PracticalDermatology

Each new year brings a host of new cosmetic treatments and technologies into focus as others fade into the background. Here, Jeffrey Dover, MD, FRCPC, co-director of SkinCare Physicians of Chestnut Hill, peers into his crystal ball for Practical Dermatology® magazine readers and offers a sneak peek into what we will see more or less of in the coming 12 months.

What will be the biggest breakthrough device in 2023?

Jeffrey S. Dover, MD, FRCPC: It’s always hard to predict the future with any accuracy. There are, however, a few devices that will be of interest in 2023. The first is a laser technology developed by AVAVA, a privately held company, that focuses laser energy into the dermis while at the same time avoiding injury to the overlying epidermis. The device has FDA approval for general use on skin, and clinical trials are underway to determine just how effective it will be for photoaging, acne scarring, and pigmentary alterations, especially in patients with darker skin tones.

The second concept is to expand the use of cold as a therapeutic modality. Most readers know about cryolipolysis for the localized reduction of unwanted fat. Rather than apply cold with applicators, a new approach being studied injects cold in the form of an ice slurry into the area of unwanted fat to selectively reduce the volume. This should theoretically be helpful, not only for unwanted subcutaneous fat but perhaps visceral fat as well.

Are any other aesthetic trends coming down the pike?

Dr. Dover: Patients are demanding no- or low-downtime procedures. Painful procedures that involve needle-injected local anesthetic or sedation with downtime are becoming less and less popular. Mini-lifts are becoming more popular in spite of the fact that the results are not nearly as impressive or long-lasting as traditional face and neck lifts. Noninvasive body contouring is slowly but surely replacing liposuction, and there are increasing reports of using localized injections of fat for breast augmentation rather than implant mammoplasty. As more and more procedures are developed that are less invasive, there will be a continued shift to no- or low-downtime procedures in aesthetic medicine.

Nothing will ever replace the surgical facelift. We’re getting closer, but we’re still not there. Patients continue to seek non-surgical, non-invasive facial skin tightening, and body contouring, with little or no downtime.

Non-surgical facial skin tightening helps significant lower face and neck sagging, but it is not a match for the results of a great facelift. It’s for that reason I continue to refer regularly to my plastic surgeon facelift colleagues for this procedure. Further, while there have been attempts to tighten eyelid skin with devices such as the Tixel and monopolar radio frequency (Thermage) and periocular laser resurfacing, there’s nothing that compares to the results of a surgical blepharoplasty. These two procedures will remain highly popular and will continue to receive referrals from me and other dermatologists and aesthetic physicians who do not do these procedures because of the great results, low risk when done properly, and duration of effect.

What’s new and exciting for cellulite reduction?

Dr. Dover: Cellulite is a very common problem, but we still don’t have a great solution. We think of cellulite in two forms: the lumpy, bumpy craters and the much more common rippled cellulite that is seen in as many as 90% of post-pubertal women. New technologies such as Cellfina and Aveli have been developed in an effort to improve the concept of subcision of the septae, which seem to be at the heart of the lumpy, bumpy form of cellulite. Non-invasive, no- or low-downtime procedures, which are non-surgical are the future for the treatment of rippled cellulite. One new entrant is from the company originally called Soliton, now known as Resonic, which was recently acquired by Allergan/AbbVie. This Rapid Acoustic Pulse technology is undergoing detailed analysis, and a study is underway to optimize this non-invasive sound wave treatment over the next year or so.

How will the neuromodulator market expand in 2023?

Dr. Dover: Botulinum toxin was first approved in the US for cosmetic use in 2002. Since its introduction, the biggest development in the neuromodulator marketplace was the approval of daxibotulinumtoxinA toxin (Daxxify, Revance), a longer-acting neuromodulator, in late 2022. It produces a mean duration of effect of 6 months, with results lasting up to 9 months in some individuals. Surprisingly, the duration of side effects was no different than with the shorter-acting neuromodulators. This will be a game-changer for some patients. A premium product with a higher price tag, daxibotulinumtoxinA seems ideally suited for those who want treatments twice a year rather than three times a year and to achieve a long-lasting and uniform result. It’s pretty clear that, while the optimal number of treatment visits for patients with traditional botulinum toxin is three times a year, the average patient comes in less than twice a year. They get good results lasting 3 to 4 months, but unless they come in regularly, the immobility is followed by movement, followed by immobility, followed by movement. The ability to produce results lasting 6 months will help patients who come in twice a year achieve and maintain long-standing benefits. Other longer-standing–duration neuromodulators are under development and could see approval in the near future.

What can we expect in terms of new fillers in 2023?

Dr. Dover: Restylane was the first hyaluronic acid approved in the US in 2003. Since then, a bevy of safe and highly effective natural hyaluronic acid products have been approved for tissue augmentation in the United States. Aesthetic physicians and dermatologists now have lots of choices when it comes to fillers, from soft and malleable ones such as RHA Redensity and Juvéderm Volbella for fine vertical upper lip lines all the way to RHA4, Juvéderm Voluma, and Restylane Contour for volume filling. There are few needs left in the filler marketplace. The most exciting new area is skin toning that can be induced with ultrasoft hyaluronic acids such as Juvéderm Volite, which is available in Europe and Canada and is approved in the US and about to be released for use. This can be used on and off face to improve the brightness, tone, and texture of the skin without truly filling contour irregularities.

Do you think the cosmetic surgery Zoom Boom is over, or will it continue?

Dr. Dover: The Zoom Boom may taper off somewhat, but it is not going to end anytime soon. Virtual work is here to stay, and while it’s going to be slightly different than it was during the peak of the COVID-19 pandemic, many employers will continue to have their staff working at least part-time or even full-time from home. While those under 30 look pretty good on Zoom and on selfies, slightly older individuals with under-eye creases, dull and sun-damaged skin, and sagging of the lower face and neck find selfies and Zoom images to be particularly deflating. It’s for that reason that we will continue to see “Zoom effect” consultations with regularity.