgeon Steven Dayan, M.D., says that plastic and cosmetic surgeons who look beyond the obvious in 2016 stand to have happier patients.

What does that mean? According to, Dr. Dayan, aesthetic physicians who only look at how a patient presents on the outside are missing something important: the patient’s mind. Look at the mind, says Dr. Dayan, who is well known and widely published for his “subliminal difference” concept, which suggests that what makes someone beautiful — and why — is subconscious.

Related: Subliminal beauty theory

“What’s happening with the mind when we’re doing these procedures?” Dr. Dayan questions. “If you’re following Botox, it’s now in phase 2 trials for treating depression. I’m not saying that plastic surgeons should treat depression. What I am saying is that what we’re seeing now is that we can likely affect mood with Botox.”

Dr. Dayan’s research today focuses on looking at how facelifts, neurotoxins and fillers affect the mind and mood. The facial plastic surgeon is author of The New York Times’ and USA Today bestseller, Subliminally Exposed: Shocking Truths about Your Hidden Desires in Mating, Dating and Communicating. Use Cautiously (Morgan James Publishing, 2013).

In This Article:

The Happiness Effect

Self-Esteem Doctors

The Happiness Effect

There’s good evidence from before the turn of the 20^th century that facial expression can affect emotion. The facial feedback hypothesis was first identified by Charles Darwin, who suggested that by freely expressing outward signs of emotion, we intensify that emotion. Repressing outward signs of emotion, softens it. American philosopher and psychologist William James later suggested that awareness of bodily changes activated by a stimulus is the emotion.

According to James, an intellectual thought without accompanying bodily changes is devoid of emotional warmth. And passion dies without one’s willingness to express it, according to Wikipedia’s Facial Feedback Hypothesis entry.

“… they were able to show that, if you frown, you become angry, and, if you smile, you become happy,” Dr. Dayan says. “There’s actually a disconnect — an uncoupling — in the limbic system of the brain between emotions and expression. So, if you don’t express anger, you don’t become angry.”

It’s also true that those around people who don’t express anger don’t recognize anger as much, according to Dr. Dayan.

“If you look at somebody and you can’t perceive if they’re angry, you don’t feel the anger. What happens is you spread this happiness effect. That’s what I think is happening when Botox is used to treat depression because it doesn’t seem to cross the blood-brain barrier. So, if Botox can do it, why can’t a facelift do it? Why can’t fillers do it?” Dr. Dayan says.

Dr. Dayan says he has looked at past pictures of all his filler and facelift patients. He has asked others to look at the before and after photos and tell him how they think the patients in the pictures are feeling. People report, for the most part, the patients look happier after they’ve been treated, he says.

“Why do they look happier? Are they actually happier, or do they just look that way? I think what happens is, when we get these treatments, we actually become happier because we either force a smile or prevent a frown. And our animated looks have more smiling or less frowning,” he says. “When people have big marionette lines, and we remove the marionette lines, not only do they look happier, I think they actually become happier.”

Self-Esteem Doctors

Self-Esteem Doctors

The thinking that cosmetic surgery can actually make people happier puts into question the concept that people have aesthetic procedures for vanity reasons, alone, according to Dr. Dayan. In fact, cosmetic surgery is not just for vain people.

“Who doesn’t want to feel good about themselves? School teachers. HIV victims. Kids with acne,” he says.

Using aesthetic medicine as a way to make people feel better, mentally, might someday be quantified and dosed. But we’re not there, yet, he says.  

For now, aesthetic physicians should recognize that cosmetic procedures are doing more than treating form and function.

“We’re affecting mind and mood. We don’t have all the science behind it, yet, but I think in the next five to 10 years we will. That’s why I’m saying look beyond the obvious,” Dr. Dayan says.

Some might not like to hear it, according to Dr. Dayan, but aesthetic physicians are mind and mood doctors. And they need to recognize their patients’ minds and moods.

“We’re self-esteem doctors. We may use surgery. We may use nonsurgical procedures; we may use skin care; or we may use nothing at all. But our job is to increase self-esteem,” he says. “I can do a perfect nose, but, if a patient is unhappy, I fail. Colleagues might think I’m great because I show a great before and after picture, but if the patient is unhappy, I’ve failed.”

