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Ideas to move Aesthetic Practice


Jeanine B. Downie, MD: Non-invasive fat melting technology of the Vanquish machine, I think, overall was the greatest innovation. It has the largest spot size of any fat melting machine and can, therefore, reduce greater areas of fat. The machine can be used on all skin types and there is very little risk of complications.

For the field in general, this innovation means that fat melting devices are becoming more consistent, better, and safer. As these machines produce better results, we will help Americans and those across the world with their expanding waistlines.

Amir Moradi, MD: I echo Jeanine’s comments on Vanquish. I believe it will be the future in fat reduction and skin tightening.

Gregory A. Buford, MD: No single product stands out for me. Instead, I feel that the influx of an anti-aging movement into aesthetic medicine has been a huge force of change that will revolutionize how we address age-related changes.

By adding anti-aging medicine, we can look directly at various factors that either lead to or worsen the process of aging and we can potentially modulate their effect. Now, instead of just performing a non-invasive body contouring procedure, we can actually look at the variables that have led to fat deposition in the first place as well as the type of diet the patient is on and make changes to further optimize their results in the long run.

Vivian W. Bucay, MD: I want to mention two technologies— Vanquish and Microneedling.

Vanquish for deep tissue heating for fat reduction is painless and effective, and we are now able to treat patients with larger BMIs who may not be candidates for cryolipolysis (CoolSculpting, which I also offer).

The field of non-invasive fat reduction continues to grow and shows no signs of slowing down. Vanquish offers the advantage of minimal cost of disposables, which adds to our bottom line.

Microneedling is gaining traction for the treatment of photo-damage, acne scarring, and wrinkles, such as “lipstick or smoker’s lines.” I have always been a big fan of laser resurfacing, but not everyone is a candidate. Although laser resurfacing can be very effective, some of the downsides include the high cost of equipment (including service contracts and consumables), a relatively high cost to the patient, the risk of hyperpigmentation in darker skin types, downtime, and the need for pain management.

Microneedling does require multiple sessions spaced three to six weeks apart, but there is no real downtime, we can treat all skin types, the devices are inexpensive as are the costs of consumables (and no service contracts). Many of these treatments can be delegated, which adds to the bottom line and also generates added revenue from skin products that work synergistically with the procedure. There are more and more microneedling devices coming to market.

Joe Niamtu, III DMD: Personally, I think Juvederm Voluma won the prize. It is the only FDA-approved filler specifically approved for cheek augmentation and it is supposed to last two years. This is a great combination for a new product and if the performance lives up to the claims, it will be top shelf.


Dr. Downie: We have had the Vanquish since June 2013 and have used it with the Exilis to treat stubborn areas of fat. The benefits have been happy patients and more practice income.

Dr. Buford: I recently began adding a specialized program to my body contouring practice and the results so far have been very rewarding. We are finding that many of these patients have chronic issues with respect to their diets as well as their nutritional levels, which can generally be addressed in a very straightforward manner. By doing so before surgery, we effectively increase their potential for success and by continuing this evaluation after surgery we can achieve far greater results than we did when we simply operated and let the patient go their merry way once they healed.

Dr. Bucay: We have been very successful with our CoolSculpting treatments, especially now that our treatment protocol is “treat to transformation” as recommended by Zeltiq. That said, there are patients with a larger BMI, for whom cryolipolysis would be more expensive because of the need for more treatments to treat the same surface area. Vanquish can treat a larger surface area compared to CoolSculpting.

Microneedling (I use the Eclipse MicroPen) has allowed us to treat many more patients who complain of acne scarring, wrinkles, and prominent pores. Many of these patients would not consider laser resurfacing or medium depth chemical peels because of the cost, downtime, or perceived risks. Patient satisfaction is very high because of the excellent results we have seen since offering this treatment.

Dr. Niamtu: I am a big user of silicone cheek implants and still think they have many advantages. Many patients, however, will not or cannot have surgery and Juvederm Voluma fills the gap.


Dr. Downie: Yes. Patients’ waistlines, hips, and/or back fat have been reduced in inches and they are pleased with the results.

Dr. Buford: I recently incorporated this specialized program into my body contouring regimen and will be introducing it into my facial rejuvenation protocol very soon. It is really too early to tell how patients have benefited, but I predict that we will see far better durability in results as compared to before. But only time will tell.

Dr. Bucay: I don’t perform liposuction, so adding non-invasive fat reduction to our menu of services has attracted patients to the practice who would otherwise not have come to us. These patients often opt for other services we offer.

Patients enjoy pain-free circumferential reduction of the abdominal area after four to six weekly treatments that take 30 minutes. By combining the Vanquish with the Exilis for skin tightening, post treatment skin laxity is less of an issue than with CoolSculpting. In fact, we offer Exilis to our CoolSculpting patients, as well. By offering two technologies for non-invasive fat reduction, we can tailor treatments for the individual.

Microneedling has allowed me to improve my protocols for acne scarring and enlarged pores. I can adjust the depth of the needle up to 2.5mm for deeper scars and wrinkles without the risk of scarring associated with CO2 resurfacing (which achieves a depth of around 1.7mm). A repeated controlled injury at this depth has yielded improved outcomes for our patients and greater patient satisfaction. Microneedling has allowed for improved outcomes and happier patients who refer other patients

Dr. Niamtu: It is too early to see if Voluma will last two years, but so far they love the product.


Frost & Sullivan recognized Sensus Healthcare, LLC’s SRT technology with the 2014 North American Frost & Sullivan Award for New Product Innovation Leadership. Sensus uses a technique known as superficial radiation therapy (SRT) in its SRT-100™ and SRT-100 Vision™. Frost and Sullivan says the devices—also used to treat keloid scars—are superior to other available treatments of non-melanoma skin cancer and other skin conditions.

In the March edition of Practical Dermatology® magazine, Mark S. Nestor, MD, PhD, Director of the Center for Cosmetic Enhancement in Aventura, FL, discussed the SRT-100 system. “Radiation treatment is great for recurrent keloids,” Dr. Nestor says. “With three treatments following excision, keloids can be reduced 60 to 70 percent versus 10 to 20 percent for excision alone.”

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