What's Next in Aesthetic Medicine?
Changing Eye Color
“This is a really exciting new topic…Their technology is non-ablative. It uses a green light laser to repeatedly heat the anterior surface of the iris to the point that instead of bleeding pigment into the eye, macrophages come in and clear the pigment through the circulatory system. It's about a three-week process. And because underneath every brown eye, there's actually a grey stroma, and this is what actually appears blue when you look at a person's eye who has blue eyes.”
—Julie Woodward, MD
Rethink Scars: Making and Erasing
“When you think about any invasion into our integument, it allows us to bleed and to allow pathogens to come into our body. Scar formation is important, but obviously scars are problematic for their appearance, and a lot of people don't realize that some scars hurt. They burn. They itch. Scars are a good and a bad thing.
In terms of advancements, I think the laser in my perspective has been one of the most important advancements in the last 25 years. I do a lot of scar resurfacing in my practice. The fractional lasers, especially the deep fractional lasers, really add a lot to that.
Also various wavelengths, such as the pulsed dye lasers and even intense pulsed light or IPL, have really been important because you can improve the size, the texture and the appearance of scars.
One of the most important things about scars is in making them. We all do surgery and we're all making scars…People that really figured that out—and I just do facial surgery—once you figure that out, it's really important to follow those tenets for a good scar. Because a good scar is the surgeon's signature.”
—Joe Niamtu, III, DMD
Watch Now: ModernAesthetics.com/tv/?f=scarprevention
Fillers for Texture
“One of the most important innovations when it comes to aesthetics is the new advancements in fillers and the filler materials that are being used. There are a few fillers out there that have not yet been FDA-approved, and are in the pipeline. Some of these fillers are longer lasting. Some of these fillers are more natural. Some of these fillers not just fill— and this is one of our understandings of fillers in the past, they're used to just fill, especially if they're HAs—but no, they actually change the structure and the texture of the skin.
There's a lot of fillers that are out there that are not yet available in the United States that do that. Hopefully, this is going to be approved fairly very soon.”
—Hassan Galadari, MD
Watch Now: ModernAesthetics.com/tv/f=fillerspipeline
Neuromodulator Combinations to Grow
“I'm a great believer in combination treatments in aesthetics. I think more and more we're using Neuromodulators in combination to reduce the hyperfunctional muscles and then using the fillers to reduce the existing atrophic lines, the atrophic scars. We are using it in combination with rejuvenation with lasers, with radiofrequency…we get a more sustained and smoother result with the lasers and radiofrequency.”
—Nick Lowe, MD
Short and Long-Term Laxity Fixes
“I'll do something quick like an Ulthera Body lift. I do it on the breasts. I do it on the buttocks. And that can be something that's done with no down time, and they're literally ok and good to go the next day and look better in their dresses…
There are some more long-term things. I love the Reaction laser from Viora for skin tightening. It's excellent for doing small areas like the elbow and the knees, the knuckles and the hands. A lot of people think that hand aging has more to do with volume, but I really think early hand aging has a lot to do with skin laxity. So those procedures, the results may take a month to two months, so you need to plan a little bit earlier.”
—S. Manjula Jegasothy, MD
RECENT DEVELOPMENTS: ESKATA FOR SKS
Late last year, FDA approved Eskata (formerly AT-101) from Aclaris Therapeutis. Eskata (hydrogen peroxide) topical solution, 40% (w/w) is indicated for the treatment of seborrheic keratoses that are raised. In advance of the decision, CEO Neal Walker, DO spoke with Modern Aesthetics® magazine about Aclaris and its then investigational therapy.
What stands out to you in the data thus far and how are clinicians reacting?
Neal Walker, DO: I think it's been a very positive response mainly because it's one of the most common things we see as dermatologists. When I used to practice, I would see about 80 patients in a day; half of them at least would have SK. They all come and ask.
I think the thing that resonates with the doctors is that they already have these patients in the office. The problem was the headwind was always concern about creating a new issue for the patient. One of the worst things you can do is create a mark for a mark. If you're removing something strictly for aesthetic reasons, you don't want to do that. With AT-101, we have exceedingly low rates of any hyper- hypopigmentation, scarring is not an issue, the pain is not there.
SK shouldn't be a throw away lesion—something you ignore. The patient's coming in and asking you about it. They want an option. You're the expert as the dermatologist. Treat it.
What is the treatment protocol like for the patient?
Dr. Walker: There's a continuum of minimally invasive procedures, starting with peels, and microdermabrasion on one end and more complex things at the other end. AT-101 is towards the lower technique sensitivity. Basically a patient comes in, the dermatologist identifies the SK as a benign lesion and tells them, “Look, this is aesthetic. This won't be reimbursed.” It falls into that aesthetic category. Staff can apply the treatment. In fact, in our phase 3 studies we had staff apply it, which we think that some offices will absolutely do. AT-101 has a pen type applicator.
