Get A Leg Up On The Competition In Time For Summer

After hibernating for such a long time, a lot of us are looking forward to coming out of hiding by Memorial Day weekend. For some, the COVID crisis has taken its toll on our bodies and our self-esteem. But now that vaccines are readily available and our day-to-day lives are getting back to something resembling normal, more patients are in the market for some tweakments, especially from the waist down.

The advantages of offering minimally invasive procedures that specifically target the legs, thighs, knees, and ankles are numerous. With myriad new treatment options on offer, practitioners have a lot of options to choose from to firm, tone, reshape, and retexturize these areas with no to minimal social downtime.

So, we talked to four practitioners to learn how they are approaching this growing treatment category.

Calfornia Dreaming

In many parts of the largest state by population, the demand for aesthetic treatments during the cycles of the COVID pandemic has remained pretty high by most accounts.

According to dermatologist Melanie Palm, MD of Art of Skin MD in Solana Beach, CA, “COVID-19 has been a powerful motivator for many of my patients regarding body rejuvenation. We just recently held a virtual Body Boot Camp at Art of Skin MD, and the response to our socially-distant virtual open houses has been very positive. These virtual events have generated nearly 300 percent the income of our traditional in-person events that attracted around 250 in-person attendees in past years.”

The scenery of SoCal beaches certainly has a way of making residents and visitors step up their game. “Patients in San Diego are very aware that swimsuit season is just around the corner. Ridding pigmented spots with light/laser energy, clearing up leg veins with sclerotherapy, and treating crepey skin with topical therapy, PLLA/dilute CaHA and RF/acoustic wave therapy are very popular requests,” she adds. “In addition, fat removal, either with liposculpture, cryolipolysis, or RF has been popular for inner/outer thighs and knees. Cellulite and skin laxity on the thighs are a frequent complaint of my patients. I like to offer a combination treatment plan that includes collagenase to treat dimples, then collagen stimulating injectables in conjunction with HIFEM and/or RF to tone muscle, burn fat, and improve skin quality,” says Dr. Palm.

Combination Approach

The East coast appears to be in full swing now, too. According to New York City dermatologist Ariel Ostad, MD, his patients start early to get their lower bodies in great shape for summer, especially after quarantines and working from home for so long.

“We tailor the optimum regimen for each individual patient depending on their timing and tolerance for repetitive treatments. Our office utilizes the latest technologies for all concerns: CoolSculpting to contour inner and outer thighs and knees, Morpheus8 to smooth cellulite and improve skin texture, or a few Fraxel sessions to target solar lentigines of the lower extremities. These procedures are easy enough so that patients don’t have to interrupt their schedule to make room for downtime, yet they can achieve remarkable results,” says Dr. Ostad.

He continues, “One of my favorite treatments to get legs ready for the summer is the Excel-V laser to address unsightly leg veins. I see this condition affect patients of all ages, and unfortunately there are not many preventative options. But there are effective treatments. The Excel-V has the right wavelength to target the discoloration that unwanted leg veins create. We can target the pigment created by the vein and close it off instantly. The treatment requires no numbing or needles with no downtime other than no sun exposure for 48 hours. I usually have my patients do a series of three treatments spaced one month apart.”

Knee Deep

After a cold and dreary winter stuck indoors, New Yorkers are ready to show their spray-tanned and Peloton toned legs.

According to New York City plastic surgeon Bryan G. Forley, MD, one of the more challenging areas to treat are the knees, but RF technologies have the potential to restore the legs to more youthful appearance. “Isolated fat pockets can be managed with conservative liposuction in the younger age group while respecting the bony anatomy so as not to create hollows. However, as patients age, poor skin tone and elasticity above the knee frequently will accompany fat excess and can result in the dreaded baggy knee. Thigh lifts and body lifts are relatively ineffective in treating the knees because of their distance from the lift incisions. This problem has defied a surgical solution due to the risk of performing an excisional procedure adjacent to a joint. The constant flexion and extension of the knee frequently results in scar spreading, scar thickening, and likely scar discoloration,” he explains.

However, Dr. Forley reports achieving excellent results from a scarless treatment approach for baggy knees, which ticks many boxes for patients who are unable or unwilling to have more invasive procedures.

“We are using bipolar radiofrequency (RF) energy that is introduced both below the skin and on the skin surface with a choice of Inmode’s BodyTite and AccuTite applicators that only require a needle puncture for entry through the skin. In addition, fractionated RF energy delivery up to 8mm deep to the skin surface is now possible with the microneedle technology of Morpheus8 Body. The 40-pin tip applicator uses Burst Mode to deliver RF energy at single depth settings or at two to three sequential levels following deployment of the needles from the skin surface. The RF energy generates a gradual tightening of the fibrous bands that extend through the fat to the skin as well as initiating progressive skin contraction. Depending on the severity of the problem, BodyTite alone or in combination with a series of four to six Morpheus8 Body treatments can improve the baggy knee. Preservation of fat in this region is crucial to avoid contributing additional laxity to the baggy appearance of the knees due to a lack of underlying soft tissue support,” he says.

Leg Perfection

Dermatologist Lesley Clark-Loeser, MD of Precision Skin Institute in Davie, FL, relates that the demand for non-surgical body contouring, smoothing, and firming has always been present, but now there are many more options to choose from.

“Our toolbox of effective and affordable treatments is more robust than ever. Combining treatments and taking advantage of multiple technologies allows us to more successfully treat our patients. There is no one size fits all treatment when it comes to treating the body. There are many different things at play that can be contributing to what brings a patient in for a consultation. Therefore, it is crucial to critically assess what specific factors need to be addressed to achieve the best outcome,” says Dr. Clark-Loeser.

“In our practice we take advantage of the power and dual mechanisms of Emsculpt Neo to body sculpt, reducing fat and toning muscle. To address skin laxity and/or cellulite, we may suggest either Emtone (RF with Target Pressure Energy) or Profound (long pulsed RF delivered via microneedles) depending on the patient’s needs. Skin laxity and crepiness can also be addressed in the upper arms, abdomen, above the knees, neck and décolleté with hyperdilute biostimulators, specifically Radiesse and Sculptra,” she says.

She continues, “Post-COVID, we have also changed the way we offer repetitive treatments and packages, and this is especially true for skin tightening to correct skin laxity, pigmentation, telangiectasia, fat contouring and muscle toning, and hair removal series for the lower extremities. For example, we are bundling BTL Aesthetics’ NEO or traditional Emsculpt with Emtone and offering maintenance sessions and memberships that keep patients coming back to our practice.”

“When it comes to cellulite that plagues 90 percent of women, Qwo is the newcomer to help us break down the fibrous bands using a collagenase enzyme, and there are more new modalities on the horizon. So, have we finally reached a non-surgical body contouring Nirvana? Not yet, but we are definitely getting closer,” she adds.