2020’s Top 5 Cosmetic Surgical and Minimally Invasive Procedures

Demand for plastic surgery is on the rise, according to new statistics from the American Society of Plastic Surgeons (ASPS).

ASPS recently gauged Americans’ perceptions of plastic surgery more than a year into the COVID-19 pandemic, analyzing responses from more than 1,000 women in a national survey fielded by market firm Equation Research, providing insights into how consumers feel about the category, top treatments and their likelihood to pursue a plastic surgery procedure.

During the pandemic, 11 percent of women surveyed indicated they are more interested in cosmetic plastic surgery or non-surgical procedures now than before COVID-19, and the figure is even higher among women who have already had surgery or a procedure—24 percent. Also, 35 percent of women who have previously had at least one cosmetic surgical procedure or minimally invasive procedure plan to spend significantly or somewhat more on treatments in 2021 than in 2020.

While the first wave of pandemic demand saw a rush on facial procedures in response to a significant surge in Zoom calls and downtime for discreet recovery at home, the new survey results show that tummy tucks (22 percent) and liposuction (17 percent) are among the top procedures that women who are extremely or very likely to consider procedures within six months are seeking. The reason is attributed to weight fluctuation during quarantine and more time to consider procedures long delayed due to time or cost.

While ASPS saw an overall 15 percent decrease in total number of cosmetic procedures in 2020 due to the pandemic, the dip is largely on par with the amount of time practices were closed. The Society’s board-certified plastic surgeons reported they stopped performing elective surgical procedures for an average of 8.1 weeks in 2020 due to COVID-19, or 15 percent of the year, which mirrors the decline in the total number of procedures performed last year.

The top five cosmetic surgical procedures performed in 2020 were:

Nose reshaping (352,555 procedures)

Eyelid surgery (352,112 procedures)

Facelift (234,374 procedures)

Liposuction (211,067 procedures)

Breast augmentation (193,073 procedures)

In 2020, minimally invasive cosmetic procedures decreased slightly more than surgical procedures (16 percent vs. 14 percent) during stay-at-home orders, dropping for the first time in four years.

Injectables continued to be the most sought-after treatments in 2020. ASPS member surgeons cited a significant uptick in demand during the pandemic with current patients eager to reschedule missed neurotoxin and filler appointments, and new patients motivated for the first time to pursue the minimally invasive facial treatments they’d been considering – some even before last March.

Among the 13.3 million cosmetic minimally invasive procedures performed in 2020, the top five were:

Botulinum toxin type A (4.4 million procedures)

Soft tissue fillers (3.4 million procedures)

Laser skin resurfacing (997,245 procedures)

Chemical peel (931,473 procedures)

Intense Pulsed Light (IPL) treatment (827,409 procedures)

Nearly seven million reconstructive procedures were performed in 2020, up three percent overall compared to 2019, despite the global pandemic’s impact on elective surgeries. Tumor removal is by far the most common reconstructive plastic surgery procedure with approximately 5.2 million procedures performed.

The top five reconstructive procedures performed in 2020 were:

Tumor removal (5.2 million procedures)

Laceration repair (386,710 procedures)

Scar revision (263,643 procedures)

Maxillofacial surgery (256,085 procedures)

Hand surgery (206,928 procedures)

“While many reconstructive procedures were prioritized as COVID-19 restrictions eased across the country, I’m encouraged that the Society’s members were able to quickly attend to patients in need of these surgeries—ranging from burn and wound care to migraine to pediatric craniofacial procedures—to improve their quality of life,” says ASPS President Joseph E. Losee, MD, FACS, FAAP.

Although not within the top five, breast reconstruction (137,808 procedures) saw a significant 29 percent year-over-year jump, a greater increase than any of the top five reconstructive procedures.

Improving Cosmetic Procedure Outcomes in Patients of Color

With cosmetic procedures in high demand during the pandemic, Cedars-Sinai dermatologist Jasmine Obioha, MD, has seen an unfortunate side effect: botched treatments for patients of color.

When performed improperly, procedures such as chemical peels and laser hair removal can inflame and darken melanin-rich skin of color.

