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Contemporary cosmetic surgeons need one eye on trends

Article-Contemporary cosmetic surgeons need one eye on trends

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  • Today's top technology trends capitalize on patient and physician demands. Among those demands are devices that continue to offer less invasive approaches and shorter downtimes, but do not fall as short as previous technologies on outcomes.

Today's top technology trends capitalize on patient and physician demands. Among those demands are devices that continue to offer less invasive approaches and shorter downtimes, but do not fall as short as previous technologies on outcomes.


Fractional resurfacing technology won big popularity points for resulting in less downtime than traditional ablative procedures, but its outcomes — especially for patients with more severe skin damage or acne scarring — were often less than desirable. "The [resurfacing] devices did not actually make real holes, so to speak, or create vacuums, where the tissue was removed by the device. Nowadays, we are seeing with fractional CO2 and fractional erbium ... the ability to create ... defects where the tissue is actually removed," says Brian Biesman, M.D., an oculoplastic surgeon in Nashville, Tenn., and president of American Society for Laser Medicine and Surgery (ASLMS). "This creates a different kind of wound and can stimulate a wound healing process that can produce very impressive outcomes from both the tightening and wrinkle-reduction standpoints and improvement in color. I call it fractional ablative versus fractional coagulative."

The Reliant company, now Thermage, is among the leaders in the technology and has secured FDA approval for its Fraxel re:pair laser system. Doctors say most laser companies are following suit with fractional ablative options.

"We are at the point where we have demonstrated that there is a real and viable role for fractional ablative devices especially in patients with more advanced photoaging or acne scarring, who are interested in significant improvement with fewer treatments than would be associated with traditional coagulative devices and who are also willing to accept a bit more recovery time in exchange for that improvement," Dr. Biesman says.

The fractional ablative trend means years of mediocre results from fractional resurfacing might be coming to an end, says Vito C. Quatela, M.D., clinical associate professor in the Department of Otolaryngology, Division of Facial Plastic Surgery, at University of Rochester, NY, and president, American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

"Every time we have deviated from CO2 to another machine in the last five years, it just did not have the horse power. ... patients were left wishing for more. For the first time, we are going to have a series of machines that are going to be capable of doing more and with the fractionation, hopefully with a quicker recovery time," Dr. Quatela says.


The future looks bright for noninvasive body contouring technology, though the FDA has yet to approve the newest device concepts.

Zeltiq Aesthetics, with its patented method called Cryolipolysis (the use of precisely controlled cooling to remove fat), is a leader in noninvasive body contouring. The company presented the technology in 2008 at the ASLMS annual meeting, according to Dr. Biesman.

Yet another noninvasive fat removal approach involves the use of high-intensity focused ultrasound (HIFU), according to Dr. Biesman.

"There are several companies working on a high-intensity focused ultrasound approach. This is a transcutaneous treatment of fat or lipolysis. One of the leading companies in this area is know as Liposonix, which was just purchased by Medicis," Dr. Biesman tells CST .

Ultrashape is yet another company with ultrasound technology for localized fat removal, according to Neil S. Sadick, M.D., clinical professor of dermatology, Weill Medical College of Cornell University, New York City. Dr. Sadick heads the Advances in New Technology and New Devices Task Force for the American Academy of Cosmetic Surgery.

Dr. Biesman says that while the noninvasive fat dissolving-type technologies are exciting, he predicts that none are yet a threat to traditional liposuction.

"These are really for focal treatment of areas of fat. Those patients who are obese or have large amounts of fat are probably not going to be candidates for these noninvasive treatments," he says.

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