Looking at the mind is no easy task. It takes work, patience and even retraining of doctors, Dr. Dayan says.

“We have mathematical formulas to make a perfect face, but I’m saying wait a second, that’s not our only outcome. Our result is not to get the perfect face. Even though we want it to be because we love beauty and art. A lot of patients want that. But that’s not the final outcome,” he says. “My success is based on the happiness of my patients. That’s what our marker of outcome should be: the patient’s happiness.”

Recent related studies by Dr. Dayan and colleagues:

Dayan SH. Mind, mood, and aesthetics. Aesthet Surg J. 2015 Aug;35(6):759-61. 

Dayan SH, Cho K, Siracusa M, Gutierrez-Borst S. Quantifying the impact cosmetic make-up has on age perception and the first impression projected. J Drugs Dermatol. 2015 Apr;14(4):366-74. 

Dayan S, Coleman WP 3rd, Dover JS, De Boulle K, Street J, Romagnano L, Daniels S, Kowalski JW, Lei X, Lee E. Effects of OnabotulinumtoxinA treatment for crow's feet lines on patient-reported outcomes. Dermatol Surg. 2015 Jan;41 Suppl 1:S67-74. 

Dayan SH. Coming face to face with our own bias. JAMA Facial Plast Surg. 2013 Jan 17:1-2.

Dayan SH, Arkins JP. The subliminal difference: Treating from an evolutionary perspective. Plast Reconstr Surg. 2012 Jan;129(1):189e-90e.

Dayan, Steven H. What is beauty, and why do we care so much about it? Arch Facial Plast Surg. 2011. 1(13): 66-67.

You could say nonsurgical cosmetic procedures have come a long way since the late 1990s. According to the American Society for Aesthetic Plastic Surgery’s 2014 statistics, nonsurgical procedures totalled 740,751 in 1997. In 2014, there were nearly 8.9 million procedures performed.

D. NiamtuSurgeons who have practiced cosmetic surgery for many years have witnessed significant paradigm changes, according to Joe Niamtu, III, D.M.D., an oral and maxillofacial surgeon with a practice limited to cosmetic facial surgery, in Richmond, Va.

“Twenty years ago, a cosmetic surgeon was just that: a surgeon. Nonsurgical procedures basically consisted of dermabrasion, and filler treatment was limited to bovine collagen [both of which were performed mostly by dermatologists]. It wasn’t that surgeons did not want to perform nonsurgical treatments; there just weren’t many that existed,” Dr. Niamtu says.

All that changed beginning in the mid-1990s, when nonsurgical and minimally invasive procedures blossomed. This, coupled with the public’s thirst for cosmetic procedures and instant gratification, opened aesthetic medicine to a mix of specialties, including not only plastic surgery but also dermatology, otolaryngology, oral and maxillofacial surgery, ophthalmology and others, Dr. Niamtu says.

Will the trend continue? We asked our Editorial Advisory Board to comment on how they think the big picture of less invasive procedures will take shape in 2016.

In This Article:

The Neck Down

Balance Is Best

Quick Fix Meets Reality

Evolving Techniques

The Neck Down

Dr. EmerBeverly Hills, Calif., dermatologic surgeon Jason Emer, M.D., says noninvasive devices have changed fat removal into a comprehensive result, including skin tightening, shaping and skin smoothing. That trend will continue, he says. Because, while the cosmetic surgery trend five and 10 years ago focused on filling lines and facial re-volumization, today’s patients are looking down at their necks, chests, hands, elbows, ankles and more.

Celebrities in skin-tight clothes and fitness trends are helping to fuel the consumer focus on body contouring. And companies are following the lead, according to Dr. Emer.

“I think companies are realizing they can’t just create devices for one thing. They want to create devices that either complement the other things that we have in those categories or [devices that do] a multitude of things, noninvasively with the least amount of downtime,” he says.

Dr. Emer says patients don’t just want fat removal in the traditional areas, including the stomach and thighs. They’re also looking into more shapely hands, elbows and knees. And they want tighter skin and less cellulite.