“I’ve had patients come to me for complications from cosmetic treatments done at medispas or even by dermatologists,” Dr. Obioha says. “It’s part of a bigger problem—disparities in healthcare affecting patients of color, and dermatology is no exception.”

The culprit? Few physicians receive training for treating skin of color.

A large part of dermatology education involves visual recognition. Physicians must identify conditions from photos of skin in textbooks or shared in the classroom. But most of the patients in those images are white and only 4.5 percent of the images show dark skin, according to a 2018 review of general medicine textbooks in the journal Social Science and Medicine.

As a result, medical students, and residents often don’t learn about skin conditions experienced primarily by patients of color, appropriate treatments or cultural practices.

“If you’re not properly trained, you won’t recognize certain conditions, know what to look for or how to communicate effectively,” says Dr. Obioha, who attended a residency program that addressed these healthcare gaps while treating patients from a diverse community.

Laser treatments and chemical peels can do serious damage to darker skin if not handled by an expert who understands melanin-rich skin and how to treat it without doing harm.

Deep chemical peels should be avoided on darker skin, but gentler, more superficial ones are fine and won’t cause hyperpigmentation. Lasers with special frequencies and micro-needling can be done safely on darker skin to remove scarring or tighten or refresh the appearance.

“Laser resurfacing technology has improved and there are more options for all skin types, so it helps to see a specialist who’s aware of the latest developments,” Dr. Obioha says.

She also cautions that liquid nitrogen treatments to freeze and remove moles and other benign growths can leave light spots on skin of color.

Dr. Obioha says, “I’d recommend another approach using electrocautery—burning off the benign growth—which carries less risk.”

Allergan to Buy Soliton and Resonic

Allergan Aesthetics is set to acquire Soliton and Resonic, its Rapid Acoustic Pulse device.

Resonic recently received FDA 510(k) clearance and is a non-invasive treatment for the short-term improvement in the appearance of cellulite. The acquisition of Soliton expands and complements Allergan Aesthetics’ Body Contouring treatment portfolio which includes CoolSculpting Elite.

The novel platform technology uses non-invasive rapid, high-frequency sound waves to disrupt targeted cellular structures and connective tissue, physically impacting the fibrous septae beneath the skin that contribute to the dimpled appearance of cellulite. In clinical trial data submitted to the FDA, Resonic demonstrated significant improvement and strong patient satisfaction with 92.9 percent of subjects agreeing or strongly agreeing their cellulite appeared improved after a single treatment session. (To learn more about Resonic, read Take 5 in this issue.)

Under the terms of the transaction, Allergan Aesthetics will pay $22.60 per share in cash for each outstanding share of Soliton. Soliton’s enterprise value for the transaction is approximately $550 million and was approved by the Boards of Directors of both companies. The transaction is subject to customary closing conditions, including clearance by the U.S. antitrust authorities under the Hart-Scott-Rodino Act and approval of Soliton’s shareholders.

RealSelf Expands Consumer Base with Acquisition of YNS Group

RealSelf.com acquired YNS Group, a portfolio of online destinations—including multiestetica.com, guidaestetica.it, estheticon.de and multiestetica.mx.—serving millions of international consumers throughout Europe and LATAM. Similar to RealSelf, the YNS platforms provide aesthetics consumers services such as doctor reviews and online booking, patient testimonials, procedure information, and access to an engaged community who offer helpful advice and guidance.

“Following our January 2021 acquisition of Tajmeeli.com—the leading cosmetic procedure resource for Arabic speaking consumers—this addition establishes RealSelf properties as the global go-to destinations for all things modern beauty while expanding our market coverage into new geographies,” says RealSelf CEO, James Coyle.

Consumers have experienced a massive shift in lifestyle due to the pandemic including virtual, work-from-home arrangements which have allowed for more discreet, at-home procedure recoveries. According to the company, these factors have contributed to continued interest in the $17 billion dollar global medical aesthetics industry and RealSelf is primed and poised to meet consumers’ worldwide demand with this acquisition.

