Despite some lingering chaos, 2022 looks like it will be another banner year in aesthetic medicine. For example, plastic surgeon Sachin Shridharani, MD, director of LUXURGERY and associate clinical professor in the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine (New York City, N.Y.) says 2022 started with similar conundrums he faced at the start of 2021. With the COVID-19 omicron variant quickly spreading, his busy practice has been trying to accommodate all the patients who wanted to get their procedures done sooner rather than later. “Ah, the joys of [pandemic] life,” he quipped.
In late December, The Aesthetic Society released its 2022 predictions suggesting the potential for a record-breaking year. The data shows Americans spent $8.7 billion on aesthetic plastic surgery in the first half of 2021, compared to all of 2020, when consumers spent just over $6 billion on aesthetic plastic surgery (plus more than $3 billion in nonsurgical aesthetic procedures). “Demand is stronger than ever and likely won’t let up in the new year,” William P. Adams, Jr., MD, president of The Aesthetic Society said in a press release.
No one could have predicted the explosion of interest in aesthetic medicine happening during a pandemic, said Chicago-based facial plastic surgeon Steven Dayan, MD. “Everyone is a rockstar right now. My practice. My friends’ practices. All the corporations are up,” he stated.
Ironically, the pandemic motivated people who were on the sidelines about having cosmetic procedures to be proactive, Dr. Dayan pointed out.“I think that was the biggest story of 2021,” Dr. Dayan said. “And it is going to continue because now you have the influx of a new generation with little to none of the stigmas of previous generations. The TikTok generation is much more open about showing off that they have had things done.”
A Year of Innovation, Starting with Injectables
The aesthetic industry maintained its research and development practices in 2020 and 2021, despite uncertainties at the pandemic’s start. This research could be available to mainstream practices in 2022, according to Michael Gold, MD, medical director of Gold Skin Care Center and the Tennessee Clinical Research Center in Nashville, Tenn.
Two neurotoxins relabotulinumtoxinA (QM1114, Galderma) and Hugel America’s letibotulinum-toxinA, could shake up the injectables market if they are FDA approved in 2022, Dr. Gold indicated.
RelabotulinumtoxinA is a ready-to-use liquid formulation being investigated for the treatment of glabellar lines and lateral canthal lines. letibotulinumtoxinA, being evaluated in the U.S. to treat glabellar lines, is available in 28 countries and has been the market leader in South Korea, according to a Hugel press release from June 2021.
“LetibotulinumtoxinA has shown good safety and efficacy in trials, and relabotulinumtoxinA is exciting for the convenience of an off-the-shelf option,” Dr. Gold reported. “I am not saying any of these are superior to what we have, but it is nice to have more choices and more opportunities to hopefully expand the market.”
In other neurotoxin news, Revance Aesthetics could get the FDA’s nod this year for its long-acting neuromodulator daxibotulinumtoxinA, according to Dr. Shridharani.
Interest is also growing in the use of botulinum toxins in micro-injections, Dr. Gold added. “We are seeing more development and interest in how we can use micro-toxin injections to improve skin quality, reduce sebum, improve acne and improve scars.”
From the filler perspective, some of the newer hyaluronic acid (HA) fillers that are trying to enter the U.S. market are typically cleared in other countries for specific indications that might be lacking in the U.S. For example, a filler like Juvedérm Volux (Allergan), which is not yet approved in the U.S., has a higher G-prime making it more optimal for use around the jawline, Dr. Shridharani revealed.
Authors of a paper recently published in Plastic and Reconstructive Surgery looked at potential uses of an investigational plant-derived recombinant human collagen, by CollPlant, as a filler and for breast implants.
Among other things, the authors report, “The photocurable dermal filler allows smooth injection of a semiliquid filler with relative low stiffness. When illuminated with visible light, rhCollagen cross-links to enhance collagen stability and filler mechanical properties and resistance to facial deformation. At the same time, the rhCollagen promotes cells infiltration and neovascularization leading to new [extracellular matrix] and collagen deposition, and a long-lasting appearance of rejuvenation.”
