The Aesthetic Society has released its 2021 predictions detailing what plastic surgery trends are expected in the coming year. With more than 2,600 board-certified plastic surgeons comprising its membership, The Aesthetic Society is at the forefront of research, education, and what lies ahead for the aesthetic industry. Insight from its members includes specific trends born out of the era of COVID-19, mask-wearing, and an uptick in video calls.   

"2021 promises to be a unique year for our specialty given the COVID-19 crisis," says Herluf Lund, MD, President of The Aesthetic Society. "Because so many people are working from home, they are able to have a surgical procedure, continue to work, and recover privately.  This represents an opportunity many patients have never experienced previously.  As we continue to spend more and more time on video calls, rejuvenation and enhancements to the face, eyes, and neck will likely be leading procedures this year. Our members are dedicated to safety and will continue to educate patients and physicians on safety protocols as we continue aesthetic surgery in 2021."

The Most Coveted Surgical Procedures:

Aesthetic Society surgeons predict jawline contouring will gain popularity in 2021. With people spending hours on screen time, complaints are rolling in from patients who are acutely aware of extra skin or fat underneath their neck. Now that virtual meetings and video calls are the new normal, patients want a sharp neck contour.

Liposuction is likely to surpass breast augmentation in 2021. The decreased access to health clubs and fitness group facilities has contributed to weight gain and people are going to look for options for improvement.

Men and Plastic Surgery:

Men will seek subtle surgical procedures with high impact like blepharoplasty. This procedure has been increasing in popularity over the past 10 years and can result in a younger appearance. With masks being incorporated in everyday style, eyes will remain the focal point of how we look.

Body contouring and liposuction remain extremely popular with men, especially now as many men do not need to be physically in the office for work— they can recover easily at home from procedures while still being on the job.

 

Read more here.

 

Source:

PR Newswire

When it comes to creating the “beautiful breast” via surgery, Eugene, OR plastic surgeon Mark Jewell, MD says one way to achieve an optimal outcome is through a lesser-known option called augmentation mastopexy—otherwise known as a breast lift–implant combination procedure.

“The typical ‘Masto-BAM’ or mastopexy and breast augmentation patient is on the more mature side,” explains Pasadena, CA plastic surgeon Lily Lee, MD. “They have lived long enough to have developed some sagging in their breast skin and lost volume in actual breast tissue. Of course, there are exceptions, as I have seen the rare young female, who has never been pregnant or breast fed, who genetically developed smaller breasts that are ptotic.”

Dr. Lee also points out that this particular procedure is really two surgeries in one and, similarly, it accomplishes two things: “One, it gives the breast more volume via enlargement with implants and, two, it creates a skin envelope that perfectly fits around the new volume.”

New York plastic surgeon Daniel Y. Maman, MD concurs and says that, usually, the woman he sees as a candidate has both breast ptosis (drooping and skin laxity) and deflation (loss of breast volume). “Doing a lift alone provides inadequate breast volume and projection, and doing an implant alone fails to address the skin laxity and ptosis.”

It’s a significant decrease in breast size—mainly due to pregnancy or weight loss—that Encino, CA plastic surgeon George Sanders, MD says is usually what propels a patient to seek this specific surgery. “They have less breast tissue and more skin, producing a deflated look. When the person puts on a bra to simulate an uplift alone, the breasts are lifted, but the bra appears empty. On the other hand, putting a large implant into the breast without a lift produces a larger, but still sagging breast, which is a poor outcome. The best option is a combination of lift and implant insertion.”

 

Read more here.

 

Source:

NewBeauty

A surgical team from NYU Langone Health performed a face and double hand transplant for a 22-year-old New Jersey resident severely burned in a horrific car crash. The surgery included transplanting both hands and the full face of a single donor. It marked the first successful combination transplant case of its kind in the world.

About the Procedure

The surgery, which began the morning of Wednesday, August 12, took approximately 23 hours—a total surgery time shorter than NYU Langone’s most recent face-only transplant for Cameron Underwood performed in 2018. A team of more than 140 healthcare professionals, including surgeons, nurses, and other staff, was once again led by Eduardo D. Rodriguez, MD, DDS, director of the Face Transplant Program, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, and chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone.

The recipient in this recent case is Joe DiMeo of Clark, New Jersey, who received third-degree burns over 80 percent of his body from a car accident in July 2018. Despite having approximately 20 reconstructive surgeries, DiMeo had extensive injuries—including amputated fingertips, severe facial scarring, and no lips or eyelids—that affected his vision and daily activities, and severely limited his ability to live a functional and independent life.

“Joe was an ideal candidate for this procedure; he’s extremely motivated and dedicated to recovering the independence he lost after his accident,” says Dr. Rodriguez. “Thanks to the institutional support we received here at NYU Langone and a world-class team committed to providing the best care for our patient, we’ve succeeded in a tremendous undertaking that shows we can continue to take on new challenges and advance the field of transplantation.”

A New Chapter for a Pioneering Program

This is the fourth face transplant performed under the leadership of Dr. Rodriguez and the first hand transplant under his direction. While two other simultaneous face and hand transplant attempts are known to have been performed, in each case there was an adverse outcome: one patient ultimately died due to infectious complications, and another required removal of the hands after they failed to thrive.

“Fundamentally, I viewed this as the same type of surgical exercise as our previous successful face transplants,” Dr. Rodriguez says. “I saw no reason why we couldn’t achieve this outcome to help improve Joe’s function and quality of life.”

 

Read more here.

 

Source:

NYU Langone Health

You asked; we listened! In a recent reader survey many of you asked specifically for review and coverage of clinical research and issues. Based on your feedback, we are excited to announce a new biannual series of articles that will summarize top aesthetic peer-reviewed literature, enhanced with commentary by an author. Two times per year we’ll share two to three top articles, chosen by the editors-in-chief of some of the most renowned journals in our industry. To kick off this new column, we are featuring two profound offerings, one from The Journal of Cosmetic Dermatology and one from the Aesthetic Surgery Journal.

Cutting Through the Haze Surrounding Injectable Neurotoxins

Injectable botulinum toxin, and its impact on aesthetic medicine, require no introduction. Products have been on the market for decades and new offerings continue to emerge. Manufacturers have funded an evolving body of scientific literature that establishes injectable neurotoxins firmly among the most well-studied therapeutic modalities in aesthetic medicine, but is it truly well-understood?

The reality is summed up in the abstract of an August 2020 review article by Nestor and colleagues¹ published in The Journal of Cosmetic Dermatology (JOCD): “The literature on botulinum toxin type A (BoNT-A) is extensive, often contradictory and confounded by a competitive market of product and research attempting to distinguish brand individuality.”

Mark S. Nestor, MD, PhD Director Center for Cosmetic Enhancement Center for Clinical and Cosmetic Research Aventura, FL

Bringing further clarity to the murky waters, the JOCD article updated the Eight Key Clinical Postulates first presented in a 2017 article in Dermatologic Surgery,² providing in-depth review of the literature and suggesting avenues for further study. It is a must-read for any physician interested in or actively injecting neurotoxins for aesthetic indications.