“For example, CoolSculpting (Zeltiq) is popular and effective for fat reduction, noninvasively. However it doesn’t really tighten much of the skin. If you combine CoolSculpting with other skin tightening devices — VelaShape (Syneron-Candela), Venus Legacy (Venus Concept) or even Thermi (Thermi) — you can get not only fat reduction, but you can get skin tightening. You can even get definition. In the case of the arms or the inner thighs, where people would typically have to go through more invasive procedures, they can do in the office and nobody would know they’ve had much done,” Dr. Emer says.

Dr. Emer says he might also combine devices, such as UtraShape (Syneron-Candela), which is fractional ultrasound for fat reduction, with CoolSculpting to enhance CoolSculpting’s effect and tighten the skin.

Balance Is Best

Balance Is Best

Dr. HirschCambridge, Mass.-based dermatologist and past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery, Ranella Hirsch, M.D., says today’s patients want balance. And, often, one procedure, product or device isn’t enough to achieve patients’ goals. 

“The idea isn’t to look tighter. The idea isn’t necessarily to look younger. The idea is to look better, and that’s a very different thought process. Five years ago, people would walk in and say, I want to look 10 years younger. Now, people often just want to look the best they can, but appropriate for who they are and what they are,” Dr. Hirsch says. 

Take fillers, for example. More targeted filler applications address specific changes in appearance, which have the ability to impact how people are perceived, according to Dr. Hirsch. The dermatologist used that targeted approach when she recently treated a 50-plus-year-old woman who had unsightly nasal-jugal folds. 

“There was a tremendous amount of puffiness, asymmetry and discoloration, and it really was bothersome to her because it really gave the impression of exhaustion and being sad all the time. And it wasn’t accurate [to how she felt or who she was],” she says. “Between judiciously selected soft tissue fillers and targeted laser treatments, she had a spectacular outcome and just looked like a rested, happy version of herself.”

With today’s array of fillers and more in the pipeline, cosmetic physicians use fillers at different planes of the skin, to address specific concerns. Some fillers are more oriented toward fine lines, others to volumization and still others to structure, according to Dr. Hirsch. 

“Very rarely now do you find that you’re using one product across the face. You have this beautiful assortment of products and that’s just going to continue,” she says.

Another advance on the filler and toxin front is product longevity, according to Boca Raton plastic surgeon Jason Pozner, M.D.

“We are getting to a more mature place with toxins and fillers. We have a nice bunch of products now. The next advance will be longer lasting toxins, like [products by Revance Therapeutics],” Dr. Pozner says.

Quick Fix Meets Reality

Quick Fix Meets Reality

Dr. FagienBoca Raton, Fla., oculoplastic surgeon Steven Fagien, M.D., says the hype of a quick fix is being tempered with the reality of expectations.

“Patient demand is somewhat dictating the direction of aesthetic medicine. People want minimally invasive procedures with minimal downtime and even reduced costs. And many of the options that are available have seen significant improvements in the way we’re rejuvenating faces. On one hand, that has driven the development of new products, which have fueled the industry. We’ve developed new products that are minimally invasive, injectable and even energy-based devices and procedures and so forth,” Dr. Fagien says. “However, the mixed message is that a lot of practitioners believe... that they’ve replaced some of the existing surgical procedures, which they simply do not.”

The attempt to respond to the public demand, according to Dr. Fagien, is somehow obfuscating the reality that something just cannot be corrected with a 30-gauge needle.

“And we’re seeing that not only in nonsurgical procedures, but also in minimally invasive surgical procedures, where surgeons trying to convince themselves and their patients that these are improvements over existing procedures or more extensive surgical procedures when they truly are not,” he says.

Blepharoplasty is one example.

“The attempt to rejuvenate eyes with fillers in my opinion, in some ways, has become a bit of a disaster. Many patients who get treated with injectables to the tear trough are not happy because it is not in many situations a sound solution to a very complicated problem. It is usually not a problem with the particular agent, per se, but rather a misunderstanding of the extent of what fillers can actually do here and what are the potential sequelae. Filling the lower lid with volume is not always rejuvenating. Yes, you can make some people look better. But you truly are not replacing or restoring or reversing the anatomic deficit,” he says.

Dr. Fagien says he sees patients daily who have been treated with fillers, including hyaluronic fillers or autologous fat, to the lower lid, and many of these patients are simply miserable and looking for better solutions.

