The use of lasers, radiofrequency (RF), and light-based technologies in cosmetic procedures has swelled in recent years, as device manufacturers explore the outer limits of safe energy-based approaches and physicians increasingly purchase new, clinically proven devices. Furthermore, people that normally would have avoided aesthetic procedures in the past – usually due to fear of surgery – are now much more open to less invasive non-surgical applications.
To further validate these trends, in 2016 the global market for all energy-based aesthetic device platforms and disposables reached over $1.5 billion (excluding skin tightening and body shaping systems), according to Medical Insight’s (Irvine, Calif.) recently released Energy-Based Aesthetic Devices market study.
As reported by Medical Insight, a major expansion of these types of systems is underway with solid growth in this segment. Over the next few years the total market for energy-based aesthetic devices, including disposables, are expected to expand by 5.8% per year to over $2 billion.
The most popular energy-based procedures, such as hair transplantation and removal, body shaping / skin tightening, facial rejuvenation, cellulite reduction and feminine rejuvenation, have advanced in high-tech sophistication and functionality, and practitioners are fully embracing these newer modalities. Many offer single session, no downtime treatments that don’t necessarily replace surgical results, but satisfy the needs of a growing patient base.
According to Jason Pozner, M.D., F.A.C.S., a plastic surgeon and medical director of Sanctuary Medical Aesthetic Center and Sanctuary Plastic Surgery in Boca Raton, Fla., “Multifunction platforms are also gaining popularity. For instance, we had been using only a portion of one energy-based system for a long time, even though it is capable of several modalities. In the past it was common for practices to utilize one device for this procedure and a different device for another procedure. However, increasingly patients have been asking for holistic, multiple treatments, so it made sense to exploit every capability of our energy-based platform.”
“Combining modalities and consolidating multiple functions in a single system, as well as joining those treatments with other approaches is the wave of the future,” Dr. Pozner continued. “Multiple modality methods are what is taking place in practices today.”
Cutting edge technology improvements and scientific breakthroughs also drive the market, noted Neil Sadick, M.D., a dermatologist and clinical professor of dermatology at Weill Cornell Medical College (New York City, N.Y.). “For instance, a great new technology features a combination of useful picosecond ability with a special red lens that operates at 670 nm, which is very good in treating pigmentation, brownish tattoos and scarring. It also has both nanosecond and picosecond pulses,” he said.
Products that offer multiple tunable wavelengths are emerging, Dr. Sadick noted. For instance, Solta Medical, a division of Valeant Pharmaceuticals North America, is developing a new system based on TRASER (Total Reflection Amplification of Spontaneous Emission Radiation) energy, which is tunable to various wavelengths from below 532 nm to close to infrared, as well as varying pulse widths and changing pulse modes to attain very high fluences.
Other laser-based technologies include the NS-532 Laser System from NewSurg (Hilltown, Pa.), a compact, portable and affordable 532 nm laser that sets a new standard in the evolution of simple, efficient aesthetic treatments. This device can be used for the safe and effective treatment of pigmented and vascular lesions on all skin types.
NeoSkin from Aerolase (Tarrytown, N.Y.) takes skin rejuvenation to a new level via 650 microsecond laser technology. Using a multi-treatment approach with a single device and handpiece, NeoSkin delivers a comfortable, efficacious treatment that addresses a number of indications, including severe and cystic acne, neocollagenesis, spider veins, melasma, tone, texture and more. This system produces consistent results without per-treatment costs or consumables, and can also be safely used on all skin types.
The SP Dynamis™ from Fotona, LLC (Dallas, Texas), joins two complementary laser wavelengths to function as versatile multipurpose systems that can perform a wide-range of applications in aesthetics, surgery and gynecology. Fotona’s Nd:YAG wavelength is effective for reaching the deepest layers of the skin, while the system’s Er:YAG wavelength is ideal for dealing with surface imperfections to reveal visually attractive, long lasting results.
As a “gold standard” skin resurfacing platform, the Phoenix CO2 laser from Rohrer Aesthetics, LLC (Homewood, Ala.), works to remove fine lines and wrinkles on the face, warts, moles and skin tags on the body, as well as resurface hands in under two minutes. Furthermore, the system’s rejuVAnate vaginal treatment addresses conditions like dryness, itching, painful intercourse and urination problems. The laser can also be engaged to resurface and improve the external appearance of the vagina.
Such feminine rejuvenation procedures represent an expanding segment of the energy-based device market, tackling a number of medical and aesthetic needs across a wide-range of age groups, according to the Non-Surgical Feminine Rejuvenation market study that Medical Insight released in April 2017.
Due to high consumer interest, energy-based feminine rejuvenation has the potential to become another channel for introducing new aesthetic patients to additional treatments, the report states. In 2016, for instance, total global sales of feminine rejuvenation products exceeded $100 million and through 2021, sales are estimated to rise by 26% annually.
