According to Global Market Insights, the energy-based aesthetic devices market was valued at $4.1 billion in 2022 and is projected to reach $13.4 billion by 2032.1
“Energy-based devices have literally opened the door for patients seeking aesthetic improvement who previously only had traditional surgical options available to them,” said David Kent, MD, founding partner of Skincare Physicians of Georgia (Macon, Ga.). “We can craft a treatment plan of complementary technologies and procedures that can help them achieve the results they are looking for.”
A Few of My Favorite Things
According to Monica Boen, MD, a dermatologist at Cosmetic Laser Dermatology (San Diego, Calif.), energy-based devices help improve skin quality with less downtime than traditional surgeries. “A key area that can be improved with energy-based treatments is skin laxity and excess fat in the neck. I use a combination of a monopolar radiofrequency (RF) sub-surface device and liposuction to improve submental fat and skin laxity in the neck. This combination produces excellent results for neck rejuvenation without surgery,” she said.
“Laser resurfacing with CO2 and Er:YAG lasers are still the gold standard for wrinkle reduction and improvement in skin quality,” Dr. Boen continued. “There is some downtime, but the results can last for years. In my clinic, we use a unique protocol to combine pico-based and and pulsed dye lasers with CO2 and Er:YAG to reduce photodamage and wrinkles, and restore skin quality. The most recent FDA-approved lasers are 1726 nm lasers to target the sebaceous glands, which are the root cause of acne.”
While the YAG laser was the first FDAapproved device for hair removal it still has a place in aesthetics today. “Laser hair removal is one of the most requested laser treatments in dermatology,” stated DiAnne Davis, MD, a medical and cosmetic dermatologist in Dallas, Texas. “Generally speaking, the 755 wavelength is used for hair removal on patients with fair skin types, while the 1064 nm wavelength is reserved for patients with skin of color.”
Dr. Davis also treats many skin concerns with energy-based devices. “Sunspots are another form of pigmentation and can be treated with intense pulsed light therapy (IPL). I also see a lot of patients for acne scars and use a multidevice protocol with a comprehensive plan to treat them,” she shared. “I use either ablative or non-ablative fractional laser devices to address acne scars on the skin’s surface, chemical peels (20% TCA) to treat the entire face, and subcision, which addresses scar bands that are underneath the skin to give rise to rolling acne scars. All of the treatments are performed on the same day as a ‘one and done’ procedure.”
“I utilize ablative lasers when appropriate for deeper wrinkles and when patients are looking to improve years of sun damage,” reported Emily Wood, MD, a board-certified dermatologist at Westlake Dermatology in Austin, Texas. “Non-ablative lasers are a workhorse for me because they help stimulate collagen to improve overall skin texture, address fine lines and acne scars. IPL is also one of my go-to devices to address skin tone, texture and pores.”
Dr. Wood explained that she also often stacks multiple modalities for customized results. “I have a three-dimensional approach using laser or IPL to improve skin tone and texture and micro-focused ultrasound with RF to produce collagen at a deeper level to improve skin laxity,” she clarified.
According to Dr. Wood, micro-coring technology is the next big thing in energy-based treatments. “It removes tiny cores of tissue to produce tighter, more youthful skin and is a great non-invasive treatment for lower face laxity and jowls,” she said.
Energy-based treatments are showing promising results in the challenging world of neck and facelifts, as well as body contouring. Dr. Kent said he uses Emface from BTL Aesthetics (Boston, Mass.) to help lift the face by contracting and strengthening the muscles as a baseline treatment. “We may use RF microneedling to improve skin texture, RF-based subdermal tissue coagulation for neck contouring and to lift the jowls, and EmSculpt Neo (BTL) to build muscle and eliminate fat for body sculpting.
Complementary procedures are key to customizing benefits with energy-based devices.”
Energy-Based Technologies for Today’s Busy Practices
UltraClear® from Acclaro (Smithfield, R.I.) is clinically proven and FDA cleared for use in dermatology and plastic surgery. Uniquely powering the first-ever Mid Infrared Cold Ablative Fractional Fiber Laser (3DMiracl™) modality, this sophisticated 3DIntelliPulse technology treats multiple skin layers from the stratum corneum and epidermis to the mid and deeper dermis. Practitioners have a range of options from lunchtime treatments to more advanced Laser-Coring™ for deep collagen remodeling. “The UltraClear system is expected to set new standards in dermatology,” said Tina West, MD, a board-certified dermatologist and founder of the West Institute (Chevy Chase, Md. and Aspen, Colo.). “My patients enjoy a transformational effect on their skin’s appearance, texture, glow and health. This device is a game-changer in our personalized approach to total skin rejuvenation and health.”