Dr. Deanne Mraz Robinson Named CMO at Ideal Image

Deanne Mraz Robinson, MD, FAAD has been appointed to serve as Chief Medical Officer for Ideal Image. She will be responsible for the overall direction of treatments and services offered by Ideal Image, the education of its clinical specialists, and helping lead the company as it expands its telehealth, wellness, prescription-based skincare, and other aesthetic-related services. Additionally, Carole Hazan, MD has joined Ideal Image’s Medical Advisory Board and will now also work directly with Dr. Mraz Robinson in her new role.

Take Five Brad Hauser, CEO, Soliton

Soliton made waves when it received FDA clearance for its Rapid Acoustic Pulse (RAP) device for the treatment of cellulite in January (it was cleared in 2019 as an accessory to 1064nm laser treatment for black ink tattoo removal). Now the company is poised to be acquired by Allergan Aesthetics in a deal valued at more than $550 Million. Brad Hauser, CEO of Soliton, offers an inside look at the company and its one-of-a-kind technology.

Soliton is Geared for Launch

“Both the tattoo and cellulite clearances give us a pathway to an initial commercial rollout, which we intend to execute with 25 key dermatologists and plastic surgeons. We anticipate a full national rollout in 2022.

We received a special 510(k) clearance in April for slight modifications to the device for commercial use with a fast release cartridge, as well as an improved user interface for commercial workflow.

We launched the Resonic™ brand in early May. We are going into the 25 key accounts with our practice development managers and training them even pre-delivery of the device. We’ll be doing initial launches, looking at their VIP patients who are interested in cellulite removal and tattoo removal for them to get a chance to experience the technology and start word of mouth advertising within each of these practices.”

COVID Doesn’t Stop the Data

“Over the past several months, it’s been challenging not being able to network in person. As the virus continues to decline, we are opening back up visits into practices, and we are hopeful that conferences, come summer or fall, will be in person. But from a podium presence, as well as publications, I think we’ve been very active, and we’ll continue throughout the summer presenting our cellulite data and case studies along with our first publication on cellulite coming out.”

RESONIC Meets Market Demand

“Physicians have been very encouraged by the cellulite data we’ve shown. There is significant patient interest in a single procedure that is completely non-invasive, without anesthesia, needles, or anything breaking the skin. The ability to go completely back to your normal activities immediately after treatment without any downtime is very different than other more invasive procedures in the market today.

When you compare Resonic to the devices that often require multiple treatments, provide temporary improvement, and require that you continue to treat to maintain that improvement, I think our single treatment and the efficacy stands apart in the noninvasive device space.”

RESONIC is a Platform Technology

“We’ll launch our first two commercial applications with the same platform. The difference is the cartridge and the very high frequency sound waves that we’re putting into the tissue, optimized based on the depth of the target.

As we continue to roll out new indications, we plan do so on the same platform. Physicians will maximize their initial capital investment in our equipment to be able to treat multiple indications. The return on that investment is higher than having a specific device do only one thing.

We’ve publicly talked about our proof-of-concept study in fibrotic scars; the results are very encouraging. We look to collaborate with the Navy to further enhance the types of scars that we’re treating. It’s a high area of interest for us.”

RESONIC is Different

“We need to have clinical and scientific evidence behind everything we do; physicians look for that for assurance about reproducibility of results and the ultimate efficacy and safety profile of technologies. We will always be investing in the clinical and preclinical activities of the business to ensure that scientific rigor.

While there are other acoustic sound devices, this is a unique and new technology that physically affects different tissues in the body without breaking the skin. That has not been done by any other technology, including other shock wave or acoustic devices. The mechanism of action is unique and the intellectual property we have around it will enable us to build a very strong pipeline.

Three key components to the sound wave make it unique and effective at disrupting stiffer materials: peak pressure, pulse duration, and repetition rate. We’re treating at up to 12 mega pascals of peak pressure, which is more than 1,500 pounds per square inch. As important is a very short pulse. Our rise time is on the order of nanoseconds, and that creates an ability to physically change tissue and structures at the cellular level. Lastly, most devices run up to 10-20Hz; while we generate between 50 and 100 pulses per second. All three components are necessary to achieve the results we have seen with our RAP technology.”