According to Dr. Sadick, “The technology behind feminine rejuvenation has also been playing an increased role, with multiple RF and laser-based energies that are improving, and good patient response. We’re still looking for a good indication to present to the FDA to obtain approval for these technologies.”
With vaginal rejuvenation devices the problem was that they were basically unproven, scientifically, stated Dr. Pozner. “When the first devices came out many thought they worked well, but there was no clinical evidence. Now the science has caught up and we know these devices are truly worthwhile to post-partum and menopausal women. Home-use devices are next. Even if they are not as effective as energy-based, in-office procedures they are something women can use at home for touch ups.”
Popular feminine rejuvenation platforms include the ULTRA Femme 360™ from BTL Aesthetics (Boston, Mass.), an RF-based system designed specifically to treat the tissue of women’s intimate anatomy. The treatment is safe and effective, as well as comfortable and without downtime, with a best-in-class procedure time lasting only eight minutes (internally). Building on the versatility of the BTL Exilis™ Ultra 360 platform, this emergent application in the field of feminine health provides added value for adopters, including many benefits that positively impact a woman’s physical health and quality of life.
ThermiVa® from Thermi, an Almirall company (Irving, Texas) is a temperature controlled RF-based device for non-surgical feminine rejuvenation treatments. Using ThermiVa’s temperature control capability, physicians can customize the selected therapeutic endpoint for each patient. During the procedure, which is non-invasive, non-ablative, non-hormonal and requires no anesthesia, the ThermiVa handpiece addresses the internal and external anatomical features of the vagina by gently heating tissue so that women can reclaim, restore and revive skin without discomfort or downtime.
Even more so than feminine rejuvenation, the market for energy-based body shaping and skin tightening is becoming quite large, as well. Many practitioners, especially surgeons are attracted to these modalities in order to offer patients less invasive therapies or as an adjunct to surgical interventions.
As part of the body shaping craze, people are looking for solutions that work to solve the problem of cellulite. “The increased demand for cellulite treatments has driven both men and women into clinics,” noted Dr. Sadick. “As products like Cellfina (Merz Aesthetics) and Cellulaze (Cynosure) have entered the market, patients are excited about new technologies that actually work.”
According to Medical Insight’s July 2017, report, Energy-Based Body Shaping & Skin Tightening, North America is the largest single market for body shaping and skin tightening devices, with platform sales of about $405 million in 2016 and annual growth through 2021 anticipated at approximately 11%. During the same time period, rising consumer interest in these procedures is expected to expand by 14.5% per year. Disposable sales are likely to rise by a robust 19.5% per year as procedure volume swells.
Alma Lasers’ (Buffalo Grove, Ill.) vShape Ultra platform system for face and body treatments, features both RF and recently added ultrasound technology, as well as a unique stand-alone photo imaging solution to track patient results. With multiple revenue streams and zero disposables, vShape Ultra represents a robust platform that features JuVaShape technology and provides a total patient lifestyle solution. The JuVaShape treatment includes proprietary Unipolar and Bipolar RF therapies for deep and superficial dermal heating to treat conditions such as cellulite, along with a microablative RF needling module for fractional skin resurfacing.
Thermi’s RF-based platform incorporates various body shaping techniques, including those addressing cellulite. ThermiRF® and Thermi250® offer temperature controlled RF-based systems that are designed to produce outcomes via the application of controlled heat. ThermiRF combines temperature control with advanced real-time temperature monitoring to enable numerous non and minimally-invasive soft tissue treatments. These procedures can be performed in-office and offer natural looking results. Thermi250 is a high-powered, temperature controlled RF-based device emitting at 470 kHz. The platform is designed with a unique feature set to enable versatility. Ranging in size from 20 mm to 100 mm, the electrodes provide precision depth control. Treatments are non-invasive, non-ablative and require no downtime.
“One concept that is gaining traction in practices is the inside-outside approach to these kinds of therapies,” added Dr. Sadick. “Physicians might want to use the Thermi system, which is a targeted internal RF probe, with a modality that works externally, such as the Venus Legacy or any of the non-invasive treatments for tightening skin, reducing cellulite and improving wrinkles. Any of the newest cellulite reduction techniques can also be used synergistically with most other RF-based systems.”
Synergistic therapies are also a hallmark of the latest hair removal and transplantation therapies, reported Dr. Sadick. “For instance, energy-based microneedling devices can work well with platelet-rich plasma (PRP) injections,” he said. “In addition, watch for new technologies in this area that might end up being extra effective in terms of less transection of follicles.”
