Sponsored by Cutera

Acne is a leading concern for patients of all ages, as it can leave visible scarring and negatively affect self-confidence and self-esteem. Until now, the leading acne treatments were systemic, often accompanied by side effects that impeded some patients from obtaining treatment, and led to aesthetic physicians passing acne patients to their dermatologist peers. But that is about to change.

AviClear^TM by Cutera (Brisbane, Calif.), reportedly the first and only FDA-cleared device that can treat mild, moderate and severe acne vulgaris, is a non-toxic and non-chemical solution that comes with no safety warnings. Aesthetic physicians and dermatologists can now treat acne on all skin types with a safe and effective device with no risk of harmful side effects. AviClear will soon be the preferred choice to clear acne, especially for patients who have not experienced successful clearance on systemic therapy or are seeking a drug-free yet effective solution.

AviClear Key Features

Michael Karavitis, PhD, executive vice president and chief technology officer for Cutera, explained that issues with current acne treatments, such as needing a prescription and lack of long-term results, led to the development of AviClear. “Acne is the number one condition presented in dermatology and one of the main reasons that people start seeing a dermatologist. Not only is acne a heartbreaking condition, but it can affect the trajectory of people’s lives,” he shared. “Developing a solution and technology like AviClear felt like the right thing to do. I am proud to say we have a solid, first-to-market device with AviClear.”

Most acne treatments do not target the production of sebum,¹ yet AviClear addresses acne at its source using specific wavelengths to target and suppress the sebaceous glands. Dr. Karavitis explained the key features that differentiate AviClear from other acne treatments. “There are three standout features. The first is the 1726 nm wavelength, which is a unique wavelength that has been traditionally hard to generate. The 100-Watt power is the second key feature. Generating a 1726 nm wavelength along with that amount of power can be difficult, but we were able to successfully engineer a device that does just that. Lastly, the AviCool^TM sapphire cooling feature cools on contact, making the treatment tolerable for most patients.”

Cutera is dedicated to defining and progressing the medical aesthetics industry through innovation of advanced technology as well as support that places physicians and their practices at the forefront of the market. According to Dave Mowry, chief executive officer of Cutera, “Acne has significant clinical needs, and acne patients are the largest demographic to visit the dermatologist. Over the last three decades, there have been no modern solutions, and a general lack of innovation in acne treatment. We saw this as a huge market opportunity, but we also looked at the patient experience and understood how rewarding it would be to be able to help relieve people from the stigma associated with acne.”

Developing AviClear was an endeavor that kept patients and modern lifestyles top of mind, with demands for an easy-to-follow treatment and satisfactory results at the forefront. “We have a much better safety profile than other treatments. We are using a natural energy source of light that is focused to deliver the right therapeutic dosage to the right part of the body,” Mr. Mowry explained. “An issue with the popular acne treatment, isotretinoin (trade name: Accutane), is that it is contraindicated with alcohol, so it may not be a choice for young people who are engaging in their social exploration. AviClear is a modern alternative that can meet the lifestyle and needs of the population versus a synthetic drug.”

Clinical Trials

With extensive clinical trials and strong clinical data, AviClear received FDA clearance in March 2022. Ashish Bhatia, MD, associate professor of clinical dermatology at Northwestern University and co-founder of Oak Dermatology (Itasca, Joliet and Naperville, Ill.), often provides clinical input on Cutera’s emerging technologies, and is one of the first to own AviClear and use it in his practice. “The clinical trials were performed as a monotherapy treatment which is particularly encouraging when you see long-term results out to two years,” he explained. “We have noticed in both the pilot and pivotal studies that the results of AviClear continue to improve over time, with some patients showing long-term clearance over two years after their final treatment. Patients of any skin type can be treated safely with good results, and they found the treatment comfortable as no patient dropped out of the study due to pain. This offers hope for patients who have not had success with other treatments, whether it be oral antibiotics, topicals, lasers or isotretinoin.”

Emmy Graber, MD, MBA, founder of The Dermatology Institute of Boston (Boston, Mass.), specializes in acne and cosmetic dermatology. She told us the clinical data of AviClear was especially significant for patients with moderate and severe acne. “I was really impressed with the improvement of nodules in patients with severe acne,” she exclaimed. “Usually, we see some improvement with nodules, but we really think of using isotretinoin for these. I was very impressed and surprised to see a 69% improvement of nodules after treatment with AviClear, which is huge. There are very few options for patients that have a lot of nodules and severe acne, so I was excited to see AviClear was effective in this regard.”

Along with being an encouraging treatment for severe acne, Dr. Graber also noted the wide range of patients that will benefit from AviClear. “What further impressed me about the study, was not only did it include patients with both moderate and severe acne, but it also included patients of all Fitzpatrick skin types,” she said. “There are many patients with skin of color and darker skin types who did very well with the treatment. There were no reported cases of hyperpigmentation in all of the 104 patients.”

But there is more behind this impressive number. Mr. Mowry explained that the most interesting and important data point from the entire study was not just the patient enrollment but the patient follow-up. “We had 104 of the 107 patients complete the study,” he emphasized. “And that is, in my mind, an endorsement from the patients that they not only wanted the treatment, but they enjoyed it, and were satisfied with the results.”

According to Mr. Mowry, the overall results mimic those of the current gold standard therapy for the clearance of acne – especially moderate and severe acne.

Early checkpoints showed data similar to that of isotretinoin; and moreover, the final results were not significantly different than those that have been published for isotretinoin. Reaching the gold standard of data without the challenges of systemic drugs will ultimately define Cutera’s success with AviClear.

In terms of numbers, clinical studies indicated that 80% of study patients saw at least half of their acne clear after the recommended treatment protocol of three 30-minute sessions. At week twelve 87% of the patients reported being “satisfied” or “very satisfied”. This success came with no significant adverse events while all post-treatment effects were transient and self-resolving.”²

Patient Compliance and the Benefits of AviClear

Until now, traditional acne treatments required patient compliance and commitment, making it difficult to see long-term results, especially for teenage and young adult patients. But another hurdle facing physicians is that patients and their families prefer natural treatments to medications, when possible. “Many are leery about taking oral antibiotics, especially for long periods of time,” explained Jeffrey Dover, MD, dermatologist and director of SkinCare Physicians (Chestnut Hill, Mass.), “Isotretinoin is difficult to prescribe and has at least two significant side effects and many irritating, less significant, side effects. Only one month of isotretinoin may be prescribed at a time, so patients have to come into the office many times during their six-month course of treatment, which adds a significant burden onto the patient and their families.”

Dr. Bhatia has found similar hurdles in treating acne patients. “While isotretinoin works well, it comes with significant side effects and warnings; it also requires the iPledge program. Some parents and patients are hesitant to go this route,” he said. “Another hurdle we have when treating acne is compliance. The majority of acne sufferers are young adults with busy, active lifestyles, making it a challenge to maintain consistency in their treatments. AviClear requires only three, 30-minute in-office treatments, which is great for patients since it easily fits into their active lifestyles.”

In addition to addressing these patient issues, the AviClear features an easy-to-use interface, enabling treatments to be delegated to a physician extender (dependent on state laser licensure laws), which can improve patient throughput as well as ROI for the practice.

“To me, the key feature is the ease of use,” stated Tahl Humes, DO, founder and medical director at Vitahl Medical Aesthetics (Denver, Colo.). “A lot of what we do for our patients can be labor intensive for us, or it may be a treatment that takes a long time. AviClear is a speedy treatment that is easy and comfortable for a clinician to do.” Furthermore, with AviClear, patients do not have to change their lifestyle, making this treatment protocol easy to follow with continued improvements as a result.

Traditional acne treatments not only come with compliance issues, but they may also be uncomfortable due to side effects. Dr. Graber reported that the safety features of AviClear can help physicians clear this hurdle. “The AviCool contact cooling allows for safety of the epidermis so that you do not see any of the hyperpigmentation that can plague other devices,” she explained. “The contact cooling also makes it tolerable for patients without the need for topical anesthesia, which really speaks volumes to the design of this device. I was also impressed with the light system on the handpiece that indicates if there is sufficient contact with the skin, and that it is safe to deploy the laser pulse.”

The AviClear Advantage

AviClear can expand patient reach and satisfaction because it does not require a prescription and can be used to treat all skin types. In addition, it is compatible to use with other therapies. Dr. Graber plans to use the device in combination with other treatments. “I will have some patients taking an antibiotic pill or a combined oral contraceptive that may be getting results, but their acne is not totally clear,” she began. “If that is the case, we can use the AviClear laser in addition to the oral treatment and treat the remaining acne by selectively targeting the sebaceous glands.”²

Dr. Bhatia shared that he will use AviClear as a monotherapy treatment, especially for patients who may not be candidates for, or who have failed, other therapies. However, he has already devised a method to bring out the versatility of this treatment and boost patient outcomes by using it in combination with other procedures.

Cutera’s history of innovation has provided forward-thinking aesthetic physicians and practitioners with solutions for achieving superior outcomes in face and body rejuvenation. Dr. Humes has recognized this opportunity to use AviClear in combination with other revolutionary procedures. “With AviClear, we saw that the integrity of the texture of their skin got better, and we can improve on it even more with Laser Genesis (Cutera). I think what we will see is that we will be doing these combo treatments on the same day.”

Changing the Future of Aesthetics with AviClear

“The potential for the new AviClear device for treating acne is significant,” Dr. Dover exclaimed. “This is the first and only FDA-cleared device which appears to significantly improve the treatment of moderate to severe acne on and off the face. This may be one of the biggest developments in the treatment of acne since the introduction of Accutane in the early 1980s.”

Having such an impact on how acne is treated makes it inevitable that it will impact aesthetic practices. According to Mr. Mowry, AviClear will be a cash-based procedure, with the economics closely modeling the out-of-pocket expenses that patients face with a prescription treatment. “Even though isotretinoin may be covered by insurance, the co-payments for the lab, the co-payments for the prescription and the co-payments for the physician visits add up over seven or eight times, so I think the economics are about even. I believe that we win on safety, efficacy and convenience without giving anything away on economics,” he shared.

Being a dermatologist, Dr. Graber treats a wide range of acne patients. “AviClear really puts acne patients in the hands of cosmetic practices and patients can now be treated by the aesthetic provider because the AviClear laser is so effective. This really broadens the scope of aesthetic practices, and everyone can benefit from AviClear; practices can benefit from having it and patients can benefit from its efficacy.”

Avi360 Partnership

With the introduction of AviClear, Cutera is also introducing a full partnership approach with practitioners and physicians that is focused on customer support and driven by their new Concierge team. As part of Avi360, physicians will have a one-stop shop, where the Concierge team will coordinate installation, training and onboarding while providing them with support throughout the partnership. Another area of Avi360 is the marketing efforts with the Key Account Management team that will provide local support as well as national marketing efforts to help drive awareness of the AviClear brand.

Conclusion

Cutera has opened the door for aesthetic physicians and practitioners to expand their patient portfolio and increase their revenue by providing a solution to treat acne patients instead of referring them to prescription-based treatment. And with a delegable procedure and 30-minute treatment times, AviClear has become a versatile and profitable procedure that will enhance aesthetic practices everywhere.

As Dr. Dover points out, devices are rarely used to treat acne – until now. “The early data using the new Cutera device shows the potential for a durable response with more patients improving six months after their last treatment compared to three months after the last treatment despite receiving no other therapy. AviClear will allow aesthetic physicians and practitioners to provide a durable, drug-free, non-systemic solution to treating acne, and that is a game changer.”³

References:
1. Chovatiya R. Acne treatment. JAMA. 2021;326(20):2087
2. Data on file, FDA clearance study. Cutera, Inc
3. Treatments can be delegated to a qualified healthcare provider as determined by state laser licensure laws

Sponsored by BTL Aesthetics

Renowned for safe, effective, non-invasive aesthetic medical devices whose development and growth are based on solid science, BTL (Boston, Mass.) also boasts top-line customer support and marketing. Their devices use minimal to no consumables and pay for themselves rapidly due to the combination of manageable operating costs and appeal – an obvious product of safety, efficacy and convenience that both patients and practitioners love. Together with their suite of market-driving platforms, this winning combination is no better demonstrated than through the success of Emsculpt Neo^®.

