PracticalDermatology

Despite fears of a looming recession, the market for aesthetic treatments remains strong, and the prospect of new entries is keeping consumer demand healthy. As a new year starts, it’s smart to consider promoting some new options to drive consumer excitement and volume. A currently popular buzzword is combination therapies. Combination injectable treatments, laser therapies, topical skincare products, and more can offer great efficacy and consumer satisfaction.

1. COMBINATION INJECTABLES

Every practitioner has their own methodology and aesthetic eye. Injectable treatments—neurotoxins and dermal fillers—are frequently combined in various ways to suit patients’ needs, priorities, tolerance, and budget.¹ Considering the growing portfolio of injectable options on the US market, experienced injectors can customize the treatments they offer to each patient to distinguish their techniques from those of every other injector and deliver an optimal experience and results.

Daxxify (daxibotulinumtoxinA) from Revance received approval from the US Food and Drug Administration in 2022 and is the hot brand for men and millennials. Some practitioners may be concerned about having patients come to the practice two instead of three or four times a year, but a huge group of consumers is eager to try a treatment that requires fewer injections and has a longer duration of action.

As of this writing, the FDA has approved Allergan’s Botox Cosmetic (onabotulinumtoxinA), Galderma’s Dysport (abobotulinumtoxinA), Merz’s Xeomin (incobotulinumtoxinA), and Evolus’ Jeuveau (prabotulinumtoxinA-xvfs) in addition to Daxxify most recently. Hugel, Inc, resubmitted the biologics license application for its botulinum toxin (Botulax) for glabellar lines in October 2022, which is expected to enter the market during the first half of this year. Aquavit Pharmaceuticals, Inc, submitted an investigational new drug application to the FDA for botulinum toxin type A drug DTX-021 in March 2022 and plans to introduce DTX-022 shortly after DTX-021.

I think some injectable treatments deserve more attention in 2023. For example, Galderma’s Sculptra Aesthetic seems to be underutilized in many practices. The product can meet a modern patient’s goals for multiple indications, including volume enhancement, acne scarring, nasolabial folds, and buttock enhancement, and can be used in combination with other injectable agents.

Another area of growth (excuse the pun) is the male and female intimate health category. Dermatologists may already offer platelet-rich plasma therapy for hair loss and other indications, but it can also serve as an in-demand adjunct at an aesthetic practice in the form of the O-Shot and P-Shot (registered trademarks of Dr. Charles E. Runels Jr).²

2. TECHNOLOGICAL INNOVATIONS

BTL’s non-invasive Emface therapy, launched in 2022, targets facial muscles and is in high demand for facial rejuvenation. In addition, Cutera launched AviClear 1,726-nm wavelength, which treats acne by targeting the sebaceous glands; three sessions are performed 1 month apart. AviClear represents a new category for acne therapy. The FDA also cleared the Accure Laser from Accure Acne, Inc, for the treatment of mild to severe inflammatory acne vulgaris. The recent relaunch of the ellacor System with Micro-Coring technology from Cytrellis, Inc, removes microcores of skin to address wrinkles and tightening in the mid- and lower face.

The market for microneedling and microneedling RF systems continues to expand. This minimally invasive treatment category is in demand among patients of all ages and skin types and has become a mainstay in many aesthetic practices and medspas. Platelet-rich plasma has become a popular add-on for consumers desiring more dramatic results. The versatility of these treatments accounts for a high profit margin in dermatology practices. Treatments can address lines, wrinkles, stretchmarks, scars, acne lesions, pigmentation, skin laxity, and hyperhidrosis. In many cases and in accordance with state law, treatment may be safely delegated to trained physician extenders, which can benefit a practice’s bottom line.

3. BODY SOLUTIONS

Competition in this highly profitable sector is increasing steadily. Patients are eager to take advantage of proven non-surgical body treatments. Many practices have taken this category to a new level by offering series pricing and combination treatments with several devices and select handpieces to maximize results to meet their patients’ goals.