Lead author Mark S. Nestor, MD, PhD, is director of the Center for Cosmetic Enhancement as well as the Center for Clinical and Cosmetic Research, both located in Aventura, Fla. “We need to understand the science behind botulinum toxin so that we can assess the properties of different type-A toxins, in order to optimize patient care. This will help us differentiate between what the toxin does, what we do, and how we get the best outcomes putting this knowledge into practice.”

The updated postulates are listed in Figure 1. “The first key issue is Postulate I, that all type A toxins act identically,” Dr. Nestor explained. “The real difference between the products is what we’ve termed ‘molecular potency’ which is the actual number of 150 kDa molecules that are active, free, non-compromised and available to bind. It is kind of like octane rating for gasoline. That value is the key because all type A toxins are the same otherwise.

Different toxins have different amounts of 150 kDa molecules for the approved units for glabella, for example, and manufacturing procedures may make a product more or less aggregated; less aggregated means there is more available to bind.”

Another vital issue put forth is the importance of cost per molecular potency unit. “In the article we call this the molecular potency quotient,” he said. “This is difficult to assess because each toxin has proprietary units, and the trials are so often constructed differently with different assessments, different standards, different investigators and different methods of injection. Bear in mind that we are talking about toxins that we have established are basically the same. What we have is a huge body of literature whose value is limited by these confounding differences.”

The article also shared about how differing patient characteristics impact the result, as well as how and why specific injection techniques maximize the result by using less toxin more effectively. “Muscle mass, age and genetics – how many receptors are available and how the body recovers from the introduction of toxin – all play a role. What we do also matters. ‘Spread’ impacts the result, which is affected by reconstitution, needle size and injection technique – the direction and number of injection points, speed of injection and how we are distributing the toxin.”

“There is a lot of confusion surrounding ‘diffusion,’” Dr. Nestor continued. “Spread isn’t diffusion, which is passive and is the same for all toxins. The area of effect is the important clinical parameter and is determined by two things, the spread and the molecular potency. We use the example of sugar dropped from a height onto a surface. If you have more sugar, the pile will have a wider diameter because there’s more sugar.”

Editor's Note:

The original article Cutting Through the Haze Surrounding Injectable Neurotoxins, is open access and available online at https://onlinelibrary.wiley.com/doi/10.1111/jocd.13702

References:

1. Nestor MS, Arnold D, Fischer D. The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key clinical postulates II. J Cosmet Dermatol 2020;19:2785-2804.

2. Nestor MS, Kleinfelder RE, Pickett A. The use of botulinum neurotoxin type A in aesthetics: key clinical postulates. Dermatol Surg 2017;43:S344-S362.

 

Making the Brazilian Butt Lift Safer: Is Anyone Listening?

With the explosion of the Brazilian Butt Lift (BBL) procedure came the unfortunate, but not unforeseeable, side effect of overhyped, underqualified personnel attempting to capitalize on its popularity. What was not foreseen was that even among reputable practitioners of the procedure, the rate of complications and mortality was shockingly high. To curtail this, a series of treatment guidelines to maximize safety was put forth by the Aesthetic Surgery Education and Research Foundation (ASERF) and published in 2017¹. However, did surgeons adopt the new protocols, and did these recommendations help improve the mortality rate of BBL?

Luis M. Rios, Jr., MD Director                               Rios Center for Plastic Surgery Edinburg, TX

A 2020 study in the Aesthetic Surgery Journal² shed light onto whether surgeons were aware of – and hopefully adopting – the new guidelines, as well as uncover the potential effect, if any, on the mortality rate. Plastic surgeon and lead author Luis M. Rios, Jr., MD, is director of the Rios Center for Plastic Surgery (Edinburg, Texas) and the current president of ASERF. He served on the ASERF board of directors when the initial study was published. “In 2015 one of our board members from San Diego, Calif. received reports from the LA county coroner about deaths associated with the procedure, so ASERF put together a task force. This task force published a paper demonstrating that the mortality rate of BBL was higher than abdominoplasty, the riskiest aesthetic procedure at the time. The paper also established recommendations on techniques that could significantly reduce the risk of pulmonary fat embolism (PFE), the main cause of mortality.”

These recommendations included the use of cannulas greater than 4 mm, avoidance of downward angulation of the cannula penetration and avoidance of muscular injections with only injection of fat into the subcutaneous space.¹ “These findings were eye-opening, as the procedure was relatively new but increasingly popular, and, surprisingly, the negative aspects of these findings did not significantly hamper the prevalence of the procedure. However, the 2017 study was one of the most widely read articles published at that time, and some surgeons stopped doing BBLs entirely.”

As in the original 2017 study, ASERF conducted an anonymous survey among members of the The Aesthetic Society and the International Society of Aesthetic Plastic Surgery (ISAPS) comprised of the 15 closed-ended questions used in the initial 2017 survey, and adding 14 more to ascertain awareness, as well as adoption, of the new techniques put forth in the 2017 paper. Respondents were also asked about the number of fatal and non-fatal PFEs in their career and over the last two years since the ASERF recommendations were published. Of 5,048 members polled, 572 completed surveys (11.3%) were included in the 2020 study, somewhat less than the 14.3% response rate to the 2017 survey.

 

Results showed a decrease from 1 PFE per 1,030 procedures in 2017 to 1 in 2,492, with concurrent decrease in mortality from 1 in 3,448 in 2017 to 1 in 14,952. Of the respondents, 94% reported awareness of the recommendations. Other results showed dramatic decreases in the use of techniques that went against the ASERF guidelines. All told, this strongly suggests that not only were surgeons aware of the new guidelines, they were adopting them, with subsequent effect reducing the mortality rate.

Commentary by Oppikofer³ highlighted the importance of recognizing the limitations of the study – the main ones being the question of correlation between survey respondents (members of ASAPS and ISAPS) versus the plastic surgery community, and inherent response bias from those seeking to showcase their adoption of the new techniques. The commentary author admitted that nevertheless, the results were encouraging. “We used the tools at our disposal at the time, and there are definite limitations, but we believe these results do show that physicians are both aware of the 2017 recommendations and putting the new guidelines into practice for better, safer procedures,” Dr. Rios responded. “We are not finished, we currently have a software platform in the works that will help us anonymously assemble data, in a HIPAA-compliant way, directly from physician office electronic medical records, which will give us better data for future studies such as this one.”

“In 2017, the tummy tuck was probably the riskiest aesthetic procedure and we discovered that BBL was much more so. Now, BBL may be less risky, but overall, it is a procedure best left to experts, such as well trained and experienced members of the Aesthetic Society and ISAPS,” he added. “If you are not going to do a lot of them, perhaps you shouldn’t be doing them at all.”
 

Editor’s Note: 

The Aesthetic Surgery Education and Research Foundation (ASERF) has provided the funding for the original article.

