Sponsored by BTL Aesthetics

“Taut and Toned” is a procedure harnessing non-invasive modalities that, together, hit the golden triangle of body contouring: fat, skin and muscle. Using Emsculpt or Emsculpt Neo with Emtone, all offerings from BTL Aesthetics (Boston, Mass.), practitioners can take a powerful approach that is not just multimodal but multi-vector, for each indication. The result is amazing outcomes that startle physicians and patients alike as a stand-alone therapy, or in conjunction with other body shaping procedures, including surgery. Moreover, the protocol does wonders for cellulite and experts believe it is the best therapy to date for this common yet challenging-to- treat condition, without consumables.

Richard M. Goldfarb, MD Plastic Surgeon Owner The Center for SmartLipo Langhorne, PA

Diane I. Duncan, MD Plastic Surgeon Fort Collins, CO

Suneel Chilukuri, MD Dermatologist & Cosmetic Surgeon Medical Director Refresh Dermatology Houston, TX

“We do what we call ‘awake’ tummy tucks and panniculectomies, as well as laser-assisted liposuction, which provide excellent results on their own. But when we add Emsculpt Neo and Emtone, it removes more fat, smooths skin and builds muscle underneath for a better, smoother, more natural-looking result,” said plastic surgeon Richard M. Goldfarb, MD, owner of The Center for SmartLipo in Langhorne, Pa. “The muscle development is the previously missing component. In some cases, we see results that mimic high definition liposculpting because of the addition of Emsculpt Neo.”

“Once I had both Emsculpt Neo and Emtone, and saw this kind of combination possibility, I thought immediately how great it would be for moms after childbirth, who are still young and too busy for anything else,” said plastic surgeon Diane I. Duncan, MD, who practices in Fort Collins, Colo. “This protocol for muscle rebuilding, abdominal separation and skin tightening gives fabulous results.”

While Emsculpt Neo will provide improved muscle building over the original Emsculpt, the classic muscle stimulation platform does an excellent job, and users should not, in any way, feel excluded, according to Dr. Goldfarb. “We have done this protocol successfully with both Emsculpt and Emsculpt Neo. We use the Neo more now because we get additional improvement from greater muscle development and fat reduction. Still, it is the combination of the high intensity focused electromagnetic (HIFEM) energy and Emtone, whether using the original platform or the Emsculpt Neo, that gives us these great results.”

Dermatologist and cosmetic surgeon Suneel Chilukuri, MD, medical director of Refresh Dermatology in Houston, Texas, agreed. “The radiofrequency (RF) component with Emsculpt Neo is not used for skin tightening,” he began. “What I’m looking for is the reduction of fat and the way the RF improves the HIFEM result for better muscular hypertrophy and hyperplasia. The Emtone handles the skin and improves microcirculation, which itself can have benefits for any treatment where the body’s natural waste removal processes are in play.”

Although the combination of hormonal, genetic and lifestyle factors causing cellulite are not perfectly understood, the vast majority of women (90%), and 10% of men, will have cellulite, according to Dr. Chilukuri. “One doesn’t need survey results to know that nobody likes it, and everybody wants to get rid of it,” he stated. “Taut and Toned hits all factors contributing to cellulite. Its etiology has four components including fat pockets, dimples from fibrous septae, loose skin from aging and poor microcirculation. The fourth, usually untreated component is fitness, growing the muscle underneath to provide volume for better skin turgor and a natural-looking result.”

BTL’s Emtone combines targeted pressure energy (TPE) with RF to improve microcirculation in underlying tissue and surface skin quality through RF heat and mechanical manipulation. “Raising tissue temperature to between 42° C and 44° C will stimulate fibroblasts to produce more collagen,” explained Dr. Chilukuri. “TPE improves microcirculation and breaks up the fibrous bands at the same time.” These are traditional treatments for cellulite, and Emtone has been used for that indication since its inception. The biggest advantage, he added, is histologic proof showing that the combined treatment in one handpiece produces more collagen and elastin when compared to a serial treatment with the two technologies.

The muscle-building phenomenon known as Emsculpt has attracted physicians, patients and a growing body of competition due to its unequaled inducement of muscular hypertrophy and hyperplasia, and how these fantastic effects can have therapeutic quality-of-life benefits beyond the aesthetic. Its HIFEM energy can be used to non-invasively induce tens of thousands of supramaximal contractions of target musculature all over the body, including the extremities. Localized metabolic effects, which modestly reduce fat in the treatment area, are a side benefit as well.

