PracticalDermatology

New year, new (fill in blank).

With everyone clamoring for fat reduction, skin tightening, and glowing skin, the aesthetic industry is not going to disappoint us this year. The pipeline is looking very robust.

Two thousand sixteen will be a big year in direct-to-consumer marketing and celebrity endorsements. Coolsculpting is leading the way with their $45M ad campaign, coming on the heels of signing Molly Sims as a brand ambassador, and Cynosure enlisted Kyle Richards to launch their SculpSure™ system to the beauty elite. As more players follow suit, direct-to-consumer campaigns have the ability to grow the market and attract more patients into aesthetic treatments.

Another growth area we can expect to be trending in 2016 is with apps that will change the way doctors practice and also impact the way consumers select treatments and practitioners. For example, in 2015 we embraced Zwivel^® as a unique and efficient HIPAA-compliant consultation platform for patients to connect with doctors in a meaningful way, and Zalea^® provided content curation with more innovations in the works to introduce consumers to top brands and doctors. Advances in teledermatology platforms that facilitate consultations, diagnosis, and treatment recommendations will continue to expand in 2016, thus capitalizing on our desire for convenience and a mobile-friendly experience.

EDWIN WILLIAMS, MD

Facial Plastic Surgeon
President of the AAFPRS
Latham, NY

We can expect to see intense competition for the aesthetic patient in the upcoming year. With the ramifications of the Affordable Care Act, and less and less physicians of all non-core specialties being less willing to take care of the insured patients, my prediction is that you will see more physicians enter in the aesthetic space at a rate we have not yet experienced. This will be a tremendous amount of pressure on our industry.

Patients are starting younger and younger in their 20s and 30s and are more aware of the effectiveness of a medical approach to skincare. (See table) They are also starting to use BOTOX^® and other injectables earlier. This is not only the result of the mainstream media, but social media plays a big role shaping this sector of the market. We now know that patients who start younger with BOTOX^® end up with less wrinkling, and using medical grade skincare is also effective for healthy skin maintenance.

The non-surgical approach to fat reduction of the neck as well as the body is going to grow exponentially in 2016 as a result of the introduction of novel and more effective technology and non-surgical treatments like Kybella^®.

DAVID J. GOLDBERG, MD, JD

Dermatologic Surgeon
New York, NY

There have been three picosecond devices up to this point. Each is missing an optimal wavelength. A new fourth picocond laser, manufactured by Focus Medical, will be available in 2016. This will be the first picosecond system that may be able to treat almost all tattoo colors.    

Female vaginal rejuvenation became a hot ticket item in 2015 and is going strong. Techniques have been aggressive approaches, for the most part, that are not likely to be used by dermatologists and more conservative aesthetic physicians. ThermiAesthetics introduced ThermiVa, a more gentle technique for the non-surgery oriented physician. In 2016, we can expect to see most if not all device companies launches their own variation.    

Look for Merz to aggressively market their Cellfina™ technology that improves the dimpling of cellulite. They may look to combine this with focused ultrasound (Ultherapy) treatment to tighten buttock and thigh skin, based on my study published in Dermatologic Surgery leading to the Ulthera “butt lift.”       

FDA studies will begin in 2016 on new botulinum toxins. Kybella will be increasingly used to melt fat of the submental region (on FDA label) as well as other areas (off label). Early data will show the efficacy of Neothetics LIPO 202 fat melting substance currently being evaluated in FDA studies.    

MICHAEL GOLD, MD

Dermatologic Surgeon
Nashville, TN

We have some new and exciting treatments coming in 2016.  These include expanded applications for the picosecond lasers, including their use in pigment and with new fractional handpieces, such as PicoWay Resolve, this has the potential to deliver rejuvenation effects with one or two treatments, with no downtime and minimal discomfort. We are excited about these platforms on the picosecond and we will see how this plays out in 2016.

Patient treated with Kybella.

Newer rejuvenation treatments with devices such as Venus Viva and the EndyMed Intensif also are showing that RF rejuvenation is also going to be important in 2016.

Body contouring is hot today. We are seeing more powerful devices that can really tighten skin and have an impact on fat, which is what consumers are demanding. New applicators on CoolSculpting and additional protocols with UltraShape^® (Syneron-Candela) will impact the body contouring field dramatically.

On the injectable side, we are expecting several new fillers in 2016 and we will see how these impact our patients, where they will fit in and where they will make the most impact.

Sinclair Pharma will reintroduce their popular Silhouette^® technology into the US market in 2016. This unique suspension method uses bioresorbable Poly Lactic Acid (PLLA) cones to provide an instant lift for our patients in a safe and effective way. Learning the new technique and how to place these fine suspension sutures will be a major teaching initiative for 2016.