* This material was originally published in Improvement in Brazilian Butt Lift (BBL) Safety with the Current Recommendations from ASERF, the American Society for Aesthetic Plastic Surgery (now The Aesthetic Society) and ISAPS by Luis Rios, Jr, MD and Varun Gupta, MD, MPH, and has been reproduced by permission of Oxford University Press https://academic.oup.com/asj/article/40/8/864/5822125?searchresult=1 

For permission to reuse this material, please visit http://global.oup.com/academic/rights.

References:

1. Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from Gluteal Fat Grafting: Recommendations from the ASERF Task Force. Aesthet Surg J 2017;37(7):796-806.

2. Rios L, Gupta V. Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS. Aesthet Surg J 2020;40(8):864-870.

3. Oppikofer C. Commentary on: Improvement in Brazilian butt lift (BBL) safety with the current recommendations from ASERF, ASAPS, and ISAPS. Aesthet Surg J 2020;40(8):874-875.

Aesthetic practices thrive when patients become loyal customers who refer their friends and family. And while an appealing office with the best technology can help draw patients in, it will be your dream team of professional, competent and compassionate employees that will keep them coming back. So, how do you find the right people to build your dream team?

Building a dream team of employees involves a combination of strategies that will help your employees feel engaged and part of a team that works together. According to analytics company Gallup, research shows that high employee engagement leads to a happier work environment and higher productivity. In today’s highly competitive aesthetic industry, this idea holds even more importance as employees are a reflection of your business and can sway clientele to return and refer others.

Recruiting for Success

Mara Shorr Partner and Business Manager Shorr Solutions Orlando, FL

Shino Bay Aguilera, DO Dermatologist Shino Bay Cosmetic Dermatology Fort Lauderdale, FL

Emily Scalise Director of Business Development and Operations NicholsMD of Greenwich Greenwich, CT

Kaeli Lindholm Founder and President KLC Consulting Marlborough, MA

Suneel Chilukuri, MD Dermatologist Refresh Dermatology Houston, TX

Nasir Mohammedi, MD Founder Bloom Medical Aesthetics Clinic Whittier, CA

To begin the recruiting process, the fundamentals of hiring require attention. According to Mara Shorr, partner and business manager at Shorr Solutions in Orlando, Fla., a leading management consulting company that specializes in helping doctors build and strengthen their aesthetic practices, when hiring for her clients, experience in the position is an important starting point. After that, their follow up, response time and ability to follow instructions indicates they will be prompt employees that can follow instructions once hired. But red flags are also a concern, she told us, “Stay away from candidates who jump from one practice to another, since yours will probably be next on the list.”

Led by Shino Bay Aguilera, DO, Shino Bay Cosmetic Dermatology (Fort Lauderdale, Fla.) enjoys an established reputation in the industry as preferred employers. As such, they consistently receive applications, which are kept on file as a convenient starting point when beginning the search for new employees. “Word- of-mouth through others in the industry like reps and training personnel results in yielding suitable candidates with relevant experience,” Dr. Aguilera stated. “It is always good to use your local network first when you are seeking staff with experience in the field.”

Emily Scalise, director of business development and operations for NicholsMD of Greenwich (Greenwich, Conn.), oversees hiring, training and team building for the business. “Hiring is very personal, based on the business and culture,” she explained. “I am always looking for someone with creativity and who can understand all procedures. For example, they should understand that the way we answer the phones has an impact on the way we make appointments, and the checkout experience must be exceptional, so patients want to come back again, possibly interested in more treatments or referrals. To me, having this deep understanding along with an entrepreneurial spirit is key.”

Skill Vs. Personality

One employee can impact the satisfaction, efficiency and overall quality of the work environment for others, so it is important to hire with a holistic view. Kaeli Lindholm, founder and president of KLC Consulting (Marlborough, Mass.), a business development company bringing fortune 500 leadership systems to high-growth aesthetic practices said her recruiting style considers certain internal characteristics when assessing candidates. “I always recommend starting with passion. Look for the things you can’t teach. If you hire someone who is the right fit culturally and is passionate about the vision of the company, they will align with the bigger goal and be willing to learn the skills it will take to be successful in their role, as well as bring solutions to the business overall,” she explained.

Since 2015, Suneel Chilukuri, MD, has been overseeing his team at Refresh Dermatology in Houston, Texas and has a similar approach. “I always go for attitude over skill because I cannot train attitude, but I can train people on technology,” he told us. “While we can give the skills to succeed, I think personality traits are the most important because each person is so different, and you cannot change internal characteristics.”

Ms. Lindholm agreed. “Hire for the things you can’t teach, someone who wants to be an ‘intrapreneur’ in their role and is looking for upward mobility. I cannot emphasize enough how important this is. They will deliver 5x more revenue for your business than a tactical hire.”

Nasir Mohammedi, MD, founder of Bloom Medical Aesthetics Clinic (Whittier, Calif.) begins with a phone interview to determine basics like personality and office skills. He also considers experience, “The sweet spot is two prior jobs in the field. The first job is where they become trained, the second gets them more experience.”

Nevertheless, the final determination is led by personality considerations, “I ask myself if I want to spend 10 hours a day with this person, and will they get along with my staff. This can help determine if they are a good fit,” Dr. Mohammedi explained.

Dr. Aguilera incorporates a very personal approach when hiring for his team as well. “Kindness, empathy, authenticity and a genuine desire to care for people are the traits we look for when bringing someone into our Shino Bay family.” He added that while experience and skills are important, hiring in an aesthetic practice requires a certain sophistication to deal with psychological and artistic aspects of cosmetic, anti-aging and rejuvenating treatments.

Time to Hire

Defining goals for the position you are hiring can help refine your decision. Each position will require specific training while some positions require a certain set of personality traits. Ms. Shorr said this is an important aspect that practices should consider when hiring to ensure a smooth transition. She elaborated on these ideas: “Hiring depends on which position the practice is hiring for. For example, we hire from the hospitality industry for reception positions, since the target market is the same. However, we urge practices to hire providers with at least one year of experience under their belt, so they know how to provide beautiful results and what to do when there are complications.”

Identifying the right person to hire can be tricky. In Ms. Lindholm’s experience, starting with your inner circle of contacts can bring credible, warm leads, but asking the right questions can help reveal character. A good interview can reveal the candidate’s resourcefulness and can reveal if their motivation is in alignment with your company mission, which will help you pare down a group of candidates.

To narrow things down even more, Ms. Lindholm incorporates a team strategy. “Implement the team test. Make sure the candidate connects with your team. Perhaps invite them into a group interview so you are able to get feedback from the team,” she suggested.

Layoffs due to COVID-19 have changed the landscape of hiring and according to Ms. Shorr, now is a good time to find strong talent for your practice. Let current staff know that you are planning to grow the team, because the right hire will benefit everyone.

Training Your Dream Team

Now that you have hired your new recruits, it is time to help them become fully participating and productive team members. Bringing new employees up to speed will take various forms, depending upon the position and the type of training required. One thing that both practice owners and business development companies have in common is that using both internal and external training is a winning combination.

“Internal and external training are equally important,” Dr. Aguilera shared. “Internal training establishes the standards and philosophy of our own family business culture, and external training opens our employees and external training opens our employees minds to other perspectives and keeps them informed of what is happening in the industry at large.”

Ms. Shorr agreed, saying that while internal training can help new employees understand the culture and routines of the practice, external training opens the door for employees to bring new ideas and inspiration into the practice. “We recommend combining both internal and external training for maximum success,” she added.

Dr. Chilukuri has a method for getting the best out of both types of training. “We always start by training internally. I want to make sure the person understands our culture and each step of our office procedures,” he reported. “But then I will get external companies, like laser or microneedling companies, to send in their clinical trainer with their specific technologies or products, and I bring the protocol on new technologies.”

Employee Engagement with a Training Tradition

Often considered a time-honored tradition of teaching in the medical circle, Grand Rounds are finding their way into aesthetic practices as an effective way to teach not only providers, but to help all employees understand what takes place behind the scenes. Ms. Scalise begins with a training checklist and assigns her new employees to an office mentor with similar responsibilities and experience in the role. But the core of her training lies in the Grand Rounds method.

“I feel that everybody on the team benefits from seeing a live treatment so they know how to speak to it, and they see the visual so they can better communicate about it,” Ms. Scalise explained. She added that since everyone has to learn their professional and public speaking skills, she requires each member of the team to present in the Grand Round. She clarified, “This is our opportunity to teach everyone on our staff what is unique about our treatment and what it looks like, which is especially important for our front office because they are the ones that typically answer questions about treatments over the phone.”

Training is an opportunity to help your new team members understand the business and culture of your practice. In Ms. Scalise’ experience, training can be used as a team building tool, which improves overall employee engagement. “We do weekly education spotlights where we may bring in a representative from a company and we make it fun,” Ms. Scalise shared. “We might do a breakfast or a lunch and learn, and here I rely on the pharmaceutical reps to kick start the training.”

Maintaining Team Morale

According to Ms. Shorr, keeping your staff happy is never easy, especially in the world’s current environment, but she did have some tips to offer. “We like to recommend a few different incentives, such as fair pay and staff bonuses based on production, especially for skincare sales,” she said. “Of course, a positive attitude from leadership down is the first and most important item on this list! You’d be surprised how many times attitude problems, tardiness and frustration within the team as a whole stems from the top.”

Dr. Mohammedi believes offering incentives such as profit sharing is another way to keep up morale. “If the employees don’t see the benefit of their labors, they won’t aggressively work to grow the business,” he said. And, while maintaining harmony in the workplace is easier if you choose people you get along with personally and professionally, sometimes change is good. As he told us, “Low turnover isn’t always a good thing as people evolve in personality, ability and motivation. Sometimes to keep a good culture you cannot be afraid to let go of the bad apple to keep the bunch from spoiling.”

Dr. Aguilera applies his personal touch and enjoys creating an environment where everyone counts. “We have created an environment where everyone, regardless of their position, is considered an equal in importance to the whole team. We recognize that mental health is critical for productivity and so we encourage honest, judgement-free discussion to facilitate a happy and secure environment. We also like to have fun and laughter is our favorite sound at work!”

Ms. Lindholm has some final words of advice. “Remember, employment with a passionate, self-motivated staff member is about a partnership. How will you beneficially help each other achieve goals? It is not one sided. When employees feel appreciated, respected and challenged they don’t leave.”

Building your dream team and maintaining engagement are key to your practice success. And, it can be the key to happiness and peace of mind for all team members, including your patients and yourself.

Sponsored by MyEllevate

For patients desiring minimally invasive neck and jawline rejuvenation with long-lasting results, MyEllevate (Newport Beach, Calif.) may prove very appealing. The procedure was created by Beverly Hills, Calif.- based plastic surgeon Gregory Mueller, MD. With a quick learning curve and minimal capital outlay, MyEllevate provides safe, predictable rejuvenation for patients who previously had no efficacious options.

Sean Paul, MD Oculofacial Plastic Surgeon          Austin, TX

Barry DiBernardo, MD Plastic Surgeon Montclair, NJ

Jason Pozner, MD Plastic Surgeon Boca Raton, FL

“We’ve had many patients walk away because they didn’t want a traditional surgical facelift or non-invasive treatments,” said Sean Paul, MD, an oculofacial plastic surgeon in Austin, Texas. “They are not ready for, or don’t need, a full surgery, and they don’t want repeated treatments like toxins or injectables.”

“What I love about MyEllevate is that in a minimally invasive office-based procedure under local anesthesia, I can get aesthetic improvement of the neck approaching a surgical facelift or neck lift,” said Barry DiBernardo, MD, a plastic surgeon in Montclair, N.J.

Along with a proprietary lattice of support sutures, MyEllevate incorporates energy-based treatment (and for Dr. Paul, sometimes radiofrequency microneedling) for skin tightening. After marking the neck and jawline, the surgeon enters through small puncture sites, loosens underlying tissues and cuts platysmal bands using the MyEllevate suture.

However, according to Dr. Paul, MyEllevate is very unlike thread lifting because results last five to ten years.

“If patients have loose skin we use either radiofrequency or laser to tighten the skin,” Dr. DiBernardo began. “If they have fat, we use a small liposuction cannula to remove that. Then we thread the MyEllevate suture around the neck behind the ear on both sides using the ICLED Surgical Suture System by Implicit Care (Newport Beach, Calif.) and tie it to get a good neck contour.”

Plastic surgeon Jason Pozner, MD (Boca Raton, Fla.), advises surgeons to perform wide undermining with the cannula, and to tie sutures to slight overcorrection. “The treatment area loosens post-procedurally,” he explained, “and liposuction fluid contributes to swelling. If it doesn’t look strange on the table, it is too loose.” For additional patient comfort, he provides an MKO Melt (midazolam, ketamine, ondansetron) by ImprimisRx (San Diego, Calif.) pre-procedure, followed by on-demand nitrous oxide in the operating room.

While a full facelift may require general anesthesia and significant downtime, MyEllevate takes one hour, and patients can return to their routine in two to three days (avoiding heavy lifting for at least ten days). “And patients have no scars around the ears,” Dr. Paul noted.

Choosing appropriate patients and setting expectations are critical, Dr. Paul added. In his experience, patients in their 60s and older probably need facelifts, but he has successfully performed MyEllevate on patients up to their early 60s.

Dr. DiBernardo said that the new MyEllevate Plus procedure, which incorporates a small skin excision behind the ear, allows him to treat patients of almost any age.

Patient response to MyEllevate has been unprecedented, Dr. DiBernardo reported. Whereas his webinars usually draw 20 to 30 attendees, a MyEllevate webinar he hosted drew more than 250. “We have new procedures and devices all the time. But this is one of the major advances we’ve seen in minimally invasive aesthetic procedures this decade.”

Platform devices providing multiple modalities in a single system have always had a place in the aesthetic practice. As a result, new combinations and evolutions are always emerging. Ultimately, the appeal of platform devices can be summed up in one word: versatility.