Emsculpt Neo is the next generation of Emsculpt (now commonly referred to as Emsculpt Classic^®), which marries the powerful high intensity focused electromagnetic (HIFEM) muscle building technology with radiofrequency (RF) energy within a single handpiece. HIFEM induces thousands of supramaximal muscle contractions in a 30-minute treatment session, with applicators and algorithms for virtually any body part (abdomen, buttocks, arms, thighs, calves and lateral abdomen) to strengthen both core and extremity musculature. While Emsculpt Classic’s HIFEM was proven to induce significant muscle hypertrophy and hyperplasia,^1,2,3 the marriage of this groundbreaking technology with RF, as seen in Emsculpt Neo, provides greater outcomes, also shown in the literature.⁴

The result is a device that non-invasively reduces localized adiposity by causing fat cell death, while simultaneously improving underlying musculature. The platform and its treatments virtually sell themselves. Zach Dancel, owner of Nava Health and Vitality Center (Columbia, Md.), shared that they did $99,000 at an Emsculpt Neo bus tour event they held last summer. “Emsculpt technology was new to our practice, so we pushed a lot of internal marketing, which drove a lot of our success,” he said.

The Nava Health clinic has two Emsculpt Neo platforms as well as Emsella. “Melting fat and building muscle in a painless, non-invasive way is hugely appealing, and Emsculpt truly delivers that,” Mr. Dancel expressed. “One simply cannot do in the gym what this device does. People are treated and can go right back to their lives.”

Nava Health is all about wellness, making Emsculpt and HIFEM technology perfect for the clinic. “We serve a varied clientele, more than just the aesthetic patient,” Mr. Dancel continued. “Many come in for wellness improvement. Because of their age or other factors, they cannot do the exercises, certainly not enough to get the enhanced physical functionality seen with this treatment. It is hard to put into words how it improves their overall function and quality of life, especially for older patients whose bodies and joints cannot easily tolerate so much physical exercise. Quality of life goes up, the chance of falling or other injury goes down.”

The tour bus itself is wrapped with visual advertising. It carries an enthusiastic cadre of motivated, trained staff to help explain things and get customers excited, as well as several devices on which attendees can receive treatments. They set up tents, signs, posters and more. The practice, supported by the stop, opens its doors to offer treatments as well, exposing as many as possible to the wonders of Emsculpt technology, and is encouraged to offer specials concurrently to drive sales.

“The bus parks nearby and everybody gets treated to the experience. They also get a free treatment before purchasing a treatment package. Locals know it is coming, so they get excited about the specials we offer with the tour,” explained Lacey Edwards, manager of Smart Skin Medspa (Homewood, Ala.). “Everyone, including patients and staff, gets swept up in the excitement. It is fun for everyone and is a massive marketing opportunity for us. We are deluged with testimonials and can pump up the hype before, during and after the event through social media.”

She added that they had just finished their fourth bus tour event and had to set up presales because it was so popular. “With last year’s bus tour stop, we did $80,000, and this year we did $104,000. We have had amazing results with Emsculpt Neo, Emsculpt Classic, Emsella and Cellutone. This has blown up our patient base in every demographic, including males, which in turn exposes them to our other offerings.”

By building awareness of Emsculpt among the general public, providing marketing solutions and support to its customer base, BTL has generated buzz that has helped build practices even as the COVID-19 pandemic raged on. Jackie Pantalone, certified professional accountant (CPA) of Studio Sculpt (Clawson, Mich.), is also chief financial officer of an automotive engineering company and a self-described health & wellness junkie who started a medspa to bring wellness to women and others in her area. “In my research I was totally blown away by what Emsculpt technology brought to the medical, aesthetic, and wellness arena with how far ahead it is compared to everything else out there,” she expressed.

Ms. Pantalone linked up with sports medicine specialist John Santa Ana, DO, who opened a small boutique but had to shut down for four months right after opening due to COVID. “When we were able to reopen, everyone was so sick of COVID and had not been able to get to the gym, so we were able to build a very robust business and grow from there,” Ms. Pantalone shared. “We are currently among the top three Emsculpt Neo accounts, which is bizarre to me because I still work my full-time job. This success compelled BTL to send Donna D’Errico as a celebrity guest for our bus tour stop last year. We made it a Baywatch-themed beach party, which generated a lot of buzz for a small town 45 minutes outside of Detroit. We had every machine from the bus and in our practice going the whole time, and it generated a lot of business both on the spot and online afterward. We really appreciate the direct-to-consumer marketing BTL has done throughout. It helped our business because the device’s scientific foundation and proven success brought the legitimacy we needed to get our practice going. A lot of the heavy lifting was already done to bring local patients to us.”

Emsculpt technology, and the bus tour, are giving a boost to small town practices everywhere. Sam R. Patel, MD, MBA, founder and CEO of LIV Wellness Lounge (La Salle, Ill.), used Emsculpt Classic, Neo, Emsella, and others, as practice builders. Dr. Patel also relied on BTL’s marketing support to promote his new practice, which opened in January 2021. “We are in a town of around 9,000 about two hours from Chicago, with many farming and blue-collar workers, so we are not ‘big city.’ Bringing a decked-out tour bus with that kind of excitement and sense of exclusivity to the area was incredibly appealing to our potential patient base. It brought us a ton of publicity and attention,” he expressed.

“BTL devices were the first we brought into our practice, so we leveraged the bus tour along with their marketing support to raise awareness through news, radio and social media,” Dr. Patel continued. “On a Saturday, we were able to shut down the block and have a party, get local businesses involved, and make it a huge event for the entire town. It was almost a health and wellness fair. Other companies involved with us also came out and set up tents. More than 500 people showed up, and we booked more than $70,000 in business within a few hours.”

“Unlike big city practices which focus on the aesthetic side, we are very much the opposite,” Dr. Patel explained. “Our niche is health and wellness. We offer ‘mommy makeovers’ to improve abdominal separation, reduce stubborn fat, and restore strength. We help people with rehab after injuries, improve urinary incontinence, and provide functional and quality of life improvement for older people. That is what attracts our patients, and it is fantastic.”

