Aesthetics Update: A Q&A With Modern Aesthetics® editors Saami Khalifian, MD, and Kay Durairaj, MD, FACS 

The world of aesthetic medicine is rapidly evolving, from next-generation polynucleotides and biostimulators to shifts in patient demands and perceptions of beauty. To discuss the latest trends in aesthetics, Practical Dermatology® turned to its sister publication, Modern Aesthetics®, and new Chief Medical Editor Saami Khalifian, MD, and Executive Editor Kay Durairaj, MD, FACS. 

WHAT WERE THE MOST IMPORTANT NEW PRODUCTS LAUNCHED THIS YEAR THAT YOU EACH SAW? 

Dr. Durairaj: The most buzzy and exciting topic has been polynucleotides: PDRNA and PDNA. They have entered the market stealthily and exploded without a lot of information. People are doing things on-label and off-label, but mostly off-label. It’s exciting. It’s unstudied. I can’t wait to see what further research about the use of polynucleotides and exosomes uncovers! However, when people are considering any of these products, they need to look carefully at the GMP status, purification method, and established batch-to-batch consistency data provided by the supplier. 

Dr. Khalifian: It’s all within this realm of topical adjuncts, with PDRN being one of them. Exosomes continue to create a buzz. I categorize them both as biochemical cues along with the plant-derived growth factors. We also have the biostimulator category and the volumizers and fillers category. When we think about injectables or adjuncts to injectables, a lot of attention has gone to biochemical cues and a lot of new products are coming out. Whether any of them will be useful to us or wildly different from some of what we already use is unclear. For example, how much better is plant-derived growth factor than platelet-rich plasma (PRP)? How much better is this than any other exosome product? PDRN is a similar concept, right? When I traveled to Korea, it was everywhere. There are so many different variants—c-PDRN, n-PDRN,, and so on. Again, all of this is in the same category of biochemical cues. 

WHAT OTHER TRENDS HAVE BEEN IMPORTANT? 

Dr. Khalifian: Another thing I observed in Korea—and international trends often tend to lead to trends in the US— was the heavy emphasis on skin quality as opposed to volumization. In the US, the emphasis is much more on volumization, and skin quality is an afterthought. Whether it’s for filler or biostimulators, the concept remains volume. Both markets still leverage a lot of neuromodulators. But the Korean facial archetype is usually fuller, so they’re not really as worried about volume, but they’re really focused on skin quality. Since I came back, I have reemphasized skin quality in my practice, and it resonates. My patients say, ‘Sign me up.’ I think that will be a trend that we continue to see gain momentum here. 

Dr. Durairaj: Skin boosters have been reliably used in clinical applications for the last 10 years in other countries, with South Korea largely pioneering the space. My hopes are that the international markets bring some exciting new research to the US market as the US market has been deficient in skin boosters. Europe has had Profhilo and other great products. We have had almost nothing. We have a hyaluronic acid microdroplet injectable, SKINVIVE, but it hasn’t tremendously caught on for my patients. This year, in particular, I’ve noticed an uptick in the number of patients who prioritize a natural look with a glassy skin quality. Not enough of us are talking about skin boosters. Another thing we need to do better is to analyze the new toxins hitting the market here in the US. We need to really dig deep into them and understand how strong each one is and what the differences are. Also, semaglutides and all of the rapid weight-loss drugs comprise a really important category that has impacted this industry, and now the ability to treat rapid weight loss for faces using collagen stimulators is an important focus of practice; so many people are stealthily on these products, and they need to do the maintenance. We have incorporated the shots in our office, and it has been great. Biohacking is another big segment—IV supplements, drips, and peptides. A lot of people are doing this sort of wellness biohacking focus with peptides, hormones, and bioidenticals. 

Dr. Khalifian: This was the year for the idea of glass skin. At Paris Fashion Week, the models all came out with literal glass on their face. To the extent that this has permeated even fashion, this idea of glass skin is not new, but when it starts to enter even the non-purely aesthetic consciousness, it is a testament to how infiltrated this concept has become. Glass skin is something people ask for, but the question is: How do you give it to them? Do you give it to them with microneedling? Do you give it to them with sother devices or topical adjuncts, or maybe other adjuncts such as peptides? Peptides are interesting, but most of them currently represent a gray area. We recently had a patient who wanted ipamorelin as part of a wellness paradigm, and in California, these peptides are rapidly undergoing scrutiny by the state, so what’s not illegal one day is no longer legal the next day. We have been monitoring this space, and we want to get in it, but it’s evolving too rapidly for us to dive in entirely. 

WHAT DEVICES OR PROCEDURES ARE POPULAR NOW? 