“Whether it is a multiwavelength laser device or a platform offering completely different modalities in one system, versatility is the goal after safety and efficacy,” stated Michael H. Gold, MD, director of the Tennessee Clinical Research Center and Gold Skin Care Center (Nashville, Tenn.). The con we don’t always consider though, is that you tie up a lot of functionality in a single device. In some ways this reality benefits the smaller practice more because they want to offer variety, but don’t have the traffic. A larger practice with more patient traffic throughout the week is going to focus on throughput. Thus, having a greater number of dedicated devices may be advantageous, but it depends on the practice.”

Michael H. Gold, MD Director Tennessee Clinical Research Center Gold Skin Care Center Nashville, TN

Edward M. Zimmerman, MD Director Aesthetic Revolution Las Vegas Las Vegas, NV

Elizabeth Tanzi, MD Director Capital Skin & Laser Chevy Chase, MD

Erez Dayan, MD Plastic Surgeon Medical Director Avance Plastic Surgery Institute Reno, NV

Sherrif F. Ibrahim, MD Dermatologist Rochester, NY

Fred G. Fedok, MD Director Fedok Plastic Surgery and Laser Center Foley, AL

Adrienne E. Stewart, MD Dermatologist Denver, CO

Another related downside is the loss of functionality when a device goes down. “When a platform goes down, you may lose the ability to use all of the attachments until it is back up,” said Edward M. Zimmerman, MD, director of Aesthetic Revolution Las Vegas (Las Vegas, Nev.). “This is admittedly rare with platforms based on solid state technology, and they can often diagnose problems remotely, send a new circuit board to you and fly out a technician to take care of it. However, if things are more complicated, you can be down for a month.”

Early platform devices – as well as many today – were multi-function IPL, multi- wavelength laser, or combined lasers and IPL systems; an intuitive choice, according to Dr. Zimmerman. “The first platform device I can remember was the ESC Photoderm VL/PL/HR from the mid-90s, and quickly grew from there to include multi-wavelength laser systems and combination laser/IPL,” he recalled.

“This makes perfect sense because the medical use of light has been an important and continually evolving segment of our armamentarium, and dermatology is where we see the obvious transition between the medical and cosmetic. Much of what we do leads down both paths,” Dr. Zimmerman continued.

“Most of the current big players in the industry had their platforms, and still do. Now, we have a new variety of non- invasive radiofrequency (RF) – bipolar and minimally invasive mono- and multi- polar – boxes for skin tightening and wrinkle reduction, even surgical RF generators for cutting and cautery, as well as subdermal tightening and full-on skin resurfacing,” Dr. Zimmerman pointed out.

Cost was, and remains, a factor. “One multifunction box generally costs less than the sum of several stand-alone treatment devices,” Dr. Zimmerman added. “It also means paying for one warranty instead of several.”

Some platforms are modular, so you can equip your unit for whatever level is suitable for the practice at the time and then add functionality as you grow. “A new or established practice can get just the IPL and Nd:YAG modules, for example, and add other available wavelengths or fractional and short pulse width lasers (Q-switched and pico) as needed, which is a practical way to manage cost with growth,” Dr. Zimmerman expressed.

There may never have been a better time than now to adopt a platform device. For a while, the downside of the platform device was ‘Jack of all trades, master of none’ because the highly sought versatility seemed to require a sacrifice in efficacy. “If you asked me years ago about platform devices, I was not as enthusiastic as I am now, for that very reason,” said Elizabeth Tanzi, MD, director of Capital Skin & Laser in Chevy Chase, Md. “That is simply not a concern at this point. Reputable companies with long experience are putting out safe, reliable, user-friendly and versatile devices that provide excellent outcomes. These kinds of devices can grow with the practice, it is what they were going for originally and are achieving now.”

The rise of combination therapies has contributed to the ubiquity of the platform device. “Attacking an indication from multiple vectors has shown time and time again to be the best way to achieve maximum results,” Dr. Gold said. “Platforms offering different versions of one modality, such as a multiwavelength laser system, or devices that combine modalities in a single box, can allow users to easily perform a combination therapy with few hassles and very little transition time between modalities.”

As such, a powerful aspect of platform devices is the way their versatility lends itself to adjunctive use, according to Harvard-trained plastic surgeon Erez Dayan, MD, medical director of Avance Plastic Surgery Institute in Reno, Nev. “So many of our gold standard surgical procedures have benefited enormously from the addition of energy-based therapy to reduce scarring or give patients a more natural-looking result.”

Some examples include emerging body contouring devices harnessing multiple modalities to improve fat, muscle and skin. “We use one that builds muscle with electrical muscle stimulation, and also reduces fat and tightens skin using different RF components,” Dr. Dayan shared. “Devices such as these give us remarkable results on their own, but work with surgery to give us better results than we have ever seen.”

“Also, there’s a growing trend toward customizable treatments,” Dr. Dayan added, “and nothing supports this like platform devices that allow you to account for patient individuality in the way you manage different components of therapy. Think about it: every patient is different and has different needs. For body shaping we see the overweight, the athletic and everything in between. With new capabilities we can treat each of them differently, based on their own unique needs, using a single device. I am sure this is as true, or more so, for laser systems treating skin.”

In turn, this expands the patient base. “Aesthetic practitioners can treat a much broader spectrum of patients nowadays than ever before,” Dr. Dayan stated, “because we have safe, effective tools at our disposal that can treat with a realistic expectation of outcomes. Platform devices are part of what makes that possible.”

The flagship multi-module JOULE X^® platform from Sciton (Palo Alto, Calif.), as well as its little sister, mJOULE^TM also bring IPL – termed broadband light (BBL), their proprietary pulsed light offering – together with lasers. JOULE is recognized worldwide for its expandable design, customizable approach and sustainable profitability path. Trailblazing technologies include the new BBL HERO^TM, Forever Young+^TM, and Forever BodyTM, plus award-winning favorites HALO^®, BBL^TM, Resurfacing Perfected, Clear Suite and diVa^®. Its onboard intelligent cloud computing data tools, known as Sciton iQ^TM, monitor system health and usage metrics.

Dr. Tanzi uses JOULE every day. “The BBL is used daily in my office, whether it is in conjunction with a resurfacing procedure like HALO, the microlaser peel or on its own. Sciton has a decades-long reputation for making robust, workhorse devices, some of which are still in use after many, many years. In my office, they are the most reliable devices I own. Currently, this is the only platform in my practice, and it serves me well.”

The affordable, expandable mJOULE offers versatile and synergistic treatments from single targeted applications to regular skincare regimens with BBL HERO and MOXI^TM, a 1927 nm fractionated thulium laser that is taking the industry by storm, according to dermatologist Sherrif F. Ibrahim, MD (Rochester, N.Y.). “MOXI provides low downtime resurfacing that is even appropriate for younger patients looking to maintain their youthful appearance rather than restore it. It is great to have that with BBL HERO in a unit which is so portable and plugs into a standard 110V outlet,” he expressed. Buyers can choose either module or both, depending on their needs.

“Simplicity, portability and expandability give you a very useful platform that grows with your practice. We have JOULE, but we augment that using the more portable mJOULE with both modules to make us more efficient,” Dr. Ibrihim added.