Rob Miracle is the practice manager at Lumera Regenerative Medicine (Tualatin, Ore.). “This practice is about two years old, we opened in June 2020, and within two weeks, we had our first bus tour event. We were just beginning to build our patient base as COVID was becoming a full-blown pandemic, so it was kind of unusual, but Emsculpt allowed us to treat without too much direct contact. We are near two busy thoroughfares, so we had a lot of visibility, and many people just showed up. The machines in the bus and ours in the office were constantly running to provide a free treatment to everyone who came.”

People hung around and got to know the practice, along with Rob’s wife and Lumera’s medical director, Roberta Huang, MD. “The majority of these people are still clients relying on our Emsculpt and Emtone devices who bought their first treatment package, kept coming back, bought long-term packages, had other body parts treated and referred friends. These devices deliver and have driven those people who are committed to fitness, health and wellness to our practice, motivating them to work harder and maintain health and well-being while losing stubborn inches. This fits in well with our whole-health mission and vision for the practice, and helps us do what we do best: counsel patients on how to best achieve and maintain the health and quality of life they desire.”

The tour’s overall result is best summed up with two words: excitement and conversion. “The bus tour is hype to drive awareness,” said Sally Razo, manager of The Beauty Crew Institute of Medical Aesthetics (Upland, Calif.). “It gets people interested and excited, compelling them to act. Even when people had not heard of the technology, they stopped in because they wanted to see what the buzz was all about. We actually had to limit the turnout because we wouldn’t be able to accommodate the number of people who wanted to participate.” To do this, Sally instituted a paid RSVP program, where people paid a deposit for the chance to be a part of the action. “That gave us that extra level of commitment from the patients that said, ‘Hey, I will be there,’ heightening anticipation and enthusiasm to produce sales, which is exactly what happened. Existing patients brought friends with them. I recall that we were able to convert about 80% of those who attended to purchase packages; I had several clients that bought more than one, and we have been easily able to retain those patients.”

As a medical spa, The Beauty Crew Institute caters to an aesthetics-driven clientele, according to Ms. Razo, but patients find the wellness aspect of treatment appealing also. “At least 90% of our clients exercise regularly and practice a healthy lifestyle but want something to put them over that edge to get them to the next level, so they are easily motivated by what Emsculpt technology can do,” she explained. “When I talk to them about how it can jump-start their healthy lifestyle, help them look and feel better, and improve wellness, that grabs and keeps their attention.”

This excitement, she added, is what makes patients so eager to purchase memberships offered by the spa, making them long-term clients. “Just as with dieting or regular exercise, if you stop, you will slide back. You need to maintain what you worked for. Our membership program allows them to come back for maintenance treatments at a discounted rate because they have already invested in the initial package. It is essential, and most people end up purchasing a membership. This gives us an infusion of cash in the short run and continuous cash flow over time. Patients can maintain their results and serve as walking advertisements for what we do.”

 

References:
1. Katz B., Bard R., Goldfarb R., Shiloh A., Kenolova D. Ultrasound assessment of subcutaneous abdominal fat thickness after treatments with a high-intensity focused electromagnetic field device: a multicenter study. Dermatol Surg 2019 Dec;45(12):1542-1548.
2. Duncan D, Dinev I. Noninvasive induction of muscle fiber hypertrophy and hyperplasia: effects of high- intensity focused electromagnetic field evaluated in an in-vivo porcine model: a pilot study. Aesthet Surg J 2020 Apr;40(5):568-574.
3. Kent DE, Jacob CI. Computed tomography (CT) based evidence of simultaneous changes in human adipose and muscle tissues following a high-intensity focused electromagnetic field (HIFEM) application: a new method for non-invasive body sculpting. J Drugs Dermatol. 2019 Nov 1;18(11):1098-1102.
4. Palm M, Kinney B, Halaas Y. Simultaneous emission of synchronized radiofrequency and HIFEM energy for treatment of lateral thighs: interim results of the MRI multicenter study. Presented at: 40th Annual Conference of the American Society for Laser Medicine and Surgery (ASLMS) virtual meeting, May 15 – 16 2021.

Sponsored by Advalight

The gentle but powerful dual wavelength ADVATx laser system from Advalight (Copenhagen, Denmark) not only provides practitioners with a plethora of practical applications for improving and rejuvenating skin, but it is also safe enough to treat skin of color. Robust and easy to use, ADVATx treats a variety of conditions including acne and acne scarring, fine lines and wrinkles, skin tone and texture as well as vascular and pigmented lesions,* all of which require more care to successfully treat skin of color without inducing side effects such as post-inflammatory hyperpigmentation (PIH). Moreover, there is little to no downtime.

Hazel Forrester, MS, FNP-BC is a renowned injector and aesthetic specialist, as well as owner of Hazel the Beauty RN (New York, N.Y.). In her opinion, “this device is excellent for treating skin of color. I’d shout it from the rooftops,” she exclaimed. “Treatment alternatives have been limited to chemical peels, microneedling and things of that nature because great care must be taken when treating skin of color with a laser. However, these therapies require numerous sessions with questionable efficacy, and have significant downtime, so they are not attractive options. Historically, it has been difficult to have so many options for Caucasian skin, while steering patients with darker skin types, including myself, toward lesser options. ADVATx improves skin quality and pigmentation safely for skin of color. And patients absolutely love it.”

Energies between 5 J/cm² and 60 J/cm² can be delivered with ADVATx via a single spot of 1, 2, or 3 mm in diameter, or via the scanner (with spots of 5x5 mm, 7x7 mm, or 10x10 mm) to tailor treatment to the specifics of the individual case, manage, or even eliminate, discomfort during treatment and minimize the potential for side effects.

ADVATx PulSync Technology uniquely pairs the strengths of the device’s workhorse wavelengths – 589 nm and 1319 nm – which can be used individually or in combination. The device features two laser modules working in tandem; the 589 nm beam is produced by emitting a 1319 nm beam through a YAG crystal prior to combination, passing the combined beam through a Q-switch, then a non-linear (LBO) crystal. The 1319 nm wavelength is ideally situated in the absorption spectrum for water and can be harnessed to induce neocollagenesis, while its companion, the yellow 589 nm wavelength, can treat pigment and vascularity.

Depth of treatment and wavelength specificity are the keys to safe, effective treatment with ADVATx, Ms. Forrester explained. “The wavelengths employed by ADVATx are specific to the applications, and depth of treatment is ideal for the indications as well, avoiding the pitfalls of overtreatment or overly deep treatment that plague skin of color or Asian skin such as PIH.”

The solid state ADVATx platform is also very user- and office-friendly. It can run on standard 120 V power and uses no consumables, with a manageable footprint of 23 x 23 inches and weighing under 200 lbs. The intuitive user interface is easy to use, and treatment settings can be modulated during use. “You can treat anybody with ADVATx,” Ms. Forrester added, “young or old, dark or light skin. That makes this laser very useful and valuable to my practice.”

*CE cleared indication

Sponsored by Acclaro Corp.

UltraClear^TM, from Acclaro Corp. (formerly FA International LP, Boston, Mass.), is reportedly the world’s first cold ablative fiber aesthetic laser. As a flagship FDA-cleared skin rejuvenation system, UltraClear is breaking new ground as a powerful, no-downtime, painless therapy for the entire spectrum of anti-aging skin conditions, including age spots, enlarged pores, fine lines and wrinkles, scars and acne scars, stretch marks, sun damage, textural irregularities and general complexion issues. Most treatments do no require topical numbing. The device it is safe for all skin types and is emerging as a leader for treating Asian and darker skin types (III – VI), specifically. The 2910 nm wavelength is at water peak absorption, maximizing tissue ablation and minimizing incidence of post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE), as well as bleeding.

Aesthetic laser innovator and Acclaro president, Shlomo Assa (Smithfield, R.I.), is the inventor of UltraClear. According to Mr. Assa, fiber lasers are the future of laser technology, “because they are more reliable with superior beam quality and speed. It is ‘cold’ relative to other lasers because tissue is vaporized so efficiently by the non-visible 2910 nm wavelength. There are no lingering thermal traces, which reduces the potential for pain, especially in the stratum corneum where there are no nerves when using the Clear Mode of the device. Furthermore, UltraClear offers an optimized solution that increases clinical efficacy while reducing risks and improving the overall patient experience.

“Painlessness with deeper penetration of energy using Ultra Mode is a product of engineering,” Mr. Assa continued. “The fiber laser delivers superb beam quality, allowing us to create a very tight, high-density spot to maximize the effect but minimize the total energy delivered because of the small individual spot. We combine this with rapid fractionated pulsing, so there is not enough energy for the nerves to feel anything. The laser can rapidly deliver a high-resolution pattern of these small spots within the tiniest fraction of the time required with an older generation laser. The patent pending blended pulse technology 3DIntelliPulse^TM creates profound, three-dimensional collagen remodeling by automatically blending cold and thermal energy simultaneously at the same micro-ablative channels and delivering fractional coagulation at multiple skin layers to optimize efficacy while increasing safety for all skin types.”

With treatment times under 15 minutes, no topical numbing required for most procedures, no consumables, or per-pulse payments, throughput is high and return on investment (ROI) is rapid. Safety and ease of use make it prime for delegation to trained ancillary staff.

Eric F. Bernstein, MD, chief medical officer of Acclaro and medical director of his practice, Main Line Center for Laser Surgery (Ardmore, Pa.), led a histopathology study of the effects of the UltraClear laser (publication pending). “With UltraClear you can get a very superficial injury, which, under the microscope, is limited to the stratum corneum and not even, or barely, into the epidermis,” he explained. “However, we see significant erythema and a dermal inflammatory response followed by a remarkable clinical effect. The end result is, simply put, a significant clinical ‘rejuvenation’ outcome with minimal superficial injury to the skin.”

Dr. Bernstein added that Clear Mode was used in this study, and studies with Ultra Mode and UltraClear mode are ongoing. “We could rapidly treat the whole face without pain, using the 15 mm x 15 mm spot which was very easy to use. My Ultra Mode study uses no topical anesthetic, and I have completed the first treatment in that study already. I have been very impressed with the UltraClear laser. This is a leap forward technology in my opinion. I have been waiting for a device like this for a long time.”

Sponsored by Cutera

Cutera (Brisbane, Calif.) is redefining aesthetic treatments with AviClear^TM, reportedly the first and only energy-based device cleared by the FDA for the treatment of mild, moderate and severe acne vulgaris. Unlike current standard acne treatments, AviClear utilizes 1726 nm laser energy to reduce the severity and frequency of acne, providing a drug-free alternative that can treat all skin types. Soon physicians will be able to add this modern alternative to their current armamentarium of acne treatments.

The excitement grows as the first patients have now been treated with AviClear. Julie Harper, MD (Birmingham, Ala.), past president of the American Acne and Rosacea Society, shared that she was looking forward to having a new, drug-free alternative for treating acne of all severities and skin types. “We have many effective topical and oral pharmaceutical products for acne, but patients sometimes need or want an alternative. There are patients who have tried all available treatments and have not achieved their desired results,” she explained. “AviClear will give us another tool to help these patients achieve acne clearance with an enduring response.”

Acne vulgaris is a common skin concern, especially among young adults. AviClear is a first-of-its-kind treatment that targets and suppresses the sebaceous glands to resolve active acne and help prevent future breakouts. With just three 30-minute sessions, 80% of patients treated with AviClear saw at least half of their acne clear in the first three months following treatment, with results continuing to improve over time, indicating durability of results and long-term efficacy.¹

Dr. Harper reported that her patients tolerated AviClear very well, thanks to the AviCool^TM contact cooling feature. “The discomfort was only during the laser pulse, and there was no residual discomfort or redness. The full-face treatment took about 25 minutes.” Cutera has reported that no pain mitigation was utilized or required by any clinical study participant, nor were there any reportable events observed during the clinical trial.²

AviClear offers a safe and effective solution to acne vulgaris and will be available to physicians throughout the U.S. over the course of 2022. Cutera plans to provide a comprehensive support program to help providers acquire and market the system to their patients. Aesthetic practices will benefit from an enhanced portfolio of treatments for acne patients that can be used alone or in combination with other therapies. “I will likely use AviClear both as a monotherapy in some patients who want the ease of a ‘no homework’ treatment, and in combination with other treatments,” Dr. Harper added.

With no downtime and no adverse events throughout the trials, AviClear should prove to be a game changer for physicians and their treatment of acne vulgaris. Cutera’s AviClear and the AviCool feature will benefit both physicians and their patients, making this unique device a soon-to-be standard treatment in the future of aesthetic medicine.

References:

1. Data on file. FDA clearance study. Cutera Inc.

2. Data on file. Cutera Inc.

Sponsored by CosmoFrance

All-natural facial rejuvenation procedures are increasing in demand, yet patients have had very few options available, until now. CosmoFrance (Miami, Fla.) has introduced its revolutionary ezGEL^®, an autologous regenerative gel that uses the body’s own powerful proteins for skin rejuvenation. Aesthetic physicians can now expand their potential market to treat patients who desire natural, highly concentrated treatments for skin regeneration with little to no downtime.

According to Kian Karimi, MD, a plastic surgeon in Los Angeles, Calif., and medical director for CosmoFrance, ezGEL is a 100% natural solution that comes from the patient’s own blood and offers an extended release of growth factors and biostimulation from Platelet-Rich Fibrin (PRF). This unmodified gel solution is obtained by isolating beneficial cells and growth factors in harvested plasma, heating then cooling this enriched concentrate to create a natural and smooth biostimulating gel.

“It can be used for patients who desire a boost to their skin and can address concerns including undereye circles and hollows, or an aged and tired appearance,” Dr. Karimi reported. “ezGEL can be used alone or in combination with synthetic fillers and neurotoxins, which will appeal to a large proportion of the population.”

Anil Rajani, MD, founder of Rajani MD (Portland, Ore.), is a leader in minimally invasive aesthetic treatments and believes that ezGEL will significantly impact aesthetic practices and patient outcomes. “To me, ezGEL is revolutionary on many fronts. It is all-natural, so the potential market is much larger than traditional aesthetic procedures as we know them now,” he emphasized. “New patients are ideal, as the barrier to entry for them is often the fear of currently available injectables. Conversely, long-time patients are now feeling distorted by traditional products and are looking to restore their natural, yet rejuvenated selves.”

The process begins with the practitioner evaluating the quantity of gel they want to yield from the patient to effectively treat their areas of concern. “We spin some of the blood at a higher speed to obtain the albumin component and then heat this portion,” Dr. Rajani explained. “While the heating is taking place, the other portion of the blood is spun at a lower speed to obtain growth factors and stem cells. The gel is then injected into the desired areas using a microcannula. It is ideal for treating areas where fillers and biostimulators cannot be used easily such as the direct undereye area, perioral area and the brow region for hair stimulation.”

Dr. Karimi explained, ezGEL can be used to customize treatments for collagen stimulation, regeneration and skin rejuvenation. “I have used it to restore volume loss from trauma or prior skin steroid injections that caused dents and divets in the face and to treat areas that have suffered from vascular occlusion and/or necrosis from synthetic injectable fillers,” he shared. “It is also ideal for patients seeking a natural and subtle boost to their skin.” Dr. Karimi pointed out that tutorials and videos with step-by-step instructions for how to make ezGEL are available through CosmoFrance’s website.

CosmoFrance has filled the demand for natural skin rejuvenation using the power of the patient’s own blood and growth factors to offer infinite new possibilities in the use of autologous blood concentrates. With an improvement in patient outcomes and the ability to increase market potential, ezGEL will certainly revolutionize aesthetic practices in the U.S. and beyond.

Sponsored by Rocasuba

With age, comes physical changes that affect skin and hair in all areas, including the eyelashes and eyebrows. It is no secret that to support healthy skin and hair, one needs to continue to replenish vitamins, minerals and antioxidants. To fight against environmental factors like UV radiation and chlorinated water, application of topical nutrients can help improve the look of lashes and brows. Finally, dermatologists can inform their patients about a topical cosmetic treatment that does not require a prescription – RapidLash^® by Rocasuba (Mashpee, Mass.).

As Alan Parks, MD, founder of DermWarehouse (Gahanna, Ohio) explained, there are more factors that contribute to thin eyelashes than just nutrients and the environment. “Some patients lose their eyelashes due to conditions like alopecia or going through chemotherapy, but others simply want to grow longer lashes to avoid wearing mascara or eyelash extensions and may not have naturally long lashes,” he explained.

Eyelash serums work best on those with brittle, weak lashes, while damaged lashes can also benefit from a conditioning treatment to improve the appearance of lashes. Purvisha Patel, MD, a board certified dermatologist and founder/ owner of Advanced Dermatology (Memphis and Arlington, Tenn., and Olive Branch, Miss.), explained that medical conditions such as thyroid disease and vitamin deficiencies could manifest with a weakening of the eyelashes, making it important to see a dermatologist if you are experiencing ongoing symptoms.

“Fortunately, RapidLash contains polypeptides, biotin, panthenol and amino acids that help lengthen the look of lashes,” Dr. Patel explained. “Biotin is a B vitamin and is an essential factor in maintaining healthier-looking lashes. Polypeptides, comprised of beneficial amino acids, help protect against breakage and support the flawless appearance of lashes. The formula is also high in beneficial lipids and vitamins and is formulated with Hexatein^® 1 Complex, a blend of fortifying ingredients,” she continued.

According to Dr. Parks, RapidLash is developed by International Research Laboratories. Their studies and tests have shown that you can see an improvement in the appearance of lashes in as little as four weeks, with more defined results appearing after eight weeks. “RapidLash is formulated with multiple ingredients that work together to enhance and strengthen lashes,” he reported. “Continuing to use RapidLash is key to keeping up with the appearance of lashes.”