Dr. Khalifian: Over the past year, one device has been generating significant buzz among practitioners and patients alike—a noninvasive skin resurfacing technology that utilizes controlled heat to enhance skin texture and complexion. The Tixel device has become a standout in the field, thanks to its thermo-mechanical action (TMA) technology. Using a heated titanium tip, Tixel creates micro-channels in the skin that promote collagen remodeling and rejuvenation, all without lasers or needles. This method not only improves skin appearance but also opens up new possibilities for transdermal drug delivery, enhancing the effectiveness of treatments with exosomes, polynucleotides, and other bioactive compounds. In a landscape crowded with options, Tixel has emerged as a versatile and innovative tool that truly meets the demand for effective, noninvasive skin treatments. 

Dr. Durairaj: I tried that, and it was interesting. It basically chars and burns a superficial epithelium in the face, which you would think would lead to hyperpigmentation and problems, but it is apparently a very thin micro-burn. It does provide nice results, similar to those of a CO2 laser. I think I think that fractional lasers, Erbium, and CO2 resurfacing lasers are the gold standard. That has been the tried-and-true method in my practice for many years and I am incorporating more radiofrequency microneedling as well. 

Dr. Khalifian: Another thing I saw that changed my practice a bit was the utilization of radiofrequency microneedling on a pulsed wave setting with exosomes for hair restoration. 

Dr. Durairaj: That idea of the hair stimulating lasers has been popular; a few different lasers on the market can do it. Artificial intelligence for hair counting to better quantify the results we’re achieving with PRP, and hair growth treatments has been noteworthy also; that should, at some point, become standard-of-care for anybody doing hair treatments. 

Dr. Khalifian: Another device they were leveraging a lot in Korea involved the TRASER concept. It is similar to a laser, but it is total reflection amplification of spontaneous emission radiation. It’s a tunable device that goes from 532 nm up to infrared. I believe there is a TRASER platform being built in the US that is a slight change from what already exists. 

HOW HAVE PATIENT DEMANDS EVOLVED? 

Dr. Durairaj: Collagen induction therapy and creating new collagen, new elastin, and regenerative procedures are the most popular thing that patients are asking for right now. Microneedling is here to stay; everybody is so excited to do that. Every time they come in, that is an easy sell, and it provides really beautiful results. Also, everyone wants to get a skin booster or a nucleotide treatment. 

Dr. Khalifian: The things that my patients are coming to ask for right now seem to be moving off the face. It’s usually been biostimulator-plus-energy-device combinations in the neck, arms, and abdomen. That might just be a byproduct of the life cycle of our practice; their faces are optimized, so now we’re moving off faces. But we also are seeing it in terms of indication exploration with the companies. Galderma has indications coming for body. Allergan has multiple body indications coming for toxins and other injectables. 

Dr. Durairaj: A key evolving trend in my practice has been the focus on collagen biostimulators, specifically procedures that boost neocollagenesis. We’re increasingly using bioregenerative therapies to grow new collagen, improve skin elasticity and elastin, and to turn on the production of natural growth factors with platelet-derived growth factors. I have been evolving people away from filler. I can sense their reluctance to do filler, and it’s an easy conversation to convert to collagen stimulators; everybody is mentally ready for that. It’s such a great value-add to grow your own collagen that lasts for a long, long time. Treating the neck is another huge new thing for us; we’re doing much more with neck treatments, just reminding people to do more than only their face. It’s collagen stimulators, it’s toxin for the neck, it’s the superficial hyaluronic acid microdroplet injectables and hydrators. 

Dr. Khalifian: I’m seeing more and more focus on leveraging calcium hydroxyapatite (CaHA) in different ways. CaHA is one of the oldest, if not the oldest injectable product from a filling perspective. Now, you have indications coming across different groups. There are the two companies I mentioned previously with body indications, and another company is looking at devices to measure the calcium content of bone and how much is undergoing resorption or deposition, and then leveraging that for the skin. There seems to be a focus on calcium modulation of skin. That is interesting. 

Dr. Durairaj: In my practice, I’m using more hyperdilute CaHA for full-face rejuvenation. I did a study on 25 patients, looking at midface, and literally, with two syringes, you can achieve a very lovely full-face treatment that lifts everything. Vectoring off the face to lift the face is also a nice approach; we are doing that with PLLA in the hairline, in the high temporal-parietal area. As we start to treat the face by lifting circumferentially around the face and into the hairline, that’s a newer approach as well. n 

—Interview by Jason Mazda 

SAAMI KHALIFIAN, MD 

• Chief Medical Editor, Modern Aesthetics 
• Dermatologist and Cosmetic Surgeon 
• Founder, Som Aesthetics, Encinitas, CA 

KAY DURAIRAJ, MD 

• Executive Editor, Modern Aesthetics 
• Plastic Surgeon 
• Founder, Beauty by Dr. Kay, Pasadena, CA