A nationwide population-based study found that 48 percent of US adults gained weight during the COVID-19 pandemic and psychological distress was a factor.³ According to the FDA, approximately 70 percent of US adults are obese or overweight.⁴ Consumer demand for non-invasive body shaping treatment continues to expand, and more dermatology practices are offering these options. It is worth mentioning that the quest for slimness has left FDA-approved drugs Ozempic (semaglutide) from Novo Nordisk, Wegovy (semaglutide) and Saxenda (liraglutide) from Calibrate Health, and Mounjaro (tirzepatide) from Lilly in short supply.⁵

A trend toward buttocks the size of the Empire State Building seems to be waning in favor of a more natural appearance. Despite the recent decision by Endo Pharmaceuticals to withdraw Qwo (collagenase clostridium histolyticum-aaes) injectable for cellulite from the market owing to injection site bruising and skin discoloration, consumer demand for body solutions remains strong. (For more on Endo’s decision, see page 26.) The recently launched Avéli device from Revelle offers a new technology for reducing cellulite dimples in a single in-office procedure.

4. THREADS

Whether used as a stand-alone treatment or in combination with other procedures, thread lifts are a popular non-surgical option that dermatologists can adopt to expand their aesthetic offerings. This minimally invasive procedure stimulates the production of collagen to produce healthier, firmer skin, and it can deliver a subtle lift depending on where the sutures are placed. Treatment is relatively straightforward and an affordable adjunct to other aesthetic procedures, and it can be delegated to well-trained staff in many cases in accordance with state law. Thread lifts can pair nicely with an injectable offering.

Another advantage is that the results of thread lifts tend to last between 18 months and 2 years depending on the device, number of threads used, and degree of skin laxity. It is therefore reasonable to bring patients back at specific intervals to determine if they need additional thread placement or supplementary treatment. This treatment category therefore gives dermatologists a reason to bring patients back for checks and supplemental therapy.

5. EXOSOMES

The popularity of exosomes is growing rapidly. These are often applied topically during a wide range of treatments—laser, microneedling, hair restoration—and in combination with injectables, peels, and many other bread-and-butter dermatologic procedures. These treatments have become a popular adjunct to enhance fibroblast proliferation and collagen production. A recent review of available studies concluded that “exosomes, or extracellular vesicles, represent a new and minimally invasive addition to the regenerative aesthetic toolbox. These nano-sized vesicles contain bioactive cargo with crucial roles in intercellular communication.”⁶

The category will likely expand as more and bigger players enter the space and invest in clinical research. For now, exosomes are a hot trend for savvy consumers, so it is worth learning more about this popular aesthetic and therapeutic option. In 2020, the FDA issued an alert to educate consumers about some potentially confusing claims.⁷

1. Rehfeldt C. Top 10 wellness markets according to Global Wellness Institute. Athletech News. March 16, 2022. Accessed January 5, 2023. https://athletechnews.com/top-10-wellness-markets

2. Cirino E. What to know about the O-Shot. Healthline. November 24, 2019. Accessed January 8, 2023. https://www.healthline.com/health/o-shot

3. Khubchandani J, Price JH, Sharma S, Wiblishauser MJ, Webb FJ. COVID-19 pandemic and weight gain in American adults: a nationwide population-based study. Diabetes Metab Syndr. 2022;16(1):102392.

4. FDA approves new drug treatment for chronic weight management, first since 2014. US Food & Drug Administration. June 4, 2021. Accessed January 8, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014

5. Thompson D. Diabetes med Ozempic in short supply as Americans use it for weight loss. US News & World Report. December 21, 2022. Accessed January 8, 2023. https://www.usnews.com/news/health-news/articles/2022-12-21/diabetes-med-ozempic-in-short-supply-as-americans-use-it-for-weight-loss

6. Vyas KS, Kaufman J, Munavalli GS, Robertson K, Behfar A, Wyles SP. Exosomes: the latest in regenerative aesthetics. Regen Med. Published online January 4, 2023. doi:10.2217/rme-2022-0134

7. Consumer alert on regenerative medicine products including stem cells and exosomes. US Food & Drug Administration. July 22, 2020. Accessed January 8, 2023. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomes