Dermatologist and leading laser surgeon Eric F. Bernstein, MD, MSE of Ardmore, PA, has just concluded his term as American Society for Laser Medicine and Surgery president, having chaired the recent meeting in Denver. “It was an absolutely wonderful time connecting with friends and colleagues. There are very few venues where there is such a massive confluence of industry engineers, physicians, other healthcare providers, PhDs, and multi-specialty disciplines,” he says.

Among the key themes set by Dr. Bernstein for the meeting included embracing science and engineering. “International participation was also a focus this year, and we welcomed presenters from all over the world. I chose three world-renowned laser experts to serve as Program Chairs: Gilly Munivalli, Dieter Manstein, and Henry Chan. We had an international abstract winner, Jose Aspizu, who presented 1,500 cases of endovenous ablation, an enormous series of patients,” he says.

“Dr. Scott Parazynski was the keynote speaker. He is a Stanford MD, an astronaut as well as a tech CEO, who summited Mt. Everest. Upon hearing his achievements, many of us felt like we hadn't accomplished much in comparision. But he inspired attendees to master almost anything we set out to do,” Dr. Bernstein observes. “It was an uplifting, fascinating story of a down-to-earth-guy doing extraordinary things by believing in himself and not seeing barriers but rather opportunities everywhere he looked.”

According to ASLMS Past President Mathew Avram, MD, Director, MGH Dermatology Laser & Cosmetic Center, Boston, “The meeting was characterized by cutting-edge technologies and treatments that will define the future of energy-based procedures for medical and aesthetic conditions. Treatments as diverse as heating with lidocaine, electromagnetic stimulation, and others were the type of thought-provoking features that continue to make this a must-attend event for those in our field. As always, you will hear about it at ASLMS first!”

Denver dermatologist Joel L. Cohen, MD got to stay in his home town this year. “ASLMS in the Mile High City was fantastic. Folks saw great lectures and were privy to new innovations in technology, as well as learning how to better use things we already own,” he says. “Sciton launched their new JouleX platform at the most important laser meeting. In my practice, our Sciton technology delivers consistency with full-field and fractionated Erbium resurfacing, minimal downtime with HALO, and pigment correction with BBL. JOULE X is bringing major innovation to the Sciton platform by adding its Clear Suite module for vascular, skin, and hair. These are very exciting additions to an already outstanding platform.”

There was also a lot of excitement around the launch of the newly FDA-approved applicator for treating arms and thighs from BTL Aesthetics' Emsculpt.

Los Angeles plastic surgeon Brian Kinney, MD, leader of the research study group presented some interesting new data. “Our one-year data from CT and MRI shows a slight ongoing improvement in the muscles, with essentially the same results as at one and three months for diastasis and abdominal wall fat thickness. Patients continued with their normal lifestyle and underwent no additional treatments during that time,” he says.

He continues, “The EmSculpt HIFEM technology is backed by research with over 200 patients in a seven-center, blinded study group. Results at various time points—one, two, and six months—were evaluated by blinded radiologists with MRI, CT, and ultrasound. In addition, 2D and 3D photography and tape measurements were taken. Animal studies, biopsies, and chemistry values showed release of free fatty acids, powerful stimulation of the muscles, hyperplasia and hypertrophy of the muscles, as well an increased apoptotic index of adipocytes. New studies presented at ASLMS 2019 confirm improvement in the buttocks. We also look forward to possible FDA clearance for the calves in the near future.”

Tina Alster, MD, Director, Washington Institute of Dermatologic Laser Surgery in Washington DC, is a staple at ASLMS. “This year's highlights included networking with other women in the field at the fifth annual celebration of ASLMS Women in Energy-Based Devices event, as well as chairing the Practice Management Workshop and picking up practice pearls from my co-faculty members. What makes the ASLMS annual meeting so special is the fact that attendees tend to be advanced laser practitioners who elevate the level of educational dialogue,” she says.

Among the most popular perennial sessions, this year's “Ask Me Anything” forum featured Drs. Arielle Kauvar, Brian Zelickson, Roy Geronemus, and Suzanne Kilmer. As always, the Tech Connect program was a full house. Chaired by Hong Kong dermatologist Dr. Henry Chan, the key topics featured included body contouring, vaginal rejuvenation, picosecond and vascular devices, and stimulated a lively debate about what works best and what's coming next. Key learnings included a discussion of energy-based options for women's health that concluded with a general consensus that women are seeking out these treatments despite FDA warnings, and the results achieved with current technology can be life changing for patients.