REBECCA KAZIN, MD

Dermatologist
Chevy Chase, MD

Undoubtedly, the FDA approval of Kybella^® for the treatment of submental fat was among the most significant advancements in 2015. We will definitely see more research into broader applications of this product for other areas of the body. Another big win in 2015 was the FDA approval of Radiesse^® for the dorsal hands, the first product approved for that indication.

Cellfina

In addition to the exciting new products coming down the pike, we are getting more creative in how we use the products and technologies currently available, both on and off label. Another big trend is more combination treatments to deliver optimal results to our patients.

For example, we are using Kybella around the belly button in combination with Coolsculpting for a flatter tummy. The Cool Mini applicator has allowed us to treat fat deposits in the axillary folds and bra fat, sometimes referred to as ‘sleavage’. For some patients, we may do one or two treatments with the Cool Mini and finish off with Kybella. Another hugely popular treatment combination in my practice is combining Clear + Brilliant (Solta/Valeant) with an IPL treatment to treat dyschromias.

More injectors are also using fillers for the upper face now to create a more youthful effect and restore cheek volume for a more youthful appearance without surgery.

Although it is a few years off, the new molecule under investigation from Kythera (Allergan) called KYTH-105, is an oral treatment for Androgenetic Alopecia that could be a major game changer.

WHAT WILL IT COST?

BuildMyBod’s Annual Plastic Surgery Pricing Report for 2016 include physician fees, ancillary fees such as operating room or anesthesia fees, implant fees, and other miscellaneous costs which have been estimated to account for 50 percent of a typical procedure’s total cost. Other plastic surgery price reports often only include surgeon’s fees. Here’s a look at average reported costs for non-surgical interventions.

Source: https://www.buildmybod.com/pricing.

Z PAUL LORENC, MD, FACS

Plastic Surgeon

New York, NY

There are more hyaluronic acid fillers in the FDA pipeline to be launched into the already crowded market in the US. We are hopeful that both Teosyal (Teoxane) and Emervel (Galderma) will be available here in the not-too-distant future.

Patient treated with ThermiRF.

Also watch for two less-invasive combination therapies for addressing the aging neck. These include ThermiTight (Thermi Aesthetics/Almirall) for fat reduction and skin tightening, and platysma band correction with the Serene RF System (Serene Medical). This device uses a combination of bi-polar radiofrequency and nerve stimulation technologies for long-lasting results.

Silhouette^® Lift, which has been popular in Europe and Asia, is coming to the US market with a new brand name. This non-invasive technique can be used as a stand-alone procedure, and can also be combined with neuromodulators and fillers to enhance volume and reduce fine lines and wrinkles.

We can also expect to see more pharma giants entering the aesthetics market in the near future. The most notable example to date is Pfizer taking over Allergan, shortly after the Actavis acquisition. There will be more mergers and acquisitions in 2016 as big brands are moving towards augmenting their aesthetic portfolios.

STEVEN FAGIEN, MD

Oculoplastic Surgeon

Boca Raton, FL

There is definite evidence of elastogenesis with injectable hyaluronic acid that has been, in my opinion, the missing ingredient in full skin rejuvenation. The old buzzword has been “collagen” and the notion that products and devices that “produce collagen” are what are required for rejuvenation is being disproven. Intradermal placement of certain hyaluronic acid products has been shown to promote elastin that is more likely to add the necessary elastic properties of youthful skin.

One of the more alarming yet escalating trends being more frequently reported in Asia is severe tissue loss and blindness related to injectable filling agents due to more frequent injections to the mid-face. I am spearheading a task force and consensus group to establish treatment algorithms and best practices for avoidance and rescue therapy to address this specific problem.

The challenge is often the injection technique used coupled with a poor understanding and appreciation of the complicated vascular anatomy, and higher risk areas that are being more commonly treated, including the nose, mid-face, pyriform, and temples.  It is not product specific, but the only real chance of reversal is by injection with hyaluronidase, as polyacrylamide, calcium hydroxyl apatite and other particulate non - HA fillers cannot easily be dissolved.

I think we are seeing sometimes weak results from minimally invasive surgical procedures that have been conceived due to many complications relating to more aggressive procedures. The pendulum is beginning to swing toward the middle where surgery is smarter, and yet not necessarily so abbreviated that the results are either non-existent or short-lived. n

Wendy Lewis is President of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy, the author of 11 books, and Founder/Editor-in-Chief of Beautyinthebag.com.