Combining 589 nm and 1319 nm wavelengths into one handpiece, the ADVATx laser from ADVALight (Copenhagen, Denmark) is creating a gold standard for treating vascular abnormalities. According to Suneel Chilukuri, MD, a dermatologist and director of Refresh Dermatology (Houston, Texas), ADVATx has over 20 FDA clearances with a high safety profile. “I use it often for rosacea and hyperpigmentation,” he reported.
“This sophisticated laser is easy to operate with preset treatment parameters for popular indications and the nanopulse technology allows me to effectively treat my patients without the inflammatory response.” Dr. Chilukuri explained that ADVATx delivers gentle pulses of energy that the skin perceives as a single pulse.
“Overall, this is one of our most reliable devices with no consumables, no downtime and high efficacy.”
According to Janine Hopkins, MD, a boardcertified dermatologist in Monroe, La., the innovative Fotona 4D laser treatment from Fotona (Farmers Branch, Texas) has added another dimension to her dermatology practice by providing her patients with an outstanding, nonsurgical procedure to smooth and tighten their skin for beautiful results. The SP Dynamis is a versatile laser system with Nd:YAG technology for skin rejuvenation and body contouring, and the power of Er:YAG for skin resurfacing. With functions ranging from superficial to deep peels and non-ablative to fully ablative treatments, physicians can tailor treatments to any specific skin condition.
The Fotona4D facelift is achieved by combining these lasers for a noninvasive treatment that rejuvenates and tightens the skin from the inside out.
The Hollywood Spectra™ from Lutronic (Billerica, Mass.) is an advanced, ultra-short 1064 nm / 532 nm laser built with nano-acoustic advantages in both full-beam and microbeam energy delivery. The Spectra Mode uniquely enables the Instagrammable Hollywood Laser Peel® and AcnePeel™, popular treatments for the Gen Z and Millennial generations, which are important for practice growth. According to Irina Damyanidu, chief executive officer (CEO) of The Hebe Medspa in Fishkill, N.Y., the Hollywood Spectra is an advanced laser technology with safety features like a square spot size to minimize the risk of thermal damage to the surrounding skin, and adjustable fluence settings for customization based on the patient’s specific needs and the area treated. “The advanced laser technology of Hollywood Spectra results in higher patient satisfaction and improved treatment outcomes, which has resulted in positive reviews and testimonials from satisfied patients,” she said.
As an FDA-approved laser with an advanced 532 nm system and solid-state KTP diode laser, DermaLight from NewSurg (Sellersville, Pa.) requires no disposables or expensive service contracts. According to Philip Loria, MD, a dermatologist at Oxford Dermatology (Oxford, Miss.), DermaLight has excellent utility in the treatment of facial veins, redness and pigmented lesions. “It is very quick and efficient. There is essentially no downtime and very significant results with one to two treatments,” he said. “It does not create purpura and we get great results on vascular and pigmented lesions. Overall, the DermaLight KTP laser system is a compact, reliable and effective device that safely treats vascular and pigmented lesions on all skin types.”
Sylfirm X from BENEV (Mission Viejo, Calif.), an FDA-registered pulsed wave (PW) and continuous wave (CW) RF microneedling device, features 300 micron depth for advanced skin revitalization, with proven effectiveness and safety through over 25 clinical studies. “This device has increased patient retention and referrals while allowing for more daily appointments, which has positively impacted both patient care and our bottom line,” reported Jessica Christy, PA-C, owner of Beauty Culture Spa (Bloomfield Hills, Mich.). “Incorporating the Sylfirm X has been a game-changer for us. It has broadened our range of treatments, making us a one-stop shop for skincare, and it is an investment that pays dividends in patient satisfaction, clinical outcomes, and ultimately, the success of our practice.”