In the vascular category, Cutera introduced their new excelV+. According to Dermatologist Kelly Stankiewicz, MD of Park City, UT, “The excel V+ is a whole new level in vascular and pigmentation treatments. It delivers 50 percent more power in larger spots sizes for much faster treatments. It brings back the beloved Dermastat for precise treatments of smaller lesions and vessels,” she notes. “It includes a novel new laser, the Green Genesis, for gentle yet effective treatment of vascular and pigmentary lesions. It's the most advanced laser of its kind on the market today.”

Another technology that attracted attention hails from Lutronic. Their Genius system for RF delivery received high marks from presenters for its ability to provide real-time feedback to facilitate customized treatments that are comfortable for patients. There was also some buzz about LaseMD, a Thulium 1927nm system that creates microchannels in the skin to deposit cosmeceuticals, tranexamic acid, resveratrol, vitamins C and A.

Cynosure's innovative tool, the TempSure Surgical RF system, offers a point of difference and versatility for practitioners of all specialties. “TempSure Surgical allows me to perform superior surgical incisions quickly and with greater precision. It is the ideal choice for cutting and coagulation and is truly a breakthrough technology that has revolutionized my practice,” says Barry Dibernardo, MD, a Montclair, NJ plastic surgeon.

Candela Corporation featured their updated pulsed dye laser, the V-Beam Prima. According to Dr. Bernstein, “Prima is the next generation of pulsed dye laser offering two wavelengths, 50 percent greater energy than the previous-generation laser, and dramatically extended dye life as well as once-a-day calibration. The Prima is often used in combination with the Candela PicoWay Resolve for a one-two punch rejuvenating treatment.”

Dr. Bernstein adds, “I would be remiss if I failed to mention all the receptions and festivities that served as the perfect contrast to the heavy science sessions each day. There were some serious parties sponsored by exhibitors including Sciton, Lutronic, BTL Aesthetics, Fotona, Cutera, Solta, Cynosure, and Alma at the host hotel for all to enjoy.”

Dr. Bernstein has turned over the reins to incoming ASLMS president, Miami dermatologist Dieter Manstein, MD, PhD.

“The ASLMS team and membership did an outstanding job putting on a world class event. We look forward to the 40th annual ASLMS conference in 2020 in Phoenix. You won't want to miss it,” says Dr. Bernstein.

The 2020 conference will be held at the Phoenix Convention Center in Phoenix, AZ, April 29 - May 3. For information: aslms.org


Allergan 360° Aesthetics Report: Global Beauty Perceptions

The digital boom and millennials are growing the aesthetics category, and wellness and self-care are the new key drivers, according to the Allergan 360° Aesthetics Report.

To develop the report, Allergan tapped into more than 14,500 aesthetically conscious consumers and 1,300 aesthetic physicians in the United States, Canada, Mexico, Brazil, the United Kingdom, Spain, France, Germany, Italy, Turkey, Russia, Saudi Arabia, India, China, Japan, South Korea, Taiwan and Australia.

The study found that 28 percent of global consumers turn to the Internet first when searching for a dermatologist or plastic surgeon for an aesthetic treatment, and 82 percent of US consumers (ages 21-35) turn to Instagram as their leading source of information.

According to the report, more than half the millennials surveyed would consider a surgical or non-surgical intervention to enhance their appearance, with 61 percent agreeing their overall appearance impacts how successful they are in life.

“When the question is no longer ‘if' I should consider treatment, but ‘when' I should consider it, the conversation with the physician changes,” says San Diego-based dermatologist Sabrina Fabi, MD. “In the past, we saw patients for aesthetic treatments before a big event such as a wedding or reunion, whereas now we see them on a more regular basis, and they use words like ‘preventative care'.”

Consumers are more motivated to make changes as part of their lifestyle choices. “We are a maintenance-focused society. The same people who are committing to monthly gym memberships and private sessions with trainers are requesting body contouring procedures when they come in for their facial injectable treatments,” says Montreal-based plastic surgeon Arthur Swift, MD.

Among respondents, 68 percent say looking their best is an important part of their daily activities and 53 percent of consumers globally would consider a non-invasive body contouring treatment. Other top concerns globally were facial lines or wrinkles around the eyes, with 32 percent of consumers worldwide currently considering a facial injectable treatment. Reac our cover focus for more on global beauty trends.


RealSelf, ASAPS To Launch Educational Initiative on Breast Implant and Brazilian Butt Lift Safety

RealSelf and the American Society for Aesthetic Plastic Surgery are partnering to conduct studies and develop new resources about the safety of breast implants and Brazilian butt lifts.

“With growing patient concerns, particularly around breast implants and the high death rate associated with Brazilian butt lift procedures, it's our responsibility to help consumers understand safety risks and the importance of going to a board-certified plastic surgeon,” says W. Grant Stevens, MD, Immediate Past President of the Aesthetic Society. “By partnering with RealSelf, we can create and distribute consumer-friendly medical information that informs the public about each and every step of the process when pursuing these cosmetic procedures.”

The new partnership will include:

  • Collaborative Research: Conducting studies and patient surveys to uncover information gaps and the highest priority needs for consumer education
  • Consumer Resources: Creating safety guides and checklists that provide consumers with clear information about the associated risks of the procedures and outline the crucial questions to ask during a consultation with a plastic surgeon
  • Awareness Campaigns: Engaging past and prospective patients and board-certified plastic surgeons to help spread the word

Crown Laboratories Relaunches Brand, Adds to Portfolio

Crown Laboratories is launching new corporate branding to reflect significant business changes made this past year, the company says. In addition to its consumer and prescription portfolios, the organization has invested in two new divisions: beauty (Vita Liberata) and aesthetics (Bellus Medical). It has also made enhancements to its OTC therapeutics division.

The new tagline, “Skin Science for Life,” is intended to define the connection of Crown's portfolio and its partnership with physicians and their patients. The new logo incorporates a multicolor palette intended to symbolize Crown's revitalized spirit, energy, and excitement in its pursuit of scientific excellence in the skin care arena.

On the heels of the rebrand, Bellus has acquired the HD PRP system for the aesthetic marketplace from Healeon Medical, Inc. The system is designed to meet the demands of busy practices seeking higher volume and higher yield platelet rich plasma (PRP) procedures. As part of their expanding PRP portfolio, Bellus Medical will re-brand its suite of offerings as the ProGen PRP Advantage and ProGen PRP Versa lines.

Crown also acquired Xycrobe Therapeutics, Inc. Xycrobe's technology focuses on utilizing the ubiquitous nature of skin microbes by turning them into vehicles for the delivery of biotherapeutics. Xycrobe technology addresses the needs of patients with inflammatory skin disease through the development of “good” bacteria strains, designed to be used for therapeutic purposes. Xycrobe's technology is challenging the current treatment paradigm for inflammatory skin issues.

Crown intends to explore use of the Xycrobe technology across its brand portfolio, including its Bellus Medical, Vita Liberata, and Consumer divisions.


BAAPS Data: Cosmetic Surgery in the UK in 2018

More than 28,000 cosmetic surgery procedures took place in the UK in 2018, an increase of less than one percent from 2017, according to the annual stats from the British Association of Aesthetic Plastic Surgeons (BAAPS).

Women underwent 92 percent of all cosmetic procedures recorded, and as in 2017, the three most popular procedures for women were breast augmentation, breast reduction and blepharoplasty. The biggest increases for women were for liposuction which rose 12 percent, and facelifts which rose nine percent.

Across both genders, liposuction saw a sharp rise of nine percent and may be due in part to the popularity of women's athleisure clothing, such as leggings and sports bras that are stylish enough to wear socially.

Overall, male cosmetic surgery dropped by 4.7 percent in 2018 as non-surgical treatments gained popularity driven by the trend for men preferring to look tweaked rather than tucked. The fall in brow lifts for both women (down 15 percent) and men (down four percent) underlines the value of Botox as an alternative but also a preventative treatment in rejuvenating the forehead and brow.


Dr. Charles H. Thorne Named New President Of The Aesthetic Society

Charles H. Thorne, MD, a plastic surgeon practicing in New York City and Chairman of the Plastic Surgery Department at Lenox Hill Hospital, is the new President of the American Society For Aesthetic Plastic Surgery (the Aesthetic Society).

Dr. Thorne and his leadership team will focus on a number of critical projects, including expanding the education programs, completing the Society's rebranding efforts to improve both member engagement and public education and overseeing the development of a robust and comprehensive data collection and standardization product.

As a member of the organization for 23 years, Dr. Thorne has served on numerous committees and task forces in the last year including the Aesthetic Training Committee, the Finance and Investment Committee, the Conflict of Interest Committee, the Women Aesthetic Surgeons Committee, the Industry Policy Committee and the FDA Breast Implant Hearing Task Force. He has served as a board member of the research arm of The Aesthetic Society, the Aesthetic Surgery Education and Research Foundation (ASERF) and has served on the Executive Committee of the Board of Directors of The Aesthetic Society for four years, serving on the Board of Directors for a total of nine years.

Dr. Thorne is certified by the American Board of Plastic Surgery and is in private practice in New York City. He serves as Chairman of the Department of Plastic Surgery at Lenox Hill Hospital and Manhattan Eye, Ear and Throat Hospital and is Professor of Surgery at the Zucker School of Medicine at Hofstra/Northwell. Other newly named Aesthetic Society officers serving on the Executive Committee President-Elect: Herluf G. Lund MD of St. Louis, MO; Vice President William P. Adams, Jr., MD of Dallas, TX; Treasurer Jennifer L. Walden, MD of Austin, TX. Dr. Walden is the first female physician at The Aesthetic Society to ascend to the Executive Committee in a leadership role on the Board of Directors.


Nestlé Enters into Negotiations to Sell Nestlé Skin Health

Nestlé has entered into exclusive negotiations with a consortium led by EQT and a wholly owned subsidiary of the Abu Dhabi Investment Authority (ADIA) for the sale of Nestlé Skin Health for a value of CHF 10.2 billion. Nestlé Skin Health had net sales of CHF 2.8 billion in 2018. The proposed transaction will be subject to employee consultations and approval of regulatory authorities and is expected to close in the second half of 2019. The company will provide an update on the use of proceeds and its future capital structure at that time.

Founded in 1981 as Galderma and operating as a wholly owned subsidiary of Nestlé since 2014, Nestlé Skin Health offers a range of medical and consumer skin health solutions through three business units: aesthetics and prescription, both under the Galderma brand, and consumer health.

The consortium says it intends to support Nestlé Skin Health in its next period of growth and innovation, leveraging EQT's long-term experience and industrial network. The strategy will build on the current direction taken by Nestlé Skin Health's management and focuses on accelerating growth further by building on the company's strong market position and brands.

Priorities will be to invest in commercial excellence and drive innovation in collaboration with health care professionals in the Aesthetics unit; to continue investments in R&D and business development to strengthen the prescription division and leverage its best-in-class commercial platform; and to increase presence in the US, launch new products and focus on international expansion in the consumer health business. The company will keep its headquarters in Switzerland and will be rebranded as Galderma.


Honoring Our Mentors

In his editor's message in the January/February edition, Steven Dayan, MD called attention to the mentors that influenced his career (read “Standing on the Shoulders of Giants” online at ModernAesthetics.com/2019/02). S. Manjula Jegasothy, MD of Maimi Skin Institute was inspired by generations of physician family members, including her dermatologist father. She shared the post below on Instagram. Drop us a note about your mentors to editor@bmctoday.com or Tweet @ModAesthetics #mentors #giants


Edward Knowlton, MD, Recros Medica

Edward Knowlton, MD, who developed a procedure for breast reconstruction and the Thermage Technology (Solta Medical) has a new creation: Rotational Fractional Resection (RFR). RFR technology uses an array of circular scalpels (called scalpets) to make tiny tissue excisions. Dr. Knowlton notes that two colleagues were instrumental in the development of RFR: Dr. Milind Ambe and Dr. Steven Yoelin.

TAKE 5

The FDA in May accepted the de novo regulatory submission for Nuvellus Focal Contouring System (Recros Medica), which utilizes the RFR technology. Based on anticipated regulatory timelines, Recros expects to receive FDA clearance in the fourth quarter of this year.

Dr. Knowlton talked to Modern Aesthetics® magazine about the technology and its potential applications.

RFR Fills a Void

Dr. Knowlton: Recros Medica just finished a multi-center clinical study, which was successful for removing excess skin and fat just underneath the chin (submentum). With one treatment session, we've had some very good results by combining fractional skin resection with focal lipectomy, to improve submental contouring.

Existing therapies have been effective in treating a younger group of patients with modest amounts of skin laxity. More significant laxity in older patients typically is an untapped need, because the energy devices really cannot tighten enough skin to show a visible aesthetic enhancement. The amount of skin laxity due to aging is going to be more significant as the population ages.

RFR Is Brief But Impactful

Dr. Knowlton: Following the sale of Thermage, I had been focused on what else I could do as far as a hybrid between an energy-based device versus a face lift, which is a very extensive procedure that in many cases requires a general anesthetic. That's where RFR fits in, it can be done under local anesthesia. Usually a face lift may take four hours of surgery; RFR takes perhaps 15 to 20 minutes and be done solely under local anesthesia in an office-based environment.

Additional Body Sites Could Be Targeted

Dr. Knowlton: There are areas on the body in which as we get older the skin does stretch and you have skin laxity, but because of the positioning of these areas, the correction would be a very poor trade off based upon the visibility of the long, surgical incision and the amount of aesthetic enhancement. Examples are above the knee, the upper arm, the thigh area. There are many areas that are currently, as we say, an untapped need. I would tell my own patients we really don't have a solution to this, because I'm not happy with the amount of visible surgical scarring you would have if I were to do the standard resection.

I don't know, quite frankly, all the potential applications of this technology, as it is brand new. But we do know that it has significant applications to reducing the visibility of pre-existing scars. And perhaps the most significant reconstructive aspect of this has to do with skin grafting. We could use the fractional excision technique to harvest skin for grafting at another site. This has applications in trauma or burns, in which actually the donor site deformity from taking off the sheet graft can be as bad as at the recipient site.

RFR Could Lead to Alternatives to Existing Fillers

Dr. Knowlton: One potential application is autologous dermal transfer or ADT. We could treat a patient for laxity, such as in the abdomen post-pregnancy, harvest the tissue and use only the patient's own tissue as a living injectable for aesthetic purposes.

But It Won't Replace Facelifts Entirely

Dr. Knowlton: There could be groups of patients we feel that would not be candidates for RFR. We're continuing to study this. For example, patients who would need to undergo a facelift would be excluded from having RFR because of severe amounts of skin laxity.

Galderma's Dysport Celebrates 10 Years Since FDA Approval

Galderma Laboratories' Dysport (abobotulinumtoxinA) is celebrating its 10th birthday. Galderma is offering double points for Dysport aesthetic treatments registered in the ASPIRE Rewards program through July 31, 2019, which patients can redeem for discounts on their next treatment. Additionally, in select US markets, Dysport is partnering with charitable organizations to donate money for every patient treatment registered.

In addition to strong safety and efficacy, recent post-approval studies have demonstrated Dysport patients experience results positively affecting their psychological well-being. When asked 30 days after their Dysport treatment, 92 percent of patients reported feeling confident, 90 percent reported looking natural and 92 percent felt they looked attractive. Four months post-treatment, patients reported looking at least four years younger than their actual age.


ISHRS Campaign Takes on Black Market Hair Restoration Clinics

The International Society of Hair Restoration Surgery (ISHRS) is launching a new public awareness campaign to help patients recognize “black market pirate” hair restoration clinics and misleading advertising claims.

Social media engagement will be the cornerstone of the physician-led campaign, with physicians and patients sharing stories of this growing problem.

The ISHRS has established detailed information on its website under the header “Beware of the Hair Transplant Black Market” to help patients.

“We hope patients will use the new ISHRS resources to educate themselves about the risks of undergoing a hair restoration procedure on the black market and to make sure they understand the local laws and regulations when considering a hair transplant in another country,” says ISHRS President Arthur Tykocinski, MD, in a news release. “Forewarned is forearmed could not be truer when it comes to avoiding being a victim of unscrupulous hair transplant clinics. This problem is also happening in every country, where greedy entrepreneurs and clinic owners choose a business turnkey model where a hair transplant practice emerges almost instantly and the patient is mainly assisted by unlicensed professionals and the physician, if present, has no experience or is minimally involved into the procedure at all.”