Among injection tools, Air-Tite Aesthetics (Virginia Beach, Va.) has recently announced it is expanding their line of Low Dead Space (LDS) hub needles with the U.S. release of the smallest TSK needle to date: THE INViSIBLE NEEDLETM. The LDS design reduces the excess effective hub space to nearly zero, which could result in a potential cost and product savings with each box. A conventional needle hub may retain a sizeable dead space, sacrificing unused product with every injection. With the new TSK LDS hub, the amount of dead space loss is minimized almost entirely. At just 0.2 mm in diameter the new INViSIBLE NEEDLE is 33% thinner than the popular TSK 30G needles, which may provide a more comfortable injection experience, while potentially reducing the risk of bruising for patients.
“I was introduced to the TSK INViSIBLE NEEDLE in Europe several years ago and cannot imagine injecting any neurotoxin or fine line filler without it,” said Heidi Waldorf, MD, of Waldorf Dermatology & Aesthetics in Nanuet, N.Y. “Patients who have been treated in other offices uniformly comment on the difference. It is almost imperceptible and a pleasure to use. My staff, my patients, and I are in love with the TSK INViSIBLE NEEDLE.”
Unwanted Dimples be Gone!
Collagenase clostridium histolyticum-aaes, also known as Qwo® from Endo Pharmaceuticals (Malvern, Pa.) was the first FDA approved drug to treat cellulite on the buttocks. Qwo’s indications could expand in 2022, Dr. Gold implied.
Cellulite is a big and relatively untapped market, according to Dr. Shridharani. “Revelle Aesthetics is coming out with a manual light-guided technology to help mechanically sever the bands and cords of cellulite,” said Dr. Shridharani, who anticipates being among the first practices to begin using the device in 2022.
A non-invasive rapid, high-frequency sound-wave technology called Resonic (developed by Soliton), which received FDA approval to treat cellulite and was acquired by Allergan Aesthetics in 2021 is another treatment option,1 “... it is like acoustic wave technology on steroids that can be safely delivered,” Dr. Gold said. “[Soliton/Allergan] have efficacy data extending out to 52 weeks.”
MedixSysteme (Ruggell, Liechtenstein) is planning to launch its U.LIFT technology for cellulite in the U.S. in 2022.
Fernando Gagliardi, manager of BodyContour in Luxembourg, said he uses the U.LIFT because it combines three therapeutic effects. “The U.LIFT emitter handpiece divides the adipose tissue lobules into separate cells and the fractionated beams break the fat cell’s membrane. Each pulse is rather long at 2.5 seconds, which is a plus for mobilizing the fat tissue,” Mr. Gagliardi said.
The U.LIFT treatment is followed by 20 minutes of ultrasonic mechanical drainage, which stimulates elimination of the fat cells, triglycerides and other waste via the lymphatic system. “What was observed after a sonography study of U.LIFT is the disruption of the ligamentous septum between the adipose cells,” Dr. Gagliardi shared. “This has resulted in skin that is more even, and a decrease in the appearance of orange peel skin/dimpling. [U.LIFT] is painless, [requires] no downtime and within 45 minutes the session is done.”
Today’s patients are more likely to consider surgery for what they think is cellulite, Dr. Shridharani expressed. But in reality, many who come to him have thigh skin laxity, which has driven up demand for thigh-plasty and his mini thigh lift approach.
“I have done more mini thigh lifts in the past six to nine months than I probably have done in three years combined,” he reported.
Ultrasound Device Updates
Ultherapy from Merz Aesthetics (Raleigh, N.C.) has long been the go-to FDA-cleared, non-invasive procedure using ultrasound imaging to lift the neck, chin and brow, as well as improve lines and wrinkles on the upper chest. But Dr. Gold hinted at behind-the-scenes work being done to update the treatment, potentially in 2022.
Now there also is SofwaveTM from Sofwave Medical (Israel), a treatment using Synchronous Ultrasound Parallel Beam Technology that has been FDA cleared for lifting of the eyebrow, submental and neck, and reducing fine lines and wrinkles. “The Sofwave device is pretty useful, well tolerated and works a little faster than the traditional ultrasound that we have had in the past,” Dr. Gold stated.
The new 10THERA “2-line” high intensity focused ultrasound (HIFU) device by Tentech (Seoul, Korea), treats in half the time when compared with a single line HIFU device, according to the company.
“Despite the shortened treatment time, patients were satisfied with the thoroughness,” said Professor EunSoo Park, MD, PhD, of the department of Plastic Surgery at Soonchunhyang University Bucheon Hospital in Korea.