In our clinical studies, we allowed up to two applications. That was sufficient to get near clear rates of 66, 65 percent, which were great. If somebody needs more treatment because the lesion's a little thicker, we did an open label study that allowed up to four applications.
Do you foresee any challenges to adoption and clinical integration?
Dr. Walker: Let's say there are about 12,000 dermatologists in the US. Based on all the research we've done, we think our target audience is about a third of them out of the gate, because you want those early adopters. We're focused on the face and neck. That's where our product really does well. That's where the highest aesthetic need is. We want to go to those offices that have that patient population.
Urban, suburban, females, 40 to 50s, willing to pay, really concerned with the aesthetic outcome—that's our initial target out of the gate, and then we'll continue to grow from that base. You want to grow from the right target base.
Take 5 with Bob Rhatigan, President and Chief Executive Officer of Merz North America
With model and original “Uptown Girl” Christie Brinkley as their first-ever celebrity spokesperson, Merz North America is coming out of the gates strong in 2018. Ms. Brinkley—who embodies beauty and aging gracefully—has helped put a face on two of the company's aesthetic brands, Ultherapy and Xeomin, and the enthusiasm is now palpable. “Patients are now coming into their doctor's offices and asking for these treatments by name and we expect this excitement and momentum to continue to grow,” says Bob Rhatigan, President and CEO of Merz North America.
Last year was a year of significant evolution and accomplishments for Merz, and I am very optimistic about our future. It was an award-winning year for us. Merz North America has been recognized by Aesthetic Everything as the Top Aesthetics Company and the winner of four other 2017 Diamond Crystal Awards, including the recognition of Cellfina as the Top Minimally Invasive Procedure and Ultherapy as a Top Non-Surgical Procedure and I was proud to be named the top CEO. I chose Merz as the next step in my career because I knew culturally it would be a good fit. I'm glad to say that has proven to be true.
Christie Brinkley, enough said
One of the exciting new ways that we are impacting the market is through our partnership with Christie Brinkley. Merz has never had a celebrity spokesperson before. Christie Brinkley had used both Xeomin and Ultherapy prior to our work with her, and loved her results. Christie is the perfect partner to help Merz educate consumers about Xeomin and Ultherapy because she shares our vision that adults of all ages should feel confident in how they present themselves to the world. She is excited to educate women about these treatment options.
We work every day to be the most admired, trusted, and innovative aesthetics and neurotoxin company, and to build a culture that is centered around the customer. In all locations in North America (Raleigh, Mesa, Franksville, and Toronto), we have prominent signage on the walls with the question “How have you helped a customer or sales rep today?” Passing these signs every day reminds us all that the end goal is to help our customers so they can in turn help their patients live their best lives. We look forward to an exciting year ahead with a renewed spirit and drive to better serve our customers each and every day. We are well-positioned competitively from a portfolio, quality of personnel, and increased customer focus, standpoint.
Merz is in a perfect spot to deliver on a large market need as a company solely focused on aesthetics and neurotoxins, with a goal in North America of creating a positive customer experience at every level. We have focused our organization on putting customers first to provide a seamless and easy experience at every touch point. We think that will continue to set us apart.
Challenger brands gain momentum
In the US, many of our products can be considered challenger brands to products that are household names. However, there is significant market potential for our products as indicated by our much higher market shares in countries where we have had an established and stable presence for a longer period of time. This as an exciting opportunity because it gives us the chance to develop and grow in the very large market in North America. The partnership with Christie Brinkley has reignited excitement with physicians and consumers about Xeomin and Ultherapy.
I see so much opportunity to continue to grow our businesses. We also have a strong leadership team with depth and breadth of experience in this industry. Based on feedback from our customers and in line with our company strategy, we have recently expanded and realigned our sales force for increased customer focus and in-office support.
We have a well-rounded portfolio including neurotoxins (Xeomin), dermal fillers (Radiesse, Belotero), innovative technologies for skin lifting and tightening (Ultherapy) as well as removal of cellulite dimples (Cellfina), an accessory to laser tattoo removal (DESCRIBE Patch), which just received clearance for use with all of the most commonly used tattoo-removal lasers, a professional dispensed skincare line (Neocutis), and an OTC line of scar creams (Mederma).
Our portfolio is comprised of many one-of-a-kind products. Radiesse is the ONLY FDA-approved, long-lasting dermal filler for both the face and hands. Ultherapy is the only FDA-cleared, non-invasive procedure that lifts and tightens the neck, chin, and brow, and improves lines and wrinkles on the chest. The Cellfina System is the only FDA-cleared minimally invasive procedure clinically proven to improve the appearance of cellulite for at least three years—the longest FDA-cleared duration for a cellulite treatment. The DESCRIBE Patch, which is placed over tattoos prior to removal with a laser, allows physicians to treat tattoos more efficiently by enabling rapid multiple laser passes in a single treatment session—is the only tattoo removal accessory of its kind.