“More often, they just want it out. The surgical procedures are often complex and it is not always easy to remove injected autologous fat. …Hyaluronic acid, fortunately, in most situations, you can reverse it with hyaluronidase, so you can cure some of the problems,” he says. “But another problem is sometimes people get dramatic eyelid swelling after they’ve had hyaluronic acid injected in the lower lid. Even if you remove the material, the swelling persists.”

The problem, according to Dr. Fagien, is that you’re taking a complicated problem of lower eyelid aging or tear troughs, which is not just a volume problem, and trying to solve it with just inflating it with filler.

Refining noninvasive techniques is helping to solve these issues, he says. The good news is newer fillers are being developed, which result in less swelling. And by using better techniques, physicians can avoid some of the problems of the older techniques in which practitioners injected tear troughs.

Dr. Niamtu says surgery remains king in his office.

“Many of my patients have been around the City and spent big bucks on noninvasive procedures only to remain disappointed with the result,” Dr. Niamtu says. “Other patients did appreciate small changes from noninvasive treatments, but now want a bigger change. Although, I go to meetings and hear lecturers say that noninvasive procedures are overtaking surgical procedures, it is not happening in my world or with many other surgeons.”

Dr. Niamtu says, for example, that while combined fat melting and skin tightening might someday rival surgery, we’re not there yet.

“In the meantime there exist many drawbacks. The biggest problem that I see with nonsurgical skin tightening [and] fat treatment, as well as Kybella [Allergan], is the inability to address excess neck skin. We can melt fat under the chin with freezing; we can melt fat under the chin with Kybella; but we can’t drastically affect the turkey gobbler skin and platysmal bands, and these are the main things patients want corrected,” Dr. Niamtu says. “I remain concerned about the over promotion of results from nonsurgical treatments.”

Evolving Techniques

Evolving Techniques

Nonsurgical options continue to evolve for the better, experts say.

One example: The pendulum with neurotoxins and fillers is reaching a point of balance. The trends with neurotoxins, for example, have gone from overtreatment to undertreatment. Now and into 2016, it’s more in the middle, according to Dr. Fagien.

“When we used to do neurotoxins in the forehead, it was dropping everyone’s brows, and they were unhappy. Then we backed off to almost no injection to the forehead, and that’s not good either because patients complain that they still have animation lines to the forehead. So, it the pendulum has to swing to the center, again, going from overtreating to undertreating and back to the middle with better technique,” he says.

Kybella is another example. Dr. Fagien, who was involved in the FDA studies for Kybella, says he and the other investigators in the clinical trials began by treating patients with what now seems to be significantly hefty doses in an attempt to get an efficacy endpoint in a reasonably short period of time.

“The drug dosing was safe and we treated patients every month. We’ve now realized you don’t always have to treat them that heavily or that frequently, and you can still get the same results with less cost. So, I think we’ve now backed off,” he says.

In 2016, Dr. Fagien says he is looking forward to the anticipated approval of a topical neurotoxin. His excitement, he says, is more around a topical’s ability to improve skin quality.

“I think, in general, we know that neurotoxins do more than just chemo denervate muscles. We know that they have some effect on the qualitative improvement in the skin,” he says. “But a topical as a chemo denervation agent for areas like glabellar frown lines probably isn’t likely going to work very well.”

Disclosures:

Dr. Emer is a consultant/luminary and does clinical trials for Syneron/Candela, Venus, Thermi and Kythera.

Dr. Pozner owns stock in Revance.

Q: What's Your Favorite Device?

Dr. EmerMy favorite surgical device is VASER by Valeant, it has transformed the way that I do liposuction. I am able to etch and sculpt the body, with very little swelling and bruising. In the past, surgical procedures for fat reduction were just about reducing local areas of fat ("problem" areas), but I have changed that to literally fully sculpting and contouring the body, creating muscular definition and being able to repair previous botched surgical jobs. It's quite an amazing result and there is no machine on the market that can deliver the type of results I can get with this.

For nonsurgical devices I love the Clear + Brilliant laser and Venus VIVA (radiofrequency). Both are fractional devices used for facial and body complexion, texture, pores and scars. Both are low energy and density so that all skin types can be treated including conditions like melasma and rosacea. They are very low downtime procedures and great for younger patients who want anti-aging and preventative treatments, as well as those who have had more agressive procedures like Fraxel or CO2 resurfacing who want to maintan their results. These are staples in my practice.

Lastly, I am VERY excited for the ProYellow 577 nm Solid State Laser, which is a fantastic new vascular laser that I am finding extremely effective for facial vessels and melasma.   

DISCLAIMER: This blog is the author's opinon only. The views expressed herein do not necessarily reflect the views of Editorial Staff.

It's been a bad couple of months for Sientra, the North American distributor of Silimed breast implants. And it's too bad because they're a scrappy young company that gave women additional choices when it came to breast implants for cosmetic or reconstructive purposes.

Just a little background before we get to Sientra: Silimed (not Sientra) is a Brazilian company that has been making silicone breast implants since 1978. In 2006, Sientra was founded to be the exclusive distributor of Silimed implants in the US. Sientra received their initial FDA approval for their round and shaped implants in 2012 and started selling breast implants to plastic surgeons. Sientra's entry into the market broke the existing duopoly of breast implant manufacturers in the US. Prior to Sientra, all implants used in the US were sold by Mentor, a subsidiary of Johnson and Johnson, and Allergan, the makers of BOTOX® Cosmetic and Juvederm®.

Unfortunately for Sientra, just as 2012 started out with good news of the FDA approval of their implants, it was also the beginning of their troubles. Once Sientra had a product to sell, they needed a workforce and many of the new Sientra employees back in 2012 were former Mentor employees. Apparently Mentor wasn't very happy about this. Mentor sued Sientra along with many of the former Mentor, now Sientra employees, in multiple states. In court, Mentor accused Sientra of corporate raiding and other anti-competitive tactics. Sientra prevailed when the jury disagreed with Mentor's argument. If Mentor was displeased before the suit, there were probably exponentially more displeased after losing the suit(s).

Related: Are saline-filled implants back?

Fast forward to 2015, September to be exact. A German inspection team, inspecting the Silimed factory in Brazil as a matter of course for Germany's version of the FDA, found impurities on the surface of the Silimed implants. Specifically, they found cotton and silica particles that are used in the processing and manufacturing of implants. While it has been known in the past that particulate matter exists on implants, these particles are sterilized along with the implant sterilization process. Per Sientra communications, "no reports of adverse events and no risks to patient health have been identified related to this matter. This finding has been reiterated by the foreign regulators reviewing this matter in their public announcements."

However, in an overabundance of caution while the manufacturing process was further evaluated, European and UK regulatory agencies revoked Silimed's certification for their implants in Europe. Because Sientra's implants are made by Silimed in a similar factory in Brazil, Sientra took the voluntary step of halting sales of their implants in the US. The FDA did not require Sientra to halt sales but they did agree with this cautious course of action.

On the surface, no pun intended, it appears that the presence of particulate matter on implants was discovered incidentally by the German inspection team. However, based purely on hearsay amongst plastic surgeons such as myself, it may be Mentor who is behind this latest Sientra crisis. Through several sources, that don't include anyone associated with Sientra, the theory goes like this: Mentor obtained a Silimed/Sientra implant, presented it to the FDA's European counterpart to start this chain reaction of disqualification of Silimed implants in Europe which led to pressure on Sientra to voluntarily suspend sales in the US. Since no one "in the know" is talking, this is difficult to confirm. As of this time, Silimed's certification revocation in Europe remains in place and Sientra's voluntary halt in US sales continues.

But Sientra's troubles continue. At the end of October, the Silimed plant in Brazil that manufactures Sientra's implants was destroyed in a fire. The cause of the fire is not known, but Mentor is not suspected!

Finally, in a possible effort to remove the proverbial lightning rod that is the root cause of Mentor's ire, the founder and CEO of Sientra has stepped down as of November 12th, 2015. He is being replaced by an existing Sientra board member.

Whether Mentor is truly behind Sientra's troubles may only be determined through a more extensive investigation. If they are found to be responsible for bringing the European and US agencies into "particulate-gate," their plan may backfire. The presence of sterile cotton and silica on the surface of silicone implants is common to all three companies' manufacturing processes. That means that whatever change in regulations are required after the European and FDA's review is complete will ultimately affect Mentor and Allergan. So in a sense, Mentor may bring more regulation on itself. Aside from the fact that the presence of these sterile particles has not been shown to cause any adverse effects, implants are routinely washed in betadine or antibiotic solution prior to implantation. Therefore, the particulates are cleansed from the surface of the implant and never make it into the patient's body.

The draw of plastic surgeons to Sientra in the past has been their commitment to only selling implants to plastic surgeons. Allergen and Mentor will sell breast implants to any doctor. Surprisingly, there is no law against an ER doctor or ObGyn performing breast augmentation even though they lack training in the field of plastic surgery. Again, it's not illegal but you could argue it's morally reprehensible to perform an operation on a patient without proper training. By committing to only plastic surgeons, Sientra created a following of loyal surgeons. This and the fact that everyone loves the underdog has also helped their mystique and early success against the better financed and larger breast implant manufacturers, Mentor and Allergan.

Time will only tell but hopefully Sientra will survive these setbacks and prove that the little guy can win and underhanded tactics will lose out to honest competition.

Dr. Jonathan Kaplan is a board-certified plastic surgeon based in San Francisco, CA and founder/CEO of BuildMyBod, an online marketplace for healthcare services. 

Called a pre-periosteal midcheek lift, this technique involves the precise release of the retaining ligaments that separate midcheek soft-tissue spaces. This approach is non-traumatic and, therefore, has little downtime, according to the study.

From November 2009 to June 2014, authors Chin-Ho Wong, M.D., of Mount Elizabeth Medical Center, Singapore, and Bryan Mendelson, M.D., Melbourne, Australia, performed the midcheek lift procedure on 184 patients. According to the study, they used a transcutaneous lower eyelid blepharoplasty incision to access the pre-septal space:

• Medially, the orbicularis oculi origins and tear-trough ligament are released sharply, connecting the dissection with the premaxillary space.
• More laterally, the orbicularis retaining ligament is released, connecting the dissection with the prezygomatic space. With this release, the entire mid-cheek can be effectively lifted.

The fat pads were managed by transposition, excision or with septal resets as indicated. Canthopexy was performed routinely to provide lower eyelid support. Superolateral traction on the orbicularis oculi elevates the entire mid-cheek, and this is secured to the lateral orbital rim periosteum. Structural fat grafting can be done in cases where patients experience significant volume loss in the mid-cheek.

Releated: Factoring face shape into surgical facial rejuvenation

The authors write that all patients demonstrated a significant rejuvenation of the mid-cheek with elimination of the eye bags, elevation of the lid-cheek junction and the cheek prominence, and improvement of the nasolabial folds. According to the study, nearly all patients (96%) were satisfied with the procedure. Complication rates were low: Ectropion and lower-lid retraction had a 1% occurrence.

“The midcheek lift by means of the facial soft-tissue spaces is safe, effective and long-lasting,” the authors write. “As the dissection is atraumatic, recovery is quick and complications are minimized.”

The study appears in the December issue of Plastic and Reconstructive Surgery.

Galderma, known by plastic and cosmetic surgeons for such popular brands as Restylane, Dysport (abobotulinumtoxinA) and Sculptra Aesthetic, and CoolSculpting’s parent company ZELTIQ, announced early in December that the companies are collaborating on their aesthetic businesses.

"The ZELTIQ and Galderma collaboration presents a significant opportunity for cosmetic dermatologists and plastic surgeons who utilize CoolSculpting and aesthetic injectables, like Dysport. The partnership is designed to better serve healthcare providers and their patients by increasing awareness of these treatments, providing the opportunity for new patients to access and experience them through promotions, and helping grow and build the profile of the practice,” ZELTIQ CEO, Mark Foley tells Cosmetic Surgery Times.

Related: Aesthetics powerhouse Allergan merges with R&D-rich Pfizer

The collaboration, effective immediately, is not a merger, says a ZELTIQ spokesperson. Rather, each company will still remain the same, but will collaborate to promote especially CoolSculpting and Dysport. This includes creating connections between loyalty programs associated with Galderma’s aesthetic brands and ZELTIQ's CoolSculpting procedure.

"I am pleased this collaboration will result in greater access to these valuable products, as well as added benefits for my practice and patients through the ASPIRE Galderma Rewards and Crystal Rewards loyalty programs,” said Marina Del Rey, Calif., plastic surgeon Grant Stevens, M.D., in a press release about the collaboration.

Pfizer and Allergan announced in November that the pharmaceutical companies are merging. The result when the merger completes in mid 2016 will be the world’s largest pharmaceutical company, in what will be the second largest merger of all time, according to Dealogic.

READ: Allergan, Pfizer merger to boost R&D, cosmetic options

There are few cosmetic and plastic surgeons in the U.S. who aren’t Allergan customers, given the facial aesthetic and plastics-focused Allergan’s blockbuster brands, including Botox, Juvéderm, Kybella (deoxycholic acid) and the Natrelle line of breast implants.

Brent Saunders, Allergan’s chief executive officer, will be president and chief operating officer of the combined company, called Pfizer plc. Saunders told Cosmetic Surgery Times that the merger with Pfizer will mean more research and development funding and capabilities, to the tune of about $9 billion. That’s the size of the R&D budget for the combined company, which makes it one of the largest research budgets in the world. And part of that will go toward aesthetic brand innovation, according to Saunders.

Related: Galderma, ZELTIQ collaborate on aesthetics in U.S.

Allergan, he said, will continue, among other things, to research and develop different neuromodulator applications, improvements for its Juvéderm line of fillers and look to expand the aesthetic and therapeutic indications for Kybella.

“One of the things that I think is important is for us to continue the innovation in breast [implants]. There are not many players left in this space, and very few that are really committed to innovating,” Saunders said. “One of the things that I did when I took over Allergan was restart R&D in breast implants, continuing to look at both textures and molecular weight. I think we have some good programs that are getting underway, but I think we need to invest more. I hope that the combination allows us to continue more in innovation in not just breasts but other areas of need for the plastic surgeon.”

The merger, combining Pfizer’s strength in research and innovation and Allergan’s product development and commercial capabilities, could make the combined pharma company a world leader in the plastic surgery space. Allergan’s focus will remain in facial aesthetics and plastics, according to Saunders. 

Results of a recent study suggest that prospective body-contouring patients would be well advised to schedule their procedure on a day that doesn’t start with the letter S.

The study authors — plastic surgeons from St. Louis University School of Medicine and the University of Maryland Medical Center — note that while previous studies show worse patient outcomes on weekend admissions for non-emergent cases (spine, breast and hernia) involving plastic surgery, there is no comparative data regarding body contouring procedures. They write that since the increase in bariatric surgery has spurred a similar increase in body-contouring operations, it would be valuable to fill that data gap.

Using the Nationwide Inpatient Sample database from 2000 to 2010, the authors undertook a serial cross-sectional study of body-contouring patients. They gathered data, based on international classification of diseases, for liposuction and reduction of adipose tissue for weekday and weekend admissions, including demographics, hospital charges and patient outcomes.

Related: The nurse's role in body contouring

The data represent 50,346 hospital admission cases of inpatient body contouring, 98% of which occurred on a weekday. When compared to weekday admissions, weekend admissions were associated with a statistically significant increase in hospitalization costs ($35,481, p < 0.000) and length of stay (5.68 days, p < 0.000). Mortality rates were found to be higher on weekend admissions (3.7%) versus weekdays (0.5%) as well.

“Although outcomes are multifactorial in body contouring patients,” the authors write, “weekday admission is associated with favorable outcomes in terms of length of stay and hospital charges.”

The study was published in Aesthetic Surgery Journal.

Though more than 30 face transplants have been performed, little is known about long-term outcomes. However, a recent study suggests that transplanted faces change based on the recipient’s bone structure and age at an accelerated rate.

The study, headed by Bohdan Pomahac, M.D., of Brigham and Women’s Hospital and Harvard Medical School tracked three full-face-transplant recipients over 36 months. Notably, Dr. Pomahac led the team that performed the first full-face transplant in the United States.

“We observed a significant reduction of volume of the bone and muscle in patients who received facial allotransplants that is different than what we see with normal facial aging, which primarily affects the fat and skin of the face,” Dr. Pomahac tells Cosmetic Surgery Times. “This observation raises many questions, which we are beginning to explore. Countermeasures to reverse, delay or prevent this issue may improve future outcomes for these patients.

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“In the short term, our results may help to set expectations for future patients,” he adds. “In the long run, we hope to understand why this process is happening, and whether and how we should intervene.”

The American Journal of Transplantation published the study.