The robust and easy-to-use Icon^® from Cynosure (Westford, Mass.) not only offers industry-leading IPL plus seven handpieces of versatility with a non-ablative 1540 nm laser, it also features their signature Melanin Reader, called Skintel^®. Users can choose treatment parameters using individual patient skin data and adjust them on the fly to treat facial and leg veins, scars of various types, wrinkles and striae as well as perform resurfacing and hair reduction.

Offering four different lasers and an IPL in one convenient platform, the extremely portable Spectrum from Rohrer Aesthetics (Homewood, Ala.) can be used for a variety of cosmetic procedures including skin resurfacing (Er:YAG), tattoo removal (Q-switched Nd:YAG/KTP), removal of pigmented lesions (IPL), vascular reduction (long-pulsed YAG), and hair removal (810 nm diode). “The Spectrum has a capable IPL handpiece in the platform. Many physicians rely heavily on IPL. I don’t, I’ll usually go to specific laser wavelengths,” said Fred G. Fedok, MD, director of the Fedok Plastic Surgery and Laser Center (Foley, Ala.). “With Spectrum you have IPL plus four laser wavelengths which, together, will cover most, if not all of your clinical needs. Its utility and versatility will lend itself to almost any practice. I’ve had this device since its inception and am extremely happy with it.”

Dr. Fedok uses the Spectrum for many things, he shared, but he believes the laser shines particularly for hair reduction and for various levels of resurfacing. “The 810 nm diode laser for hair removal – we have used it on skin types I through V – is superb, we achieve excellent results with it. Resurfacing depends on the patient’s aesthetic needs, coupled with the downtime they are willing to undergo. With the Er:YAG for lighter resurfacing we get refreshment and textural improvement appropriate even for patients in their late 20s or early 30s. Perioral radial lines are among the most frustrating signs of aging for patients. I use the Er:YAG with the 6 mm aperture for global improvement in the perioral region, going to the 2 mm or 3 mm aperture for a second pass to treat any deeper, fine radial rhytides on the lips. Downtime is modest.” Spectrum easily separates into two pieces, making it easy to transport and share among operators and move to different offices.

The eight key benefits of the non-inva- sive, hands-free Ultracontour NG from MedixSysteme AG (Ruggell, Liechtenstein) start with high focalized fractionated ultrasound (sonodynamic therapy) to treat subcutaneous fat in the arms, belly, legs, buttocks, love handles and hips with simultaneous point-by-point targeting at the precise depth of local adiposity between 0.8 cm and 1.3 cm. The unique, intense pulsing causes an ultrasonic mechanical drainage (UMD) effect delivering intense pulses to the fat in larger areas automatically. Treatment also boosts blood flow and neocollagenesis to restore elasticity of skin tissue. Up to five levels of UMD power can be selected, based on fat thickness and the area treated, with automatic programs for men or women. The six flexible UMD belts adapt to body areas on each individual patient for a total of 18 custom-programmed emitters that, together, can treat an entire body in one 20- to 30-minute session. Treatment is painless with no needles, no suction and no downtime.

As the world’s only solid-state laser producing both 589 nm and 1319 nm wavelengths, ADVATx features more than 15 FDA/CE cleared indications including vascular conditions, acne, scars, warts and wrinkles. This unique combination of 589 nm and 1319 nm provides the ideal solution to not only eliminate undesired superficial abnormalities but provides total dermal restoration by stimulating the production of collagen types I, III and VII, as well as elastin.

According to dermatologist Adrienne E. Stewart, MD, in Denver, Colo., ADVATx is particularly suited to dermatology practices such as hers that treat both aesthetic and medical indications. “In many cases the line between aesthetic and medical treatment is blurry, they go hand-in-hand because we are talking about skin,” she said. “We use it a lot for reds – rosacea or vessels – but I love it for acne and acne scars. I will use the 589 nm for active acne and redness, then the 1319 nm to treat acne scars, and for the redness as well. This allows me to treat both at the same time, which is very commonly requested in my office, but not easily achievable until I had ADVATx. I’ll use it with fractional resurfacing for collagen stimulation, doing the 1319 nm first, then the fractional treatment. We commonly use it for sebaceous hyperplasia as well. ADVATx lends itself well to delegation to staff if your state allows that. And overall, we see little, if any, downtime with this device.”

It is not so much about having the best platform, as much as the best platform for your practice. “Whether you are the new kid on the block or an established physician, you need to consider the unique needs of your practice,” said Dr. Gold. “It is about where you are now and where you plan to go. Platforms are often an excellent solution to cost-effectively expand your capabilities or move your practice in new directions, but you have to self-assess and then look at your options. There is a lot out there and if you take the time, you’ll find a quality device that suits your needs.”

Sponsored by Aesthetics Biomedical

Vivace, the radiofrequency (RF) microneedling treatment device from Aesthetics Biomedical (Phoenix, Ariz.), is setting records with consumers and providers. The Vivace Experience provides a personalized approach to treatment coupled with products that ensure comfort, outcomes and minimize downtime.

Consumers, young and older, have embraced Vivace RF microneedling. At the start of 2021, Vivace is the most requested microneedling treatment on RealSelf, a trusted online platform for individuals considering elective cosmetic treatments. Consumer searches and demand made Vivace the top trending microneedling treatment in 2020 as well. Vivace also ranks #1 among all the microneedling device options on RealSelf, for driving leads to physicians. And most importantly, Vivace has three times more reviews on RealSelf than the next leading microneedling competitor.

W. Grant Stevens, MD, FACS Plastic Surgeon Clinical Professor of Surgery USC Keck School of Medicine, Division of Plastic Surgery Marina Del Ray, CA

Emil A. Tanghetti, MD Dermatologist Sacramento, CA

Ashley Magovern, MD Owner and Founder Manhattan Dermatology Manhattan Aesthetics glowmd skin care Manhattan Beach, CA

Shelby Miller, DNP, FNP-C Board Certified Nurse Practitioner Owner RUMA Aesthetics Lehi, UT

Michael DeWolfe, MD Plastic and Reconstructive Surgeon Elevare MD       Chicago, IL

Kelly DeWolfe             Advanced Practice Nurse                   Elevare MD        Chicago, IL

Tara Brown, MD Ophthalmologist       San Diego, CA

Physicians have also given their thumbs up to Vivace. According to Tara Brown, MD, a San Diego, Calif.-based ophthalmologist who specializes in cosmetic procedures and surgery, Vivace is her top-selling service at the start of 2021. “Especially in the last six months, demand for Vivace has really exploded,” she reported.

While many consider FDA-cleared Vivace treatment an ideal skin tightening and rejuvenation option for middle-aged patients, Dr. Brown says she has young influencers who have heard about Vivace and want the treatment. For the younger set, Vivace tightens pores, decreases blemishes and more, with little downtime. “The young people love it,” she emphasized.

Vivace is also ideal for patients who want a comprehensive skin treatment for the face, neck and décolleté, according to plastic and reconstructive surgeon Michael DeWolfe, MD, of Elevare MD in Chicago, Ill. “The treatment creates a uniform glow to the skin, while tightening, improving fine lines and reducing pore size,” he shared.