Dr. Parks added to the list of nutrients that make RapidLash so effective. “Vitamin B5 seals in moisture to provide the nourishment lashes need. Amino acids boost the protein structure of lashes, soybean oil provides essential vitamins needed to enhance lashes and pumpkin seed extract provides fundamental vitamins and minerals to nourish and enhance the luscious appearance of lashes.”

RapidLash is suitable for both men and women who desire to enhance the appearance of their eyelashes. It is suitable for those who wear contact lenses and can even be used with eyelash extensions. When patients are losing eyelashes, whether due to a medical condition, age or the damage that may come from lash extensions, RapidLash may be their answer for improving a fuller-look of their lashes. RapidLash gives dermatologists another tool they can recommend to patients concerned about their eyelashes while solidifying patient loyalty and satisfaction.

Sponsored by Venus Concept, Inc.

Combining the strengths of the tried-and-true 1064 nm diode laser with proprietary (MP)² and best-in-class electrical muscle stimulation (EMS) technology, Venus Bliss MAX^TM from Venus Concept, Inc. (Toronto, Ont., Canada) is a standout 360° non-invasive body shaping solution in an increasingly competitive market. Though sophisticated, it is easy to use and safe. Treatments can be done in a single session requiring only about 20 minutes, or in combination with TRIBODY^TM, by mixing and matching the three distinct modalities.

Michael H. Gold, MD is the founder and medical director of Gold Skin Care Center, Advanced Aesthetics Medical Spa, The Laser & Rejuvenation Center and Tennessee Clinical Research Center in Nashville, Tenn. According to him, “By combining these three technologies, Venus Bliss MAX allows us to target the three key treatment vectors of body contouring: fat, muscle and skin laxity. The laser for fat reduction and radiofrequency for skin tightening components are proven technologies. Add to that the new FlexMAX EMS for muscle toning and strengthening from underneath, plus high patient satisfaction, and it is easy to see why we like it so much.”

“Bliss MAX is the only device in its category to combine these three technologies in a single body shaping platform, taking this treatment category to the next level,” added Anat Kotler, vice president of global marketing and product management for Venus Concept. “It builds on the success of the original Venus Bliss, providing a comprehensive solution for existing and new customers. With the FlexMAX EMS, we introduced our exclusive Adaptive Mode featuring AdapTarget, AdapTrain and AdapTensity. We can target seven muscle groups selectively, use adaptive algorithms, and tailor treatment parameters to achieve optimized results with maximum comfort. We believe the adaptive mode will be a game changer for the muscle toning category and the industry overall. The Bliss MAX is the ultimate one-stop-shop to address the most in-demand body shaping procedures.”

The 1064 nm diode laser is known as the gold standard in non-invasive fat reduction, Dr. Gold noted. “We have seen the science. It delivers energy more uniformly, and the device’s onboard water cooling maximizes our ability to deliver that energy safely to get the most out of the treatment.” The diode laser is indicated for non-invasive lipolysis of the abdomen and flanks, and recently achieved clearances for the back and thighs as well for patients with a BMI of 30 or less.

Proprietary (MP)², powered by MultiPolar Radiofrequency (RF), and Pulsed ElectroMagnetic Fields (PEMF) with VariPulse^TM technology, propels the final result to new heights. “We know, from extensive experience, that these types of magnetic fields affect fibroblast production while improving lymphatic drainage. Mechanical massage has also been scientifically demonstrated to enhance non-invasive body contouring outcomes,” Dr. Gold said, “but this is also where you turn a body shaping therapy into a treatment for cellulite. RF plus PEMF by itself is FDA cleared for the temporary improvement of the appearance of cellulite because we really need to improve local microcirculation and drainage to do that consistently and effectively.”

The unique body contouring results come from the powerful synergy of these modalities, said Dr. Gold. “This is what both us and the patients are looking for in a body shaping platform, the ability to comprehensively, non-invasively, and comfortably recontour the silhouette with a tightening of the related areas of laxity or potential laxity.”

Sponsored by CAREstream America

Doris Day, MD, a dermatologist in New York City, N.Y., compares having the Pro-Nox^TM pain management analgesic device from CAREstream America (Lake Mary, Fla.), at her practice to her love for French fries. “It is funny. When I go to restaurants I ask, ‘What comes with French fries?’ I sort of love the French fries more than the main course,” Dr. Day shared. “And when people come in and have had a cosmetic treatment with Pro-Nox, they say, ‘so, what else comes with Pro-Nox?’”

Pro-Nox does not make patients’ faces younger looking or bodies more toned, but it does remove a major barrier to certain treatments – pain – making it possible to fully optimize each treatment more efficiently, resulting in patients looking forward to their next procedure with Pro-Nox, Dr. Day indicated.

Pro-Nox is an FDA-cleared pain management device that delivers a fixed blend of nitrous oxide, or laughing gas, and oxygen. Patients self-administer and control the amount of gas delivered as needed. According to Dr. Day, Pro-Nox answers the “Will it hurt?” question.

Studies have shown that Pro-Nox helps by decreasing the sensation of pain and patients’ recognition of the presence of pain, as well as diminishing the patient’s anxiety.

Authors of a German study looking at the use of nitrous oxide analgesia in the setting of aesthetic dermatology concluded: “The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes, as well as the low ratio of side effects make the N2O/O2 inhalation an ideal addendum in the management of larger painful dermatologic procedures as long as contraindications and safety precautions are respected.”¹

“Pro-Nox makes everything just so much more pleasurable,” Dr. Day stated. “Knowing that they have something they can control and count on that is going to help with that discomfort makes everything better even before a patient has treatments done. Their heart rate is down, blood pressure is down, risk of bruising is down, the procedure goes faster and they are just very happy.”

Joel L. Cohen, MD, director of AboutSkin Dermatology and DermSurgery in Greenwood Village, Colo., frequently uses Pro-Nox for the more uncomfortable laser procedures – specifically, for heavy, full-field Erbium resurfacing. “People often have anxiety about the procedure and about the nerve blocks. Pro-Nox helps to take the edge off all of that,” Dr. Cohen expressed.

To prepare for full-field laser resurfacing, Dr. Cohen asks patients to take about five to seven deep breaths of Pro-Nox as a loading dose.