Professor Park (and other clinicians) favors 10THERA for increased skin elasticity, improving wrinkles and line correction, but even he had his doubts at first. “Initially, I had my doubts about a 2-line irradiation method. I questioned the difference between 2-line and 1-line HIFU, but now I’m experiencing high patient satisfaction in terms of effectiveness, procedure speed and pain [level],” he said.
Dr. Dayan gives a thumbs up to the SaltFacial (SaltMED, Merz), a three-in-one device featuring ultrasound, a salt-based debrider and LED light. “It combines all three in a nonsurgical device that can be used by surgeons and extended providers,” he expressed. “It is a good introductory device for resurfacing and rejuvenation.”
Acne Treatment Evolves
Lasers to treat acne might change the treatment landscape in 2022, according to Dr. Gold. “I have a huge acne population, and the Aerolase Neo is a great device. It is a short-pulse 1064 nm.”
In Dr. Gold’s experience, aother effective acne treatment is Advalight's ADVATx, which has 25 FDA-cleared indications without the use of consumables. The device combines 589 nm and 1319 nm wavelengths.
Additionally, companies, including Accure (Boulder, Colo.) and Cutera (Brisbane, Calif.), are developing acne lasers in the 1700 nm range, Dr. Gold noted. “Both are in the final stages of their FDA work, and both devices work by targeting the sebaceous glands,” Dr. Gold explained. “I love the concept as long as they can control any pain that is associated with the device.”
Microneedling Still Trending
Microneedling continues to be a hot topic in aesthetic medicine, according to Dr. Gold. “More advances in the microneedling space are yet to come,” he stated. “We have learned that whether needles are insulated or no- insulated, the science from reputable companies has shown that it is possible to increase the depth of penetration and customize treatments for acne scars, skin tightening and lifting – not only on the face but off the face.”
What is new in microneedling is the potential addition of biostimulators, or exosomes, said Dr. Dayan, who is conducting studies on exosomes and skin rejuvenation.
Exosomes are not ready for prime time yet, but could be an important trend in the increasingly popular practice of regenerative medicine, Dr. Dayan advised.
Exosomes are cell-derived nanoscale vesicles which are capable of communicating with adjacent or distant cells. Exosomes can serve as novel treatment options to repair, regenerate and rejuvenate skin tissue,” according to authors of a recent paper published in Pharmacological Research.2
Fertile Ground for Regenerative and Holistic Treatment Options
In recent years, patients have reduced office visits, diagnostic testing and time spent one-on-one with primary care providers and specialists outside of aesthetic medicine, according to J.D. McCoy, ND, a naturopathic doctor who specializes in aesthetic medicine in Gilbert, Ariz. He says this has carved an opportunity in aesthetic medicine for having conversations with patients about health and wellness.
“In cosmetic medicine, we typically have more time to interact with a patient than their other providers,” he said. “Patients are ‘hungry’ to discuss topics including nutrition supplementation, drug interactions and optimizing immune health. We can use the duration and frequency of time with patients as an opportunity to engage some of these topics and elevate the quality of care we provide.”
If holistic health wasn’t a priority before, COVID-19 has shifted the mindset of many, said Mar Soraparu, partner and chief wellness officer at BIÂN, a private wellness destination in Chicago, Ill., built on a foundation of holistic wellness and social well-being. Services offered include beauty services, such as injectables, as well as nutrition, fitness, mental health services, concierge medical and alternative medicine.
“It seems that the world is craving a more well-rounded, preventative approach to their wellbeing and it would behoove any business to get on board with additional holistic healing practices,” Ms. Soraparu said.
Customized wellness, a focus on prevention and recovery are in demand, according to Ms. Soraparu. “In-depth assessments that take everything into consideration – physical, mental, emotional, social and spiritual. It all contributes to our well-being – regardless of what service [a person is] seeking,” she said. “When you serve clients in a meaningful, customized and deep way, you create clients for life.”
Body Contouring, Skin Tightening in 2022
Cutera, a leading provider of laser, light and other energy-based aesthetic devices, announced the launch of the next generation of truSculpt flex. The new truSculpt flex+ rapid treatment mode takes Cutera’s proprietary Multi-Directional Stimulation (MDS) to the next level – offering the same toning, firming and strengthening results in a fraction of the treatment time.