Kelly DeWolfe, an advanced practice nurse and acute care nurse practitioner at Elevare MD, finds that Vivace is a great treatment for clients in their 20s and 30s who have textural issues like acne scarring or are beginning to see signs of aging. Vivace gives them the smoothness and evenness they desire without makeup,” she stated. “I also love it for clients in their 40s and 50s who are noticing the aging process. Vivace stimulates collagen production and can provide the lifting and tightening that they desire.”

For Ashley Magovern, MD, owner and founder of Manhattan Dermatology, Manhattan Aesthetics and glowmd skin care (Manhattan Beach, Calif.), her Vivace patients often come back asking for more. “That is something we don’t always see [with other treatments]. I think patients really appreciate the difference that they are seeing in their skin. Their friends comment on their skin, and we are finding their friends are calling and asking for Vivace,” she said.

Many providers say it is hard to find a facial rejuvenation treatment that is as effective, comfortable and with as little downtime. “Many don’t realize that the combination of RF and microneedling has less downtime than microneedling alone,” Dr. Magovern pointed out.

“A lot of our patients want procedures where they can function and don’t have a significant amount of downtime. The Vivace procedure with its dermal wounding is very well suited to that,” said Sacramento, Calif.-based, dermatologist Emil A. Tanghetti, MD. “There is some slight swelling and erythema for a few days and that is about it. People can function normally. Typically, people are able to go back to their activities the next day without a problem.”

Shelby Miller, DNP, FNP-C, board certified nurse practitioner and owner of RUMA Aesthetics in Lehi, Utah, says the Vivace is the “Lamborghini of RF microneedling.”

“One of the most highly recommended and sought-after medical skincare treatments right now is fractional microneedling with radiofrequency,” Ms. Miller stated. “We are thrilled to offer the top-of-the- line Vivace treatment at RUMA Medical Aesthetics. The mixture of both multidepth microneedling and various levels of RF heat is changing the skincare game for uneven skin tone and texture. We have loved having this machine at our practice.”

The Science

Vivace RF microneedling has been fully verified and validated, according to plastic surgeon W. Grant Stevens, MD (Marina Del Ray, Calif.), chairman of Cle’ Global Aesthetics and clinical professor of surgery at the University of Southern California Keck School of Medicine, Division of Plastic Surgery.

“For verification, Vivace recently published anelectrocoagulationandthermaldiffusion study that looked at the thermal effects of RF microneedling with a porcine skin model. The Vivace showed best thermal coagulations using a 1 MHz insulated microneedle and showed that the radiofrequency diffuses uniformly within the dermis,” Dr. Stevens reported. “Vivace then took their porcine skin model study and performed it in abdominoplasty to verify the electrocoagulation within the human skin tissue to further the translation of study results to the clinical practice.”

Vivace was also validated through a clinical trial that allowed Aesthetics Biomedical to obtain FDA clearance for fine lines and wrinkles in Fitzpatrick Skin Types I-V, Dr. Stevens added.

“Vivace is one of the only devices in the RF microneedling marketplace that truly has comprehensive scientific understanding of radiofrequency and how it is applied combined with microneedling,” Dr. Stevens noted.

Dr. Stevens referred to a recent study published in August 2020 in the Journal of Cosmetic Dermatology,¹ in which researchers examined the histologic effects of RF microneedling on porcine skin. Researchers compared dermal thermal effects of a RF microneedling device producing 1 and 2 MHz signal amplitudes, with respective voltage and current gradients, utilizing non-insulated and insulated needles, according to the study’s abstract.

Investigators conducted two separate animal studies to evaluate the electrocoagulation and thermal diffusion effects using the device. They assessed electrocoagulation effects histologically using hematoxylin and eosin staining and studied heating effects through thermal imaging.

The investigators found the 1 MHz insulated needle produced larger coagulations with an increase in power. The 1 MHz non-insulated array was comparable to the 2 MHz insulated array with similar histologic features. According to the authors, “Full thermal diffusion occurs seconds after the [radiofrequency] conduction time.”

The Aesthetics Biomedical-funded study shows that significant changes happen to RF microneedling treated tissue in real time.

“As much as we can see the effects of treatment when we are doing it on patients, we cannot tell what is actually going on under the skin,” Dr. Brown explained. “Radiofrequency microneedling with Vivace actually causes real coagulation and tightening, leading to a cascade of controlled inflammation which is then ultimately going to lead you to more collagen and elastin.”

Vivace Differentiators: Treatment is Comfortable

Dr. Brown, who’s first experience with microneedling was surprisingly painful, noted that one of the things that stands out about Vivace treatment is that it is the most comfortable microneedling option on the market.

“Before I bought the Vivace, I had a microneedling treatment done on myself by a dermatologist. I do not know what brand he used but I do know it felt like I was getting slapped in the face for 30 minutes straight. When he started, I jumped and he asked, ‘Are you ok?’ I said ‘Yes, but I was not expecting that.’ He explained that it always kind of catches people off guard because it is such an abrupt motion when the needles go in,” Dr. Brown recalled. “When my rep brought the Vivace by, I tried it, and it was so much better. It has a super smooth, gentle motion. Still the same needles, still the same radiofrequency, but a lot more pleasant.”

For an optimal patient experience, providers apply a topical numbing cream prior to the treatment to ensure comfort. “Everyone can tolerate the Vivace. The key is a really good numbing cream,” Dr. Brown emphasized.

Dr. Magovern finds that performing Vivace is so relaxing for her, as well as for her patients, that it offers an opportunity for doctor-patient bonding. “Vivace is an easy procedure to do in the scope of an aesthetic provider’s day, taking about 30 minutes to perform,” she shared. “It also is easy on patients, and they tend to be comfortable and relaxed. I feel like it is a great time to connect with your patients.”

Customizable Treatments & Consistent Results

Vivace is known for not only comfort and minimal downtime, but also consistent results, Dr. DeWolfe stated. “The robotic motor allows gentle delivery of pulses unlike those that utilize ‘snap’ motors,” he reported. “Vivace RF also senses if the needles are experiencing an increased impedance and keeps the needles from causing damage.”

Dr. DeWolfe explained that the Vivace utilizes 36 gold plated needles to penetrate the skin. The technology simultaneously delivers up to approximately 60 W of energy when using 1 MHz, via a chevron circuit, which allows even distribution and prevents hot spots.

“Depth of treatment can vary between 0.5 mm up to 3.5 mm at 0.1 mm increments,” Dr. DeWolfe said. “In addition, Vivace offers simultaneous delivery of red or blue light LED for anti-aging or antibacterial properties. You essentially are receiving three treatments in one: microneedling, radiofrequency and LED light therapy.”

Vivace’s needles are insulated except at the distal 0.4 mm, Dr. Brown said. The design allows for a controlled delivery of radiofrequency to the tissue, she pointed out.

Every individual is different, so the ability to personalize treatment is important.

