One of the most exciting things about greeting the New Year is the anticipation of what’s next for the aesthetic industry. Therefore, we asked several aesthetic doctors to offer their perspective on trends that could impact aesthetic physicians and their patients in 2019. Here’s what each had to say:
Mary Lynn Moran, M.D., president-elect of the American Academy of Facial, Plastic and Reconstructive Surgery (AAFPRS)
Social Influencers Rally
“Increasingly decisions about appearance, cosmetic procedures and skincare, etc., are being affected by social media influencers,” according to Dr. Moran.
While the Hiltons and Kardashians are among the original social media influencers, just about anybody who has a significant following on Instagram, Facebook or other social media platforms can influence. Those with a large following are sometimes getting paid to promote anything from what kind of grapes they eat to what filler they’re using, Dr. Moran says.
“Everything is documented and sometimes monetized,” she says.
Some aesthetic physicians are positioning themselves as social influencers, by posting procedures, results and even personal pictures. They’re also partnering with influencers and sometimes offering treatments in exchange for the influencers’ social media exposure. Influencers don’t always disclose if they’re getting what they promote for free or at a reduced rate. The information is being presented in a very compelling and relatable way but patients aren't always in a position to determine the accuracy or bias of the information presented.
On the positive side, by posting procedures and promoting cosmetic procedures, social influencers are reducing fear associated with cosmetic treatments.
“It’s making treatments seem more accessible and normalizing it. On the one hand, it’s good because people are being educated — albeit in a way that’s sponsored in some cases,” she says. “I would say that’s probably lowering the threshold for younger people — as well as for men — to have procedures done.”
Dr. Moran says she believes the trend will continue to grow.
Dr. Moran says the surgical lip lift is getting new life among aesthetic patients.
“People are becoming a little disenchanted with fillers, and they don’t always work the way you want them to,” she says.
The desire for a more permanent solution is propelling the popularity of the outpatient surgical lip lift, according to Dr. Moran.
And thread lifting, which came and went a few decades ago, is back because the technology is more refined, she says.
New Take on Injectables
“There are definitely going to be some longer lasting neurotoxins,” Dr. Moran says.
RT002 (daxibotulinumtoxinA, Revance Therapeutics) is among today’s pipeline neurotoxins. Revance plans to file a Biologics License Application the first half of 2019, according to a public relations person representing the company.
"There will be some new hyaluronic acid fillers," she adds. "They’re all just variations on the same theme but I think they will continue to improve.”
Dr. Moran says micro doses of both fillers and neurotoxins are trending.
“Some practitioners are diluting neurotoxins or hyaluronic acid and then putting it in a little stamper device and injecting it. That’s supposed to help with pores and fine wrinkles. There’s also a technique where you inject smaller amounts throughout the skin using a needle,” she says. “Smaller amounts of injectables early on and on a more regular basis is becoming more of a trend.”
Alexander W. Sobel, D.O., president of the American Board of Cosmetic Surgery
Safety in 2019
Safety will be the mantra in 2019, fueled by international news coverage of the dangers of fat grafting of the buttocks.
“The industry is really trying to wrap its head around the best way to afford patients those kinds of outcomes but with a safety profile that’s more reasonable for elective cosmetic surgery,” Dr. Sobel says.
To a lesser degree, discussions about safety will also arise from the rare but headline-making cases of anaplastic large cell lymphoma associated with breast implants, he says.
The ripple effect could reduce demand for the Brazilian butt lift and even breast augmentation, but Dr. Sobel admits patient demand for these procedures seems unflappable. He thinks the spotlight on safety might help educate the public about potential dangers of going to inexperienced or unqualified providers for cosmetic treatments.
“I hope the fallout is something very positive where the public and physicians have very open discussions about facility accreditation and the sorts of environments of care in which these procedures are taking place,” he says.
Biologically Active Fillers
Today’s burgeoning array of synthetic fillers have their places in facial rejuvenation. What they don’t do well is biologically improve skin or tissue for long-term results. That’s where biologic products come in, and 2019 could be the year those injectables become available, Dr. Sobel says.
“The inflammation that’s created by fillers does help, but you’re not really donating stem cells or any other biologically competent body products that can help in the long-term from an antiaging standpoint,” he says. “Allergan has gotten interested in fat grafting recently but has been very quiet about it. My hope is that we’ll start seeing more conversation about the role of biologically active fillers, particularly fat grafts to the face, platelet rich plasma, a variety of other human derived products that could be tremendously helpful in the antiaging armamentarium.”
Hair Restoration Revival
Dr. Sobel thinks demand for hair restoration will increase like a tidal wave over the next few years.
“Devices like the NeoGraft and others are making hair transplantation much more economical and effective, with a lower side effects profile. If you do all three of those things simultaneously, you can’t help but have a big uptick in the volume of patients treated,” he says.
Less Laser Risk
There’s always something new in the laser and light device market, but the industry has yet to get a real handle on pigmentary disorders and understanding how laser and light therapy can exacerbate them, according to Dr. Sobel.
“I’d like to see more safety,” he says. “Laser light is sexy. It’s what patients want.”
Dr. Sobel says the solution is a treatment paradigm in which physicians use the devices more sensibly by educating patients about the risk of hyperpigmentation from treatment and putting patients who are at risk on topical skin medications, like hydroquinone, to reduce that risk and enhance results.
Joel Schlessinger, M.D., a dermatologist and cosmetic surgeon practicing in Omaha, Neb.
Competition and Value for the Core Injector
With the likely addition of one or two new neurotoxins, there will be more competition in an already crowded provider marketplace, according to Dr. Schlessinger.
“This will provide more options for dermatologists and cosmetic surgeons to provide for their patients. And it will further cement the importance of relationships between companies and dermatologists and cosmetic surgeons,” he says.
Dr. Schlessinger says increasing outreach to “non-qualified practitioners” to get sales is putting significant strain on physicians’ relationships with these companies.
“You see many people who are