Cynosure to Buy MyEllevate Surgical Suture System

Cynosure is acquiring the MyEllevate Surgical Suture System, which allows practitioners to place a suture support system without incisions.

MyEllevate, performed with the ICLED light-guided suture system, is the only patented light-guided technology for use in soft tissue approximation and the elevation of sub dermis and underlying muscle. This one-time use disposable surgical kit enables the placement of a suture support system through a series of guided needle punctures for a less invasive approach. It can be performed under local anesthesia in a surgeon’s office and can be used as a stand-alone procedure or in combination with other treatments such as TempSure Surgical or SmartLipo laser lipolysis treatments and energy-based skin tightening.

“Acquiring MyEllevate will broaden Cynosure’s already extensive surgical product portfolio, enabling us to offer this ground-breaking procedure in combination with other energy-based skin tightening technologies for optimal, long-lasting results,” says Todd Tillemans, Chief Executive Officer of Cynosure. “Also known as the Zoom Lift, MyEllevate has gained popularity recently”

Benign Skin Lesions Top Concern for Many Aesthetic Patients

A majority of patients with unwanted benign lesions are interested in a new procedure to clear these lesions, according to a new survey by Pulse Biosciences that was presented at the American Academy of Dermatology (AAD) Virtual Annual Meeting.

A diverse sample of 405 aesthetic patients in the US who are likely to pay cash to improve their skin condition participated in the online survey. Participants with the target lesions were provided a procedure description modeling the potential CellFX profile and its unique cell-specific NPS mechanism, as well as before and after photos from controlled clinical studies of target lesions. Results indicated that on average 76 percent of aesthetic patients rated the value of a new procedure to clear lesions as higher than other popular aesthetic procedures, such as botulinum toxin or fillers, that they have paid for in the past, and would prioritize clearing lesions over these other common available procedures.

“We see many aesthetic patients with visible skin lesions that have a substantial impact on their psychosocial health and quality of life. More than a nuisance, these skin lesions often become a burden affecting patients in terms of their physical appearance, self-confidence and other important aspects of life,” says Thomas Rohrer, MD, a dermatologic surgeon at the SkinCare Physicians Group of Chestnut Hill, Massachusetts. “This study of patient perceptions reminds us that patients have their own preferences and priorities regarding treatments that are important.”

Phase 3 Data: Qwo Smooths Cellulite on the Buttocks

Endo’s Qwo provides a clinically meaningful improvement in the appearance of moderate to severe cellulite in the buttocks of adult women, when compared to placebo, according to Phase 3 data.

The RELEASE-1 and RELEASE-2 Phase 3 studies, which were identically designed, randomized, double blinded and placebo-controlled, assessed the efficacy and safety of Qwo for the treatment of cellulite in women. A greater percentage of the 843 women treated during the studies (Qwo vs. placebo: RELEASE 1, n=210 vs n=213; RELEASE-2, n=214 vs n=206) met the primary endpoint of a composite 2-level response on a 5-point cellulite severity scale. Over half of the women treated with Qwo in both studies met the secondary endpoint, a 1-level improvement in the patient reported assessment.

Data were published in Dermatologic Surgery.

Cynosure Introduces New Fusion Tip for Potenza RF

Cynosure launched a one-of-a-kind Fusion Tip, the newest addition to its Potenza radiofrequency (RF) microneedling system. With its dual-air chamber design, the Fusion Tip captures and releases air toward the skin with each pulse, enhancing the penetration of topicals into the skin by 67 percent for maximum results.

The Fusion Tip is the latest addition to Cynosure’s Potenza system, its four-mode RF microneedling device, which uses ultrafine needles and RF energy to penetrate the top layer of the skin, triggering the body’s natural healing process to regenerate new collagen and elastin. Potenza treatments can be performed on all skin types, anywhere on the body and any time of year.

The Fusion Tip is commercially available in the US and only compatible with Cynosure’s Potenza device.