Scarlet SRF from Aesthetic Management Partners (Cordova, Tenn.) is a next-generation short-pulse radiofrequency (SRF) microneedling treatment that produces noticeable tightening results and dermal remodeling to improve skin texture and achieve overall face and neck regeneration. Non-insulated microneedles treat the entire length of the dermis for a comprehensive procedure, while achieving independent tissue coagulation around each needle, also known as the ‘Na Effect’. With the Scarlett SRF, physicians can treat fine lines and wrinkles, large pores, hyperpigmentation and acne scarring with safe, comfortable and effective treatments. With over 500,000 treatments having been performed globally, the results achieved with Scarlet SRF provide ideal solutions for the most common aging concerns on all skin types.
Looking at traditional microneedling, the cordless Collagen P.I.N.® from Collagen P.I.N. (Louisville, Ky.) offers a precision dial that controls depths from 0 mm to 3 mm, providing an improved treatment experience. According to the manufacturer, the device offers a 6.2% higher puncture rate with 14% more speed than many other similar devices. “Collagen P.I.N. is my goto device for the treatment of perioral rhytides, scars and striae. No other mechanical microneedling device compares,” said board-certified dermatologist Tina Alster, MD (Washington, D.C.). “Patients have noted marked improvement of perioral rhytides, stretch marks on the body and scars resulting from acne, surgery, or trauma, and are pleased with their quick recovery. This reputation has made Collagen P.I.N. one of the most common procedures in my office.”
Secret™ DUO by Cutera (Brisbane, Calif.) offers dynamic facial revitalization for expanded skin types and little to no downtime. This device combines dual non-ablative fractional technologies: Secret RF microneedling paired with a 1540 nm erbium glass laser, in one platform. Each modality can be used individually or in combination for highly effective non-ablative facial rejuvenation. “We use it for building collagen, to reverse signs of aging, and even to help with remodeling scars,” reported Ashish Bhatia, MD, a board-certified dermatologist in Itasca, Ill. “Both modalities can be used with any skin type at any time of the year, so this device has been a great addition for providing meaningful rejuvenation with minimal downtime.”
Oligio, distributed by AMA Meditime (Brea, Calif.), uses monopolar RF to help patients achieve skin enhancement and lifting. It is an advanced, high-frequency device operating at 6.78 MHz and is designed to target the skin’s dermal layer, promote collagen production, and enhance elasticity in a treatment that is less invasive than RF microneedling and thread lifts. “Patients notice the cheeks are lifted and the jawline appears tighter,” said TJ Tsay, MD, owner of Ageless MD in Tustin, Calif. “There is an immediate effect which we show our clients after performing just one side of the face, and a delayed effect four to six weeks later when collagen is produced. Oligio offers yet another option in our toolbox to lift and tighten the skin with no downtime whatsoever.”
Plasma devices for skin revitalization continue to evolve, but the NeoGen PSR, manufactured by Energist (Swansea, U.K.) and distributed in the U.S. exclusively by Emergent MedTech (Hudson, N.H.), stands alone. Unlike coronal discharge devices, which use electrical current paired with atmospheric gases to form a plasma spark, NeoGen PSR proliferates planar and volumetric collagen and elastin, and restores hyaluronic acid (HA). “Nitrogen Plasma is a source of thermal energy that is highly conductive. The heat released from this plasma has a profound effect on the architecture of the skin,” said Shaun Spanos, NP, and co-owner of Shaun Charles MedSpa (Wakefield, Mass.). “We have treated over 3,200 clients and consider NeoGen’s results to be absolutely unrivaled in the medical aesthetic space,” added co-owner and business manager, Jeff Spanos.
Another plasma device on the market is PlaDuo™ from SHEnB Co., Ltd. (Seoul, Korea). PlaDuo is an instrument used to coagulate tissue using RF energy. “Plasma is currently being used to treat various skin lesions based on the theory of tissue changes caused by nitrogen plasma,” said Sung Bin Cho, MD, PhD from Yosei Seran Dermatology and Laser Clinic in Seoul, Korea. “Low-level nitrogen plasma stimulates tissue changes and regeneration in the epidermis and dermis without excessive thermal coagulation or necrosis and reaches the sebaceous glands through hair follicles to trigger cellular changes. One study showed it can be a very effective treatment for excessive sebum secretion or large pores accompanying acne. Five treatment sessions are recommended for all indications. Most patients see the results quickly after one to five treatment sessions.”
