A Non-surgical Alternative to Neck Lifts

By Gregory Mueller, MD

MyEllevate is a solution that enables surgeons to do more to define the jawline and elevate the profile. Efficient to perform, lasting in effect, MyEllevate offers the convenience of an in-office minimally invasive treatment. Cosmetic practitioners can treat patients who want a beautiful jawline and more youthful appearance without surgery, like a traditional neck lift, and the downtime associated with it . The MyEllevate procedure is done in about an hour under local anesthesia. Patients can expect rapid healing with minor bruising and swelling and can return to normal activities within a few days.

The MyEllevate procedure is performed using the patented ICLED® Surgical Suture System. It is the first and only light-guided suture suspension technology to support and shape underlying muscles and glands. It also utilizes the illuminated Suturod® to accurately place sutures through small (~1mm) punctures. A permanent 4-0 braided polyester suture is placed at the appropriate tissue plane without going behind the muscle. The use of a lighted needle guides placement of the corset, thus eliminating the need for a larger incision. There are no sutures needed to close the skin post-treatment. The results are long-lasting, with some of my early patients now five years out from their initial treatment and still showing good results.

As a board-certified plastic surgeon in practice since 1998 in Beverly Hills, I was trained to do big, elaborate, complex, neck rejuvenation procedures. And I love doing them. I love technically challenging things but, patients don’t like complex surgeries, they want a quick solution that works and lasts a long time.

This is an elegant solution that any core aesthetic physician can master with training, but it is not something that should be undertaken by someone without the proper background and training. Inspired by my training in laproscopic surgery, I developed a technique that allows the surgeon to pass a lighted needle underneath the skin; transillumination through skin allows for visualization of the suture. The surgeon knows exactly where they’re going and they know how deep they’re going. So it makes the procedure very safe and exact. Anyone trained in surgery of the neck can perform the procedure safely, consistently, and accurately. Compared to other devices in the market, MyEllevate uniquely addresses the deep muscle layers producing a significant and long-lasting enhanced jawline. Importantly, though, placement of the sutures does not preclude the use of energy-based treatments aimed at tightening the envelope or reducing signs of skin aging like pigmentation. In fact, I use devices for many of my patients who undergo MyEllevate and I believe that one plus one truly equals three in these cases.

I have been performing the MyEllevate procedure for years now, and I am excited that we have partnered with Cynosure on the launch of this procedure into the broader market. From a patients’ perspective, this offers an incredible solution for anyone looking for a neck lift but, is afraid of invasive surgery or does not want the downtime. The ideal patient is likely the older patient who presents with classic sagging of the neck and jawline associated with aging. However, this is also a suitable treatment for a younger patient who genetically has that ski slope neck and is seeking a more sculpted jaw line.

For surgeons, MyEllevate opens the potential to treat a wide range of patients across age groups with a minimally invasive procedure. It gives us another tool in our armamentarium that addresses all the different concerns that patients may have. Of note, since I started marketing MyEllevate in my practice in 2018, the average age of my patient base has dropped by 6 years. Based on overall aesthetic market trends and the demographics of the US, I believe that demand for this procedure will grow steadily in the near future.

Gregory Mueller, MD, FACS

• Plastic surgeon in Beverly Hills, CA
• Developer of MyEllevate

Focusing on Epidermal Barrier Repair

By Carl Thornfeldt, MD

Thirty years ago, the epidermis was considered to be like a cellophane wrap of dead and inactive cells. I believed more scientific investigation in all physiologic aspects of skin barrier and cutaneous inflammation, including their regulation, was warranted. That led to the scientific hypothesis: If we could optimize the structure and function of the skin, could we treat disease and conditions better and prevent them from flaring or rebounding? Moreover, could these morphologic adjustments impact visible skin aging and even skin cancer incidence?

Being involved with epidermal basic skin biology research resulted in a new understanding of the skin barrier structure and destructive chronic vs. healing acute cutaneous inflammation. Further research documented that skin conditions and diseases characterized by both chronic inflammation and a compromised permeability barrier include not only visible skin aging but also sensitive skin. It follows then that the foundation for the most effective treatment and longest lasting remission of these diseases rests upon optimizing barrier function and safely reversing and preventing destructive chronic inflammation.

My goal as a dermatologist was to achieve what I desired for my own chronic skin condition: to get completely clear, be itch free, and stay clear. When I began a private practice, I believed people did not get well due to the physician not being diligent enough to leave no stone unturned in searching for the cause of the disease. Within the first two years of practice, I realized how foolish this thought was. In a scientific epiphany, I realized that in polymorphous light eruption (PMLE) and asteatotic dermatitis (ASD), chronic inflammation resolved after the stratum corneum barrier was strengthened and thickened. It also followed that the inflammation and itchy dermatitis must also follow a compromise of the stratum corneum barrier. This made sense, as the poorest barrier occurs on the sites of lowest sebum production, such as lower legs, and is also deficient in those with atopy.

Chronic inflammation is characterized by lymphocytic cell infiltrate and upregulation of MMPs. With frequent, recurrent or prolonged insult, accumulation of excessive amounts of MMPs results in excessive damage of collagen and elastin fibers and glycosaminoglycan ground substance. Reversing and preventing this destruction is needed with therapeutic ingredients focused on chronic inflammation while at the same time attempting to slam the incompetent skin barrier shut.

Barrier repair requires the key physiologic lipids—cholesterol, ceramide, and free fatty acids—in a specific molar ratio to maximize repair and optimize barrier function. Many different ratios were tested, but the ratio ultimately found to be most effective accelerated barrier repair by nearly 2.5 fold over any other ratio—which is what is used in the Epionce products.

After years of additional research, I settled on a barrier repair formula based on extracts of safflower, rosa canina, avocado and flax to achieve the optimum ratio of lipids. This product accelerated barrier repair more than twice as effectively as 100% petrolatum and four times better than any commercially available moisturizer product used by the dermatology community. Additionally, an anti-inflammatory formulation was created based on extracts of date, meadowfoam, apple, flax, and avocado, all of which were more potent than grape, olive, teas, and soy, respectively. This product inhibited chronic inflammation 2.5 fold better than 1% hydrocortisone. I strongly believed that the final formulations then need to be tested for safety and efficacy. Epionce is the first product line to have more than 15 studies on final formulations, in many cases against prescription products, to prove the product the patient is buying works.

There are still many who believe that applying products that damage the skin barrier—like retinoids or corticosteroids—without also using a barrier repair product to correct the damage is effective because that’s what they were taught. However, the shift is happening. This year “Skin kindness” is trending strongly with the consumer, as people are realizing the effects of years of over-exfoliation and the improper use of harsh ingredients.

I truly believe that these products have helped me be a better dermatologist and provide better care for my patients.

Carl Thornfeldt, MD

• Clinical Dermatologist
• Founder of Episciences, creator of Epionce.

An Eye-Opening Take on Skincare

By Ashley Brissette, MD, MSc, FRCSC

More and more, patients are concerned about the appearance of their eyes; they are bothered by redness and fine lines, and they wish their eyes looked more refreshed.

Dry eye and blepharitis affect a significant portion of the population and are common reasons for visits to eye care professionals. Makeup debris, pollution, and allergens in the environment also build up on the eyelids and eyelashes and further contribute to irritating eye symptoms. Many people do not seek care for these conditions but instead turn to poorly regulated cosmetic-grade products for use around the eyes.

Mainstream cosmetic products contain ingredients that can be harmful to the ocular surface and delicate eyelid skin. For example, cosmetic-grade eye makeup removers contain harsh ingredients that strip away natural oils and can leave the skin dry and irritated. Patients often ask about the use of cosmetic products around the eyes, and in the past I did not feel satisfied with what was on the market.

So began my quest to create a hero product that would revolutionize the space: one that exists between cosmetic and medical-grade products for use around the eyes, is effective yet safe for everyday use, and is designed for individuals of all genders and ages. I worked with a certified organic lab to create a novel product, and, after 15 rounds of revisions, Eye Revive (Daily Practice) was born. Eye Revive is a 3-in-1 foam cleanser that cleanses, removes makeup and pollutant debris, and hydrates the delicate eyelid skin. It includes ingredients that contain fruit extract antioxidants (citrullus lanatis + pyrus malus), vitamin B complexes, naturally occurring moisturizers (sodium PCA), and a gentle antimicrobial (xylityl sesquicaprylate).

Ashley Brissette, MD, MSc, FRCSC

• Assistant Professor of Ophthalmology, Weill Cornell Medicine, New York Presbyterian Hospital, New York
• asb9040@med.cornell.edu
• Founder, Daily Practice Eye Care

A Novel Approach to Patient Access

By DHaval G. Bhanusali, MD

In general, drug prices have been rising sharply and to the point where they are making medications inaccessible for patients. The increase in the amount of prior authorizations required has led to a burden in many offices. Compounding itself has been around for a long time, but the process was previously inefficient and not easy to do.

We built Skin Medicinals to 1.) Provide a platform to allow dermatologists the ability to get medications to patients at an affordable price and 2.) Relieve the strain of increased office work for staff. The compounds themselves are created unique to each patient and we’ve been so thankful by the warm response from the field.

Skin Medicinals is a technology platform that allows dermatologists the ability to custom craft compounded medications for patients. There are options for various conditions, like acne, rosacea, pigmentation, warts, etc. It also allows access to oral medications at a reasonable cost (such as doxycycline starting at $10 or spironolactone starting at $9).

Doctors can craft truly unique options for each patient and help drive down the costs for patients.

The process is simple. The doctor evaluates the patient and determines the select the appropriate ingredients for the patient. The patient then “checks out” via their phone or laptop and the pharmacy then prepares the medication and ships it directly to the patient’s home. The prices are cheaper than most co-pays and patients can conveniently manage prescriptions via their devices. This can often save the need for multiple expensive medications or in many cases make access to certain ones possible.

A great example was a medication with Iodoquinol and hydrocortisone that recently was seen to go from $226 to $10,000. A compound with Iodoquinol, hydrocortisone, and niacinamide is available on the platform for $45 (no insurance needed for the patient and no prior authorizations by the doctor staff). We hope this will eventually lead to lower prices for patients across the entire field

We have served more than 385,000 patients, have more than 8,400 prescribers on the platform (skinmedicinals.com), and have grown organically.

Patients receive texts/emails with their prescriptions and can check out when convenient. We continuously seek feedback from our community and always look to improve. The idea has been to build from within and in a way that was supportive to everyone. We want to simplify things for our community and remove the burdens and red tape of care. We are hopeful that other fields will see this as something useful for them as well and this is the first step in a much larger movement to improved patient access.

DHaval G. Bhanusali, MD

• Private practice, New York City
• Founder, SkinMedicinals