“I will do passes at different layers and at different strengths. It is so endlessly customizable,” Dr. Brown expressed. “Even people of color, like myself, can feel comfortable [with this treatment], knowing that the RF is not going to cause inflammation, hypopigmentation or hyperpigmentation at the skin’s surface.”

According to Ms. DeWolfe, almost everyone is a good candidate for Vivace. “It is safe for most skin types and can be performed year-round, unlike lasers, which I am very conservative with during the summer months,” she stated.

There are times, however, when Vivace is not the best treatment option.

“I would avoid treating someone with moderate or severe active acne to avoid spreading bacteria and worsening breakouts,” Dr. DeWolfe explained. “In addition, patients with severe wrinkling and poor skin quality are not good Vivace candidates,” he advised. “Those patients likely require deeper resurfacing to get an improvement,” he said.

Best Practices

Providers say they use the Vivace technology as a stand-alone treatment or in combination with other devices and topicals.

In Ms. DeWolfe’s experience, she achieves best results when she uses varying depths for each of her three passes with the device. This allows her to treat both superficial and deep areas of the skin to create meaningful change. “We recommend a series of three treatments spaced six to twelve weeks apart for best results,” she said. “However, I’m confident that even with one treatment patients will see a change.”

“With treatment, patients can expect to see a reduction of fine lines, shrinking pore size, moderate skin tightening, improvement of acne scarring and improvement of skin tone and texture,” Dr. DeWolfe indicated.

Dr. Brown often combines Vivace treatment with platelet-rich plasma (PRP). “The PRP is going to get us the patient’s own growth factors, which are going to be superior to any sort of growth factor serum that you can find,” she said.

Dr. Brown injects the PRP straight into the face in problem areas and saves a couple of ccs to drip on the face post-treatment.

“Those microchannels stay open after treatment, so I take advantage of that by dripping the PRP right on as soon as I am done with the needles,” she said.

Dr. Magovern, who also offers patients treatment combining PRP and Vivace, says that in her experience the combination quickens healing and enhances outcomes.

Aesthetic clinicians also combine the Vivace device with other modalities to treat skin and aging concerns.

“We like to stack Vivace RF treatments with other devices such as a CO₂ laser or facial,” Dr. DeWolfe confirmed.

To enhance results, Dr. Tanghetti combines Vivace with devices that target different parts of the skin. “The Vivace primarily wounds the dermis. We can combine it with something that is primarily directed at epidermal rejuvenation and wounding, such as a thulium procedure or a fractional picosecond procedure,” he stated.

“The goal is to use other devices that improve results without increasing downtime. That means treating patients over a period of time – in three or four treatments – rather than one treatment,” Dr. Tanghetti added.

Good Skincare Helps to Enhance Results

Ms. DeWolfe loves SoME Skincare, which utilizes a patient’s own PRP to provide a personalized skincare regimen. “I find that incorporating SoME Skincare enhances the textural improvements and radiance that Vivace excels at,” she said.

Dr. Brown, a big believer in augmenting treatment with good skincare, uses a variety of products, including the Vivace Experience Kit, which includes a booster serum and soothing mask for the ultimate patient experience.

“I will use the Boost Serum immediately after the procedure, and then the patient takes it home and uses it morning and night. It is just a very good all-around peptide serum,” she advised. “Then, there is a soothing sheet mask that everybody loves. It goes on when the whole face is done and takes away some of the redness.” This total experience minimizes downtime and accelerates outcomes.

 

Dr. Magovern also recommends patients use the Vivace Experience Kit post treatment. “In addition, we recommend incorporating a vitamin C serum into their regimen,” she added. “We do not like patients to put makeup on for several hours after treatment because the channels are open for a finite period of time, so we want to take advantage of that with the good stuff that we put in. We don’t want anything that can irritate the skin or cause an allergic or irritant reaction.”

Aesthetics Biomedical announced in October 2020 that it partnered with the popular professional skincare brand SkinCeuticals (New York, N.Y.) to offer Vivace Radiofrequency Microneedling with a SkinCeuticals C E Ferulic post-treatment protocol.

SkinCeuticals C E Ferulic daytime vitamin C serum is proven to deliver advanced environmental protection and visible anti-aging results.

According to the Aesthetics Biomedical press release about the collaboration, “C E Ferulic works to further enhance the Vivace Experience 24 hours post treatment and provides astonishing results after just one session. SkinCeuticals antioxidant formulations are the gold standard and results have shown a 44% improvement in skin radiance, 36% improvement in the appearance of wrinkles and 37% increase in skin firmness.”

The bottom line is that today’s aesthetic providers have plenty of devices from which to choose. “I think people have to pick devices that have a track record and that work. Certainly, the Vivace unit is one of those devices,” Dr. Tanghetti affirmed. “Based on the histology and our results, I am convinced that this is a very effective treatment that we extensively utilize in our practice.”

Reference:
1. An evaluation of electrocoagulation and thermal diffusion following radiofrequency microneedling using an in vivo porcine skin model. Wootten. Journal of Cosmetic Dermatology - Wiley Online Library.

The morphologic changes our faces undergo with age are the result of a complex interplay between the underlying craniofacial skeleton, our mimetic musculature, compartmentalized facial fat, facial retaining ligaments, and our skin envelope. Changes in each of these components contribute, at least in part, to the characteristic stigmata of the aged face.

With age, there is an overall reduction in both dermal organization and thickness. This is driven largely by a decrease in the total collagen content of our skin, resulting in thinning of our skin with age. In addition, the proportion of immature type III collagen in our skin increases and there is a depletion of normal elastic fibers within the dermis beginning at approximately age 30. It is these intrinsic degenerative changes, compounded by actinic damage, that contribute to the loss of physiologic recoil, increased skin laxity, and fine rhytides characteristic of the aged face.

The age-related changes our facial skeletons undergo with time are thought to include a reduction in facial height, an increase in facial width, and maxillary retrusion secondary to bony resorption—resulting in a downward and inward rotation with respect to the cranial base. This clockwise rotation of the maxilla is believed to contribute to the disruption of the smooth transitions between facial convexities through its effect on the facial retaining ligament system. Although these theories have been studied extensively, the concepts have never been demonstrated in a single cohort of patients longitudinally.

The changes our midface soft tissues undergo with age are an area of great interest to aesthetic surgeons, as it is the soft tissue we most often target during attempts to rejuvenate the aged face. Numerous studies have attempted to quantify these changes and have led to two predominant theories in midfacial aging: the traditional gravitational theory and the more recent volume-loss theory. Stuzin et al. provided early support for the gravitational theory when they introduced the idea of retaining ligament attenuation as a cause for midface soft-tissue descent. Through historical photographs and photogrammetry, Yousif et al. concluded there is an inferior, lateral, and anterior displacement of the cheek mass with age leading to a deepening of the nasolabial fold. Lastly, more recent support for the gravitational theory of aging includes the work by Mally and colleagues, who documented a restoration of midface volume and a more youthful appearance when patients were photographed supine compared to an upright position.

 

Read more here.

 

Source:

Plastic and Reconstructive Surgery