This muscle-sculpting technology is now enhanced with a 15-minute no-downtime, rapid muscle building mode, with the ability to treat eight areas simultaneously – reportedly the largest treatment area in the body sculpting industry. Practices can now treat more patients in less time. With body sculpting treatments projected to spike in 2022 truSculpt flex+ is set to help meet that demand with fast treatment times and effective results.
In addition, BTL’s Emsculpt Neo and Venus Concept’s Venus Bliss laser have changed body contouring by offering not only fat reduction, but also skin tightening and muscle toning, Dr. Gold stated.
Dr. Dayan is excited about newcomer devices, including Lumenis’s NuEra Tight RF for skin laxity and cellulite. “We are definitely seeing improvement with this device in one or two treatments. It has amazing results and is comfortable for patients,” Dr. Dayan said.
Another potential Lumenis addition to the U.S. market in 2022 is the Legend Pro+, which is already available outside the U.S., according to Dr. Gold. “This device offers muscle tightening on the face.”
ENDYMED (Freehold, N.J.) aims to introduce its device that focuses on tightening skin around the eyes. ENDYEyelift is a nonsurgical eyelift treatment that uses RF technology to safely reduce under-eye bags, smooth and tighten skin, and lift the upper eyelid for a more open eye. The treatment uses 3DEEP RF technology for a volumetric, focused, homogeneous dermal heating in a minimally invasive treatment. ENDYMED’s iFine handpiece is designed to treat hard-to-reach, delicate areas around the eyes, fine lines and wrinkles, with maximum efficacy, according to the company.
“The key thing about ENDYMED’s eyelift treatment protocol is being able to tighten elastotic skin of any color with virtually no downtime or risk. The course of treatment gives undeniable results that lasts years,” said Sach Mohan, MD, MBBS, a cosmetic physician in London, UK.
This year will include more aesthetic treatments that are based on artificial intelligence (AI), Dr. Gold pointed out. “There is a whole field of AI for aesthetics that is being developed, including the use of algorithms and the cloud to enhance care delivery,” he said.
For aesthetic clinicians that worry about how AI might eliminate some of what they do, Dr. Gold argues AI will further enhance what clinicians do.
“AI is driven by us. We are going to be the decision makers for being able to use the data to make better decisions,” Dr. Gold assured. “AI is going to be a big deal, but we have to use it in a way that protects patient information. We have to do it in a very ethical way.”
DEKA (Florence, Italy) is developing its LipoAI, a novel laser-assisted liposuction device that uses AI algorithms. According to the company, the patent-pending system allows special views and feedback controls of the operating ‘ongoing status,’ with no need for physicians to look at the system display.
Another example of AI-driven technology being developed for U.S. dermatology practices is the Barco Demetra, a dermoscopy device, Dr. Gold shared.
“We are working with Barco on an AI platform that is done through a Smartphone with incredible imaging capabilities at the skin’s surface, which goes to the cloud and that gives us information back on that lesion,” Dr. Gold said. “The plan is real time feedback to help make a decision or do a mapping that you can follow over time.”
Dr. Gold and his research team are studying the device’s sensitivity and specificity and should have more data to report in early 2022, he said.
Reaching Potential Clients in 2022
It’s no secret that social media marketing has had monumental influence on aesthetic medicine. “I think a really shrewd, creative, authentic marketer can [do amazing things]. I have a new partner named Benjamin Caughlin, MD, who has over 200,000 TikTok followers,” Dr. Dayan remarked.
The younger generation is drawn in by social media. Dr. Dayan said his partner’s patients are an average age of 27, while he markets on Facebook and Instagram, and his patients are in their mid-40s and older.
Dr. Shridharani recommends that aesthetic clinicians remain true to their culture and cultivate that in their social media messaging. Done right, social media marketing can inspire people who might not realize aesthetic options for their concerns exist. “The power of social media is definitely important,” Dr. Shridharani concluded.
1. Soliton. (2021, May 10). Allergan Aesthetics to Acquire Soliton, Expanding Body Contouring Portfolio [Press release]. https://ir.soliton.com/press-releases/detail/139/ allergan-aesthetics-to-acquire-soliton-expanding-body
2. Xiong, M., Zhang, Q., Hu, W., Zhao, C., Lv, W., Yi, Y., Wang,
Y., Tang, H., Wu, M., & Wu, Y. (2021). The novel mechanisms and applications of exosomes in dermatology and cutaneous medical aesthetics. Pharmacological Research, 166, 105490. https://doi.org/10.1016/j.phrs.2021.105490