The spectrum of facial aesthetics is constantly evolving. As we learn more about the anatomy of the face and refine our uses of different tools and products, our understanding of facial rejuvenation is also changing. The explosion of injectable products over the last 15 years has arguably revolutionized our field. In addition to giving us the ability to relax dynamic muscles and refill volumetric loss, injectables may soon encompass treatment of submental fat.

But injectables don’t tell the whole story. In fact, we are now beginning to see a broader picture in which injectables and other modalities—such as skincare and energy-based therapies—can be married together for optimum results. The next step in minimally invasive facial aesthetics may be to explore the potentially limitless ways in which we harness these various tools to treat the full facial canvas.

A COMPLEMENTARY AESTHETIC APPROACH

Devices have long been used for facial rejuvenation, particularly for redness and photodamage. Within the last several years, much of the buzz related to device-based aesthetic procedures has been for body treatments. During that time, demand for energy-based skin tightening and fat reduction treatments has skyrocketed. Although liposuction and surgery remain the gold standards for fat treatment, energy-based non-invasive treatments have allowed patients to receive targeted therapy for subtler adjustments to tighten skin or melt fat.

However, a greater emphasis on the combined effect of skincare and energy-based treatments has reinvigorated interest in energy-based facial treatments. Increasingly in my practice, patients are receiving a complete regimen that includes skincare, an energy-based treatment, and injectables. And since we now have multiple options in all of these modalities, physicians can pick and choose the specific combination based on the individual needs of the patient. This has allowed patients to understand the full benefit of these various therapies when used together, which has lead to more proactive and early interventions in my practice.

One regimen that has produced favorable results is a combination of home-based fractionated laser treatments with topical antioxidants. We’ve known that fractionated lasers can enhance topical agents and now we are starting to see earlier signs of photodamage. In office, combining Clear + Brilliant and Fraxel lasers with topical agents such as Lytera, vitamin C, and other cosmeceuticals can be synergistic with the efficacy of the procedures, especially in the treatment of melasma and pigmentary disorders. For patients who are not quite ready for an office procedure, the addition of fractional maintenance can enhance the delivery of cosmeceuticals. The Tria Beauty device, for example, is a very low level fractionated laser that can be used with the SkinCeuticals antioxidants CeFerrulic and Resveratrol.

MEASURED IMPROVEMENT

With new products, devices, and partnerships that are pushing the concept of combination-based facial aesthetics forward, studies are also underway to examine the benefits of these interventions. For example, I am currently in the process of completing a systemic study of combined injectables (fillers and toxins) from the standpoint of patient satisfaction. Until this point, we have not been able to quantify how certain therapies, when combined, may enhance each other. Many case studies and anecdotal reports endorse the notion, but it is likely that we will see more scientific inquiry into these notions, which will hopefully produce more interest in the possibility of these combinations.

Since devices fall under a different regulatory structure than drugs, there is likely some potential for more investigation into how devices are used in combination with other agents to produce better and more predictable results.

Physicians are already routinely performing procedures involving some combination of injectables, devices, and cosmeceuticals cosmeceuticals, but the future of combination-based approaches to aesthetics may be even brighter. With continued interest, inquiry, and experimentation, we will learn more about how these agents actually interact together, which can potentially lead to enhanced delivery of all agents and greater longevity of results. That is why this approach will likely become the standard of care in coming years.

SEEING THE WHOLE PICTURE

Although energy-based device treatments have traditionally been used for sun damage and basic resurfacing, perhaps it is time to think of these modalities in a more global way. It’s important to educate patients about the variety of modalities we offer and how they are natural complements to offering optimal treatment.

Patients may arrive at our practices with a single procedure in mind, and physicians, too, can become cornered into thinking about individual treatments. But if we compartmentalize and commoditize different parts of the body, we’re limiting ourselves in what we can accomplish and patient outcomes suffer.

As dermatologists, we are trained to look at the whole picture, and as we face increased competition from noncore practitioners, that will be what separates us from those who cannot deliver the same quality of care. Therefore, we should look at the full face and consider ways in which a synergistic approach incorporating the wide range of tools we have available can help us achieve the best results.

PRACTICAL POINTER

The next step in minimally invasive facial aesthetics is to explore the ways in which energy-based devices, cosmeceuticals, and injectables are complementary and can be combined to treat the full facial canvas. Combination approaches can lead to enhanced delivery and greater longevity of results.

ENERGY-BASED THERAPIES: WHERE THEY ARE, WHERE THEY ARE GOING

In recent years, we’ve seen great strides in the device arena regarding the treatment of more diverse skin types. The development of fractionated and picosecond lasers has helped greatly in the treatment of isolated pigmented lesions, in particular. One area, however, that devices could stand to improve is in the treatment of melasma. In fact, we are lacking a predictable and long-term treatment for melasma. Hopefully, this will change as we learn more about combined delivery of topical and energy-based treatments.
—Vic Narurkar, MD

A NEW BODY REJUVENATION COMBINATION

One of the newer combination approaches gaining attention in the arena of body rejuvenation is energybased therapy with cosmeceuticals that enhance tightening. One of my favorite combinations to use in practice is the CoolSculpting or Thermage treatments with several newer skin tightening lotions. This combined body rejuvenation technique not only can produce better results but also allows us to improve areas that the initial energybased treatment did not complete.
—Vic Narurkar, MD

Vic Narurkar, MD is a past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery and co-director of the Cosmetic Boot Camp, LLC.