The emergence of Emsculpt Neo, adding RF to the mix in a unique way, allows previously unseen simultaneous delivery of the two technologies with a remarkable synergistic effect. RF energy warms the muscle while causing subsurface heating to induce fat cell apoptosis; HIFEM stimulates the muscles, causing local energy deficits. Scientifically demonstrated reductions of fat, as well as improvement in muscle hypertrophy and hyperplasia, beyond what was seen with the original Emsculpt platform, were noted in clinical trials and make the platform a true game-changer. Even high-BMI patients, previously untreatable, may be viable candidates.

“Using Emsculpt and Emtone together in four treatments over two weeks, spaced at least 48 hours apart, works for any application of Taut and Toned,” Dr. Duncan stated. “We use Emsculpt first to go deep, then treat the surface with Emtone.”

The multifactorial nature of cellulite makes it difficult to treat, and nobody escapes it entirely, so a multifactorial approach is exactly what the doctor ordered. “Cellulite will always come back to a varying extent based on genetic, hormonal and lifestyle factors,” Dr. Goldfarb explained. “Treating all factors contributing to cellulite with a variety of modalities gives us the best overall effect. What is amazing about Taut and Toned is that these marked improvements persist for longer than I have seen with other cellulite treatments. And when patients do come back, they haven’t regressed to baseline, so it is easier to maintain with an additional session or two. This is the best I’ve seen for cellulite, hands down, in terms of outcomes and longevity of results.”

“This is a rare case of results often being better than expected,” said Dr. Duncan. “I had one woman who wanted a tummy tuck but opted for Taut and Toned instead, and after four sessions she looks amazing. If you can do something that non-invasively mimics a surgical result cost-effectively, with virtually no discomfort or downtime, it is the best option.”

Successful treatment will expose patients to other therapies the practice offers, further building the patient base – as long as you can deliver the results. “One unmet expectation based on a recommendation, and the patient’s faith in your practice can take a hit,” Dr. Goldfarb warned. “As a plastic surgeon, I have not been happy enough with anything non-invasive to confidently recommend it until I had this. I feel safe offering it for cellulite because not only am I confident enough in the result, but the lack of consumables means I can add a treatment if I don’t like the result to make it worth the patient’s while without adding much to the cost.”

“Single modality treatments are going to go by the wayside because there are unserved patients and unmet patient needs,” Dr. Duncan said. “BTL expands the patient base and meets those needs. I have people flying in from other places for cellulite treatment. One of my patients flew in and had previous therapies that didn’t do much. This gave her what I’d call a 98% result.”

Sponsored by Fotona

Using the next-generation SP Dynamis^®, StarWalker^®, or TimeWalker^® platforms from Fotona (based in the U.S. and Europe), laser peels and the LipLase^® treatment provide practitioners with simple, safe, effective skin therapy that is easy to perform and provide excellent results. They can provide stand alone treatment, or work with other proce- dures to improve the global outcome.

Fotona’s flagship SP Dynamis offers the most features with 20 handpieces and the widest variety of modes with either its onboard 1064 nm Nd:YAG or 2940 nm Er:YAG wavelengths. StarWalker features Nd:YAG and 532 nm KTP as well as 585 nm and 650 nm dye laser wavelengths with a variety of handpieces and modes, complementing the capabilities of SP Dynamis. The more accessible TimeWalker offers many of the core platform features combining the Nd:YAG and Er:YAG as well, allowing practitioners to per- form the vaunted Fotona4D^® protocol (which can also be performed on the SP Dynamis) and other therapies at a lower price point.

Martha H. Viera, MD Dermatologist Coral Gables, FL

Dermatologist Martha H. Viera, MD (Coral Gables, Fla.) uses TimeWalker to help her patients meet their skincare goals. “With the Er:YAG and Nd:YAG in TimeWalker, we have a variety of both aesthetic and medical treatments available,” she expressed.

For LipLase – a no-downtime lip plumping protocol without injectables – Dr. Viera uses the Er:YAG in SMOOTH^® mode, a series of ultra-rapid, low-fluence pulses that mimic a super-long pulse of 200 to 350 ms, without exceeding epidermal thermal relaxation time. This provides gentler heating and coagulation with very little ablative effect. “We see volumization and smoother texture, with better definition of the lip, vermillion border and cupid’s bow,” she began. “There is an immediate visible effect, and neocollagenesis creates additional, lasting improvement over time.”

