PracticalDermatology

By all accounts, cosmetic dermatology is booming in 2023. Reports from multiple organizations depict rises in both surgical and minimally invasive aesthetic procedures. Lesley Clark-Loeser, MD, co-founder of Precision Skin Institute in Davie, FL, dishes on the procedures that her cosmetic patients love.

What’s your most popular combination treatment?

Lesley Clark-Loeser, MD: The hottest procedure would be the combination of RF microneedling with BTL’s Exion and BTL’s Emface, which delivers high-intensity facial electromagnetic stimulation (HIFES) muscle-contraction technology and transcutaneous synchronized radiofrequency (RF) to address muscle laxity. We call it the Natural Lift. Its popularity is being driven by the desire to be strategic about having natural-looking outcomes and durable results. We generally recommend a series of four treatments. Emface takes 20 minutes, and we can do full-face treatment with RF microneedling with Exion in 20 minutes. Sometimes I will add on treatment with Exion’s monopolar radiofrequency and targeted ultrasound mode to further stimulate fibroblasts within the deep layers of the dermis.

What injectables are hot in your practice today?

Dr. Clark-Loeser: Biostimulating and bioregenerative fillers are trending. These stimulate sleepy fibroblasts so they produce more collagen, elastin, and hyaluronic acid, With age, our cells produce less of these substances. Excitement about lip flips is dwindling as people realize it is only appropriate for a small group of people. What’s more appealing is restoring lip shape and enhancing lips to give rise to better proportion or symmetry. The filler proven to be amazing for this is Revance RHA Redensity 1. It is extremely well suited to treat this area. It’s US Food and Drug Administration- cleared for perioral lines, but we use it off-label for lips. Revanesse Lips is great for adding soft natural volume to the lips.

How do you address skin quality in 2023?

Dr. Clark-Loeser: Skin quality is definitely top of mind right now. With energy-based devices, we work on skin quality all the time. These devices lead to improved skin quality by upregulating the production of collagen and elastin. Skin boosters hydrate the skin from within. These are new to the US but not new abroad. They are hyaluronic acid gels that are injected superficially into the skin. SkinVive by Allergan Aesthetics is first to market here, but there are many more in the pipeline.

Are we getting any better at smoothing cellulite?

Dr. Clark-Loeser: Cellulite is one of the most common skin findings in post-pubertal women. The demand to treat cellulite is not going away. We are better at treating it now than we were three to five years ago. We get nice results by injecting hyperdilute Radiesse or Sculptra along with the use of energy-based devices designed to break up fibrous bands and remodel collagen within the tissue for a smooth appearance. We are better at doing it now than we were three to five years ago.

What else is exciting in cosmetic dermatology?

Dr. Clark-Loeser: The addition of exosomes in our toolbox is exciting. We are just at the tip of the iceberg in understanding which will be the best exosome to use and how best to use them to enhance our procedures either during, before, or afterward by reducing inflammation, speeding up recovery, or enhancing outcomes. We will see a lot of innovation with exosomes in the years and months to come. I use it after mechanical microneedling, RF-microneedling, ablative resurfacing, and hair loss treatments.

Microcoring is also hot. There are two devices on the market now: The ellacor System from Cytrellis removes microcores of skin to address wrinkles and tightening in the mid- and lower face and the UltraClear laser, which removes micro-channels deep into the dermis by laser ablation to create new collagen and elastin.

What’s possible today with minimally invasive aesthetic treatments?

Dr. Clark-Loeser: Not only are we getting better at treating what was once thought to only be corrected by surgery, but we are achieving results that are better than surgery in some cases. With facelifts, we do nothing with the remaining skin, soft tissues and muscle that are left behind. Energy-based devices, however, can impact this tissue in lieu of surgery or before surgery to give the surgeon a better canvas to work with.