Currently, the trend in hair transplantation is the growing popularity of the minimally invasive Follicular Unit Extraction (FUE) technique, in which hair grafts are removed one at a time from the donor area. Compared to earlier approaches, FUE is less painful and can result in faster recovery time with little or no scarring. “The era of FUE is here now,” Dr. Pozner reported. “Many people want it and the devices are getting easier to use and are much better than previous versions. The biologics are beginning to take off, as well. For instance, we have combined hair therapies with PRP, which seems to have potential uses in helping grafts take.”
Scientific studies of PRP use in medical aesthetics, particularly for hair restoration procedures, are beginning to show up, as well. As reported by Dr. Sadick, “A major study on PRP expected soon will look at the correlation of platelet counts, efficacy and the concentrate of the molecular simulating cytokines within the platelets.”
PRP is not a new technology but it is a hot area, Dr. Sadick continued. “The question is still, what is the best delivery system? Is it RF-based microneedling or fractional lasers that create random cutaneous channels, or is direct subdermal delivery via a needle the best way? We’re trying to iron out the exact treatment protocols for PRP,” he said.
Additionally, microneedling devices are designed to address more concerns than just hair transplantation. One such product, the INTRAcel fractional RF microneedle (FRM™) manufactured by Jeisys Medical (Seoul, Korea) and available in the U.S. via Perigee Medical (Tracy, Calif.), applies monopolar and bipolar RF-based energy via 49 insulated microneedles to treat acne scarring, wrinkles, various skin irregularities, large pores, general rejuvenation, reduction of stretch marks and collagen stimulation. Offering proprietary real time impedance feedback, INTRAcel allows precise and independent control of RF energy delivery, depths and thermal zones in any layer of the skin. Physicians can fine tune treatments by selecting and combining the ideal energy needed to achieve the best results with the most patient comfort.
The Dermapen3 MD from DermapenWorld (Fort Lauderdale, Fla.) provides vertical microneedling via proprietary Automatic Oscillating Vertical Needling (AOVN™) fractional rejuvenation technology. The device creates up to 1,300 micro channels per second at precise treatment depths from 0.01 mm to 2.5 mm without compromising tissue integrity, while ensuring reduced epidermal damage. DP Dermaceuticals Skincare Protocols complement Dermapen treatments to eliminate downtime and ensure patient comfort for all skin types. In addition, DermapenWorld offers a host of training protocols to successfully treat numerous indications, including facial rejuvenation, antiaging, hair restoration, stretch marks, pigmentation and more.
“We continue to see therapies where providers are meshing biologics with energy-based treatments,” stated Dr. Pozner. “That’s the future direction. Microneedling devices that deliver substances to the skin, such as PRP, have a good place in the practice. They are great for treating acne scars and for skin tightening.”
Gradually, practitioners have been adopting combination therapies to address facial anti-aging, as well, Dr. Sadick added. “This approach employs delivery of serums, growth factors and various biologics using energy-based systems.”
For instance, systems that pneumatically introduce substances to the skin can be used for face-lifting, repairing scars and regenerating skin. “Multiple modality treatments are important when considering the combination approaches to structural rejuvenation,” said Dr. Sadick. “The concept of age prevention is being pioneered as we speak. It includes the concept of using external topicals with internal antioxidants to prevent free radical damage.”
In modern medical aesthetics, there is a big shift towards approaches that emphasize prevention and prophylaxis. Adjunctive products have appeared that also support multiple modality procedures.
For instance, for facial rejuvenation Allumera® from Bellus Medical (Addison, Texas) is a light-activated, professional-grade photodynamic cosmetic cream that can be used as a standalone procedure or in combination with other modalities, in order to minimize the appearance of pores; revitalize skin for a younger looking, clearer complexion; help reduce the appearance of fine lines; and improve skin firmness and overall texture.
For fat reduction and body sculpting procedures, Z Wave Pro from Zimmer MedizinSystems (Irvine, Calif. and Neu-Ulm, Germany) can be used as an adjunct to enable easier, faster recovery and produce quicker, visible results. This no downtime treatment is comfortable and non-invasive and can enhance body contouring results by transmitting powerful sound waves onto and through the skin. Septae and fat cells are positively impacted, significantly enhancing outcomes and recovery when used following body contouring devices. Z Wave Pro treats the abdomen, upper arms, legs and buttocks following the entire range of energy-based technologies, including Cryolipolysis®, lasers, RF and ultrasound.
“This product represents a textbook example of how physicians can develop multiple modality treatments that make sense and work well together,” said Dr. Pozner. “For instance, you can combine CoolSculpting with the Zimmer device to help break up fat more effectively.”
As energy-based systems evolve there are more protocols being used effectively and safely, along with improved ease of use, less downtime and better outcomes, which will continue to bolster both patient expectations and the overall market’s meteoric rise.