Dr. Viera recommends a course of six treat- ments at an interval of one to two weeks. “You can compare the volumization effect achieved with this protocol to that of a single syringe of filler, without the potential side effects such as bruising so you can get back to activities, or even attend an event, the very next day,” she noted.

According to Dr. Viera, laser peels with Fotona platforms can vary in aggressiveness depending on the patient’s needs and tolerance for downtime, from resurfacing to treat fine lines and wrinkles, to a low-downtime light laser peel to refresh healthier skin in a younger adult. “In an elderly patient with deep lines I perform more aggressive resurfacing,” she noted. “We see tightening and reduction in depth of the lines, amazingly after only one treatment, though ideally we will have them undergo a series of three or four treatments at least. I use lighter peeling for mild refreshing of skin and collagen stimulation, depending on the patient. Even a light, non-ablative peel will smooth skin texture and provide a nice glow with maybe a few days of mild redness. A better result will come after five to seven days’ of downtime, but the more aggressive treatment will yield better results.”

Dr. Viera favors the Er:YAG in most cases. “With water as the chromophore, even with its ablative component, the effect is very superficial and healing is rapid. I may use the Nd:YAG in FRAC3 (pseudofractional) mode for a deeper collagen stimulation in the dermis as well,” she shared.

Dr. Viera’s most popular treatment along these lines is medium to superficial peeling, with less downtime. “Patients want to avoid recovery and downtime as much as possible, but those who choose downtime are very happy with their outcomes.”

Sponsored by Dp Derm

Shino Bay Aguilera, DO, a dermatologist who practices on Las Olas Blvd., in Fort Lauderdale, Fla., has extensive experience treating patients with sun damaged skin. To address skin quality and pigmentation issues, Dr. Aguilera often turns to microneedling, but he doesn’t stop there. He also adds infusions with megadoses of active ingredients, which are part of the MG Collection from Dp Derm (Miami, Fla.).

Shino Bay Aguilera, DO Dermatologist Fort Lauderdale, FL

“Dermatologists love microneedling because we know that we can improve skin quality without a lot of downtime,” Dr. Aguilera stated.

While microneedling alone improves skin by creating controlled mechanical injury, the open channels that the treatment creates offer an opportunity to “flood” the skin with active ingredients that have additional skin effects, Dr. Aguilera elaborated.

“I see the MG Collection as a megadose of active ingredients that have already been studied and used for hydration, to correct acne scars, improve stretch marks or treat pigmentation,” Dr. Aguilera explained. “The concentrations in this line are a lot more than in other products in this space.”

When Dr. Aguilera infuses the MG Collection active ingredients, which are targeted to alleviate specific skin issues, he has observed better and faster results than with microneedling alone. Another upside is that patients can continue with any of the five products in the MG Collection (MG- BL, MG-HA35, MG-HA35+, MG-R.A.S., MG-CLR) as stand-alone therapies to address their skin concerns.

Dr. Aguilera’s Go-to Combinations

To treat hyperpigmentation, Dr. Aguilera likes to use MG-BL, which features bioactives known to normalize melanocyte activity and prevent melanin overproduction. He often adds MG-HA35+ to the microneedling infusion. MG-HA35+ features 35 mg of hyaluronic acid per mL. “MG-HA35+ adds amazing hydration to the skin,” he emphasized.

Dr. Aguilera often uses MG-R. A.S. with MG -HA35+ on his own skin. “I like MG-R.A.S. because it has retinaldehyde, a vitamin A derivative, vitamin E and copper peptides. It provides results that are near those of a fractional CO₂ treatment when you have sun damaged skin, without the long downtime,” he commented.

Dr. Aguilera also favors MG Collection’s MG-CLR because he sees a lot of acne or problematic skin.

“The MG-CLR has niacinamide, licorice root, honey extract, vitamin C, Oligopeptide-10 and kojic acid,” he pointed out.

In addition, providers do not have to worry about aggravating active acne when microneedling problematic skin and adding MG-CLR.

“It will not only help with acne scars but also with blemishes, discoloration and inflammation,” he said. “I use the MG Collection not only for aesthetic indications, but also for rosacea, acne and melasma. Some patients love it so much when we use it in the office with microneedling that they want to take it home to continue using between microneedling treatments. And, while the particles in this megadose collection are small enough to penetrate the skin without microneedling, when you do microneedling, the MG Collection allows you to really flood that area with a lot of active ingredients.”

Sponsored by Air-Tite Aesthetics

Air-Tite Aesthetics (Virginia Beach, Va.) is proud to announce the upcoming release of two exciting new additions to their portfolio of specialty hypodermic products. Air-Tite is the U.S. distributor for TSK Laboratory, the source of this exciting and unique needle technology.

Susan H. Weinkle, MD Board Certified Dermatologist Bradenton, FL

Heidi A. Waldorf, MD Board Certified Dermatologist Nanuet, NY

These product advancements are the patented Low Dead Space (LDS) hub needles from TSK, and the ultra-thin 0.2 mm LDS needle, which is the smallest TSK needle to date.

What makes these needles different than the ones commonly used? A conventional needle hub may retain a sizeable dead space. This represents the amount of medicine that may be left unused in every injection. With the superior design of the TSK hub, the amount of dead space is reduced to nearly zero, leaving behind almost no wasted product. Over time in a busy practice, this could represent a potential cost savings with every box of needles used.

As well, the new 0.2 mm LDS needle is 33% thinner than the popular TSK 30G needles, which may provide a more comfortable injection experience, while potentially reducing the risk of bruising for aesthetic patients.

The LDS 0.2 mm needles have received accolades from physicians already familiar with this technology. In a recent interview Susan H. Weinkle, MD, a board certified dermatologist from Bradenton, Fla., remarked, “I have been using TSK for many years. The Low Dead Space 0.2 mm thin needles are excellent! If you use this needle, your patients will love you! You can’t even feel it. It is absolutely what [neurotoxin] injections have been calling for.”

Similarly, Heidi A. Waldorf, MD, a board certified dermatologist in Nanuet, N.Y., offered, “I was introduced to the TSK 0.2 mm Low Dead Space needles in Europe several years ago and can’t imagine injecting any neurotoxin or fine line filler without it. Patients who have been treated in other offices uniformly comment on the difference. It is almost imperceptible and a pleasure to use. My staff, my patients, and I are in love with the TSK 0.2 mm LDS needle!”

Editor's Note: The expected release date of these LDS products in the U.S. is late spring, 2021. Please contact Air-Tite customer service for more information.

Sponsored by Artemis Distribution

Body shaping treatments are continually evolving as the aesthetic industry searches for comprehensive therapies that address both health and aesthetics. At the same time, cellulite remains a top cosmetic concern for aesthetic patients, resulting in high demand for solutions. Artemis Distribution from Rye Brook, N.Y., offers Endosphères^® Therapy, a revolutionary mix of health and beauty that is rapidly becoming a patient favorite as a non-invasive treatment to address cellulite.

Katie Gross Business Manager and Partner CryoPure Spa Highland Park, IL

Jessica Abreu Owner Core Nutrition & Wellness Dobbs Ferry, NY

Chris Santos Owner Dr. Refresh Wellness Center West Hollywood, CA

Endosphères Therapy combines microvibration and micro-compression to break down fat fibroblasts and accelerate lymphatic drainage. The combined technologies restore physiological vascular tissue function, while increasing collagen and elastin production to effectively remodel and smooth the dimpled skin of cellulite.

As Katie Gross, business manager and partner of CryoPure Spa in Highland Park, Ill., explained, the application of compressive microvibration helps create a multitude of benefits. “The Endosphères handpiece includes a cylinder with 55 silicon spheres that are arranged in a honeycomb like formation to produce optimal results on the tissue,” Ms. Gross indicated. “The treatment area extends from the skin to the muscle and Endosphères uses the client’s muscle as active resistance, which leads to remodeling of the localized fat tissue and increased metabolism.”

Many aesthetic practices are finding success using Endosphères in combination with other treatments, such as cryotherapy, which destroys fat cells. Jessica Abreu, owner of Core Nutrition & Wellness (Dobbs Ferry, N.Y.) told us that adding Endosphères Therapy helps speed up lymphatic drainage to remove excess waste, including the dead fat cells. “We start by opening up the lymph nodes with the wand, then finish the session by using moves to tone the muscle and tighten the skin,” she said.

As for results, in Ms. Abreu’s experience, patients typically see results around the sixth to eighth session, but experience more than aesthetic benefits. “Patients generally feel results immediately, and many have reported regulated bowel movements, better moods and even pain relief within days of their first treatment,” she stated. Patient satisfaction is the dominant theme for both patients and aesthetic practices.

Ms. Abreu added that patients see best results with two sessions per week for a total of 12 sessions. According to Chris Santos, owner of Dr. Refresh Wellness Center in West Hollywood, Calif., which is currently in its second month of offering Endosphère Therapy, clients like what they see and feel even from the first session. This is prompting them to purchase session packages. “Endosphères is different because it wakes up the muscle underneath the fat,” he explained. “And, with basically no consumables, the machine is already paying for itself.”

When incorporating Endosphères into their patient protocols, aesthetic practices are both creative and comprehensive. At Dr. Refresh, Endosphères is combined with cryotherapy, a specific diet and post session body wraps for best patient results.

“Because each patient has a different body type and goals, it is important to take a personalized approach,” Ms. Gross shared. “We learned that the speed at which we were administering the service was the biggest factor in creating the best results for our clients.”

With outstanding results and high patient satisfaction, this completely non-invasive therapy sets Endosphères apart from the competition as an innovative approach for the treatment of cellulite.

Sponsored by MedixSysteme

Combining its signature Focused 3D Intensive Ultrasound with 635 nm low-level laser, SygmaLift 3D from MedixSysteme (Ruggell, Liechtenstein) reinvents non-invasive facial reshaping, providing physicians with the capability to rapidly remodel the face painlessly for patients of any age and skin type. Features include three distinct handpieces that each provide a unique aspect to treatment.

Nuttapol Larpcharoenkij, MD INFINIZ CLINIC Bangkok, Thailand

Kenneth Thean, MD Founder ENSOUL Medical Clinic Singapore

The overall purpose of the SygmaLift 3D protocol is to treat multiple tissue layers during each 30-minute session: the dermis at approximately 1.5 mm, subcutaneous tissues at 3 mm deep, the superficial muscular aponeurotic system (SMAS) at about 4.5 mm, and facial fat at approximately 5 mm deep. “The novel combination of high intensity focused ultrasound (HIFU) and low-level laser, seen only in SygmaLift 3D, provides powerful therapy at different depths while reducing inflammation,” explained Nuttapol Larpcharoenkij, MD (Dr. Aou) of INFINIZ CLINIC in Bangkok, Thailand. “This, and the lack of pain or downtime, are the main selling points of the treatment.”

According to aesthetic physician Kenneth Thean, MD, founder of ENSOUL Medical Clinic (Singapore), each HIFU handpiece (3D Spatula and 3D Trifocal) directs the focused ultrasound in a different way, while the 3D Laser handpiece emits low-level laser energy. “This allows us to treat in the X, Y and Z planes,” he said. “The HIFU delivers both thermal and mechanical effects for lifting, oxygenation of tissue and increased production of collagen and elastin.”

The 3D Spatula handpiece is best for lifting and tightening flaccid neck or cheek tissue, and recontouring the jawline. “This ultrasound handpiece is used to treat larger areas. Treatment depth is controlled by the device between 2 mm and 5 mm. The 3 mm and 4.5 mm depths are best used to target the dermis, SMAS, submentum and neck, Dr. Thean noted. “I use this to treat heavy jowls, as well as reshape the cheeks and jawline. The 5 mm depth excels for submental fat and double chin treatments. Reducing unwanted fat with concomitant skin tightening is a good nonsurgical option.”

The other HIFU handpiece, 3D Trifocal, also lifts and tightens and is ideal for periocular and brow treatment as well as reducing wrinkles around the eyes and mouth. “3D Trifocal can treat smaller areas,” Dr. Thean explained. “This allows more precise tightening and smoothing around the eyes, forehead and mouth. I use the 3D Trifocal transducer to lift the eyebrows, reduce eyebags, dark eye circles, crow’s feet and forehead lines.”

“Physicians estimate the depth of the SMAS and other tissue layers to choose the correct handpiece and select the proper energy level and treatment time for maximum results,” Dr. Aou said. He added that the 635 nm low-level laser energy of the 3D Laser reduces unwanted inflammation and stimulates cellular repair after treatment, encouraging healing for a radiant look, as well as a better overall result and experience. “The treatment experience is gentle and easy, contributing to patient satisfaction.”

Only a few sessions are required to produce results for most patients, according to Dr. Thean. “Remember, every patient responds differently. And, even if after careful pre- treatment assessment and patient selection, the results are not as good as expected, I find that I can get the desired outcome with additional 3D SygmaLift treatments. It is safe and easy enough to do that.”