“I will then start with the regional blocks and numbing. As the Pro-Nox starts to attenuate in four to five minutes, we will have them take a few more deep breaths to get them to a point where we can finish the nerve blocks and start the resurfacing,” Dr. Cohen noted.

Using Pro-Nox has all but eliminated the need for Dr. Cohen to write Ativan (lorazepam) prescriptions for patients. “With a good regional block in most areas, patients feel pretty comfortable in terms of pain. They do feel some heat and vibration, and for some people that leads to a bit of anxiety. So, we typically blow the Zimmer cooling device onto them and give them the opportunity to have more Pro-Nox when they feel they need it.”

Dr. Day likes Pro-Nox as a physician because it is an analgesic, not anesthesia. “I don’t need to update anything in my malpractice. I don’t need to do any monitoring,” she explained. “I also like that patients self-administer Pro-Nox. It is something that they breathe in and out. It is not something that is forced on them at a certain rate.”

Even though Pro-Nox is an analgesic, it helps with both the pain and the anxiety, Dr. Day reiterated. “Patients can feel some discomfort, but they don’t care. And they don’t have the anxiety that goes with it, which is often more than the discomfort itself,” Dr. Day pointed out. “Then, it clears out of their system within five to ten minutes, so they can drive home and get back to their lives. I don’t have to worry about them operating heavy machinery, as I do with some other medications.”

Dr. Day uses Pro-Nox before and during treatments that result in some discomfort, including ultrasound- and radiofrequency-based tightening devices like Sofwave (Sofwave Medical Devices), Ultherapy (Merz Aesthetics) and Thermage (Solta Medical).
“There are also people who have anxiety around just getting neurotoxin injections, so I take that anxiety away (with Pro-Nox). Some people are just really, really sensitive, so we let them know that we have it if they want it,” Dr. Day shared.
Jason Pozner, MD, of Sanctuary Plastic Surgery in Boca Raton, Fla., has been using Pro-Nox for about four years, on more than 1,000 patients.

Pro-Nox is so popular and useful at his practice that one-third of his revenue is now from local anesthesia cases, which has fueled higher profits in recent years.

“I do a lot of small area liposuction cases, fat grafting, laser resurfacing and eyelid surgery, and use Pro-Nox in many of those cases,” Dr. Pozner advised. “For nervous patients we also use Pro-Nox for neurotoxin and fillers, and they can drive home because it clears in five minutes or so,” he reiterated.

At Dr. Pozner’s practice, Pro-Nox has been a game changer during other popular proce- dures, as well, including Ultherapy, Sofwave and MiraDry (Sientra). The cost of having Pro- Nox for the practice is reasonable, according to Dr. Pozner. “We have three Pro-Nox units going all the time.”

Reference:
1. Drosner M. Lachgas-Sauerstoff-Inhalation zur Analgesie in der ästhetischen Dermatologie [Nitrous oxide - oxygen analgesia in aesthetic dermatology]. Hautarzt. 2013;64(6):435-442. doi:10.1007/s00105-013-2588-z.

Sponsored By PDO Max

Thread lifting procedures continue to rise with the demand for minimally invasive facial rejuvenation treatments. With modern technology paving the way for greater advancements in thread lifting results, PDO Max® (Liverpool, N.Y.) does not disappoint. The new Levo Lock^TM is PDO Max’s latest thread device used to maximize the support of traditional PDO threads as it locks lifted tissue into place. Much like a scaffold to anchor the skin, the new Levo Lock enhances an advanced PDO thread technique known as “inferior to superior,” where the thread is inserted from the bottom of the face toward the scalp.

According to Dina BenDavid, DNP, MS, FNP-C (Edgartown, Mass.), director of Training and Clinical Development at PDO Max, Levo Locks were developed with the objective of improving the longevity of the lift. “The Levo Locks were designed to be used in conjunction with our traditional Levo threads, which I still find to be the lifting workhorse,” she explained. “These are typically used in an inferior-to-superior manner past the hairline to boost the results and sustain the lift.”

Kati Midgley, PA-C, owner of Clarity Medical Aesthetics (Guilford, Conn.), feels PDO Max listened to practitioners’ concerns for technology that delivered significant lift and lasting results. “The configuration of the barbs provides broader coverage and greater tissue engagement. The Levo Lock can be used with traditional omni-directional thread vectors across the mid-cheek or along the jawline to add improved tissue elevation; or alone from the zygoma, in a brow lift along the frontal bone, or along the angle of the mandible to enhance jawline contour. A helpful pearl is to perform your traditional vector lift, anchoring into the fascia or a ligament, and then tie in one or two Levo Lock threads in a superior direction for maximum lift.”

The traditional laser-cut Levo threads by PDO Max provide an improved grip with omni-directional barbs that are equally placed in a 6D pattern. When the threads are placed in a can- nula, they lay flat, giving the diameter of the thread more thickness as it takes up the entire space within the cannula. The molded Levo Lock threads are evenly spaced, bi-directional barbed threads that lock in place and anchor the lift that was created using traditional Levo threads.

Lisa Topham, RN, BSN, director at Split Rock Aesthetic Institute (Greenwich, Conn.), specializes in nonsurgical facial rejuvenation proce- dures. In her experience, Levo Lock threads offer a strong anchor when attached to a 19x100 or 18x100 barbed thread, in the vectors of the mid-face, specifically at the temple insertion as well as the pre-auricular vectors. “Levo Lock is most effective in advanced treatments for heavier, thicker skin that is sagging,” she shared. “In my opinion, reducing the skin envelope in the mature face is paramount. The use of threads to physically lift the cheek, jowl, brow and neck is brilliant. The addition of the locks makes an amazing procedure even better.”

PDO Max Levo Lock threads have taken lifting results to a whole new level, but Dr. BenDavid emphasized that advanced techniques are re- quired to use them properly since these are ad- vanced threads. PDO Max offers introductory and advanced training to ensure practitioner success, with six hours of one-on-one training.

Along with superior thread technology, training can be the factor that helps aesthetic practices stand out from others. As Ms. Topham exclaimed, “I started using PDO Max in 2018, and the magic began; the thread lifting aspect of my practice exploded. It is the training that made all the difference.”