Known for its highly effective PLEXR Shower, PLEXR Plus from MedResults (Glendale, Calif.) is an FDA-cleared medical plasma device approved in over 60 countries. This device allows physicians to offer both ablative and nonablative treatments with a triangle tip to cover a wide spot size, so the entire face can be treated in just five minutes. “I use PLEXR Plus for skin rejuvenation and skin tightening,” said Maryam Hekmat, MD, the founder and medical director of VIP MedSpa Clinic in San Diego, Calif. “I have used PLEXR Plus for shrinking of the large pores on the nose and cheeks and in combination with injectables like fillers to help with volume loss or PDO threads for lifting, with great results.”
Synchronous Ultrasound Parallel Beam, or SUPERB™ Technology, drives Sofwave™ from Sofwave (San Clemente, Calif.), a non-invasive treatment that remodels collagen and improves facial lines and wrinkles. Ultrasound technology is used to create cylindricalshaped thermal zones that penetrate 1.5 mm into the dermis for a full and effective treatment. This device is FDA cleared to lift the brow and neck tissue, lift lax skin under the chin, reduce fine lines, and the appearance of cellulite. “Because people age in a multifactorial way, I need to address it in a multifactorial way,” said board-certified dermatologist Doris Day, MD (New York City, N.Y.). “This device targets lifting without destruction and allows me to layer my other products. We notice a nice lifting effect to the brows – sometimes 2 mm to 3 mm – and the jawline is smoother because of the lifting effect to the lower face.”
EON, manufactured by Dominion Aesthetic Technologies, Inc. (Houston, Texas) and distributed by Monarch Aesthetics (Laguna Hills, Calif.) is a technological benchmark in touchless, robotic laser contouring and FDA cleared for abdominal, flank, thigh and back fat reduction. “Since COVID-19, our demand for body contouring has gone up dramatically, but not every patient wants surgery,” reported Gregory Buford, MD, a board-certified plastic surgeon in Englewood, Colo. “EON is a perfect bridge to body contouring for patients who are either not surgical candidates or not interested in surgery, and it has been a feeder to our surgical practice. There are no consumables, no pain and no risk for paradoxical adipose hyperplasia (PAH). The robotic no-touch arm helps patients feel more secure as it hovers above the treatment area and applies laser energy and jet cooling to the site. Adding EON to our body contouring menu has increased our versatility and capabilities.”
UltraSlim® by Photonica USA (Cocoa Beach, Fla.) represents a breakthrough in noninvasive body contouring and fat reduction. Backed by clinical trials where 98% of patients lost at least two inches2, this FDA-cleared device is safe for all skin types. It utilizes advanced photonic technology that targets and stimulates fat cells, prompting them to release stored fatty acids, resulting in immediate loss without pain, discomfort or downtime. “Non-invasive fat loss and skin tightening are the future of skincare and UltraSlim is the safest, most effective of these modalities that I have seen,” said Sheila Barbarino, MD, an oculoplastic and cosmetic surgeon with practices in Austin, Texas and Redondo Beach, Calif. “My patients have a significant reduction in recovery time from having surgery and procedures like nothing else, which means they come in for more surgery and more procedures.”
The Z Wave by Zimmer MedizinSystems (Irvine, Calif.) is making waves in the aesthetic industry with applications spanning from cellulite reduction to post-procedure recovery enhancement. A Class 1 device, Z Wave is renowned for the temporary
reduction of cellulite appearance and can improve, and even resolve, capsular contracture post-breast enhancement surgery. Powerful sound waves radiate deep into the tissue, stimulating lymphatic drainage and enhancing blood circulation making it an ideal treatment for postliposuction and postcryolipolysis. Rakesh Nanda, MD, medical director of Jiva Med Spa (Columbus and Dayton, Ohio), reported that the device replaces the uncomfortable and sometimes painful postcryolipolysis massage. “With cryolipolysis alone, fat in treated areas can be reduced by 20% to 25%,” Dr. Nanda reported. “But when Z Wave is added, those results are bumped up another 8% to 10%, reducing fat by 28% to 35%.”
1. Energy-based Aesthetic Devices Market Share, Trends - 2032. Global Market Insights Inc. Published June 2023. Accessed September 8, 2023. https://www.gminsights. com/industry-analysis/energy-based-aesthetic-devicesmarket#:~:text=Energy%2Dbased%20Aesthetic%20 Devices%20Market%20size%20was%20valued%20 at%20USD
2. NCT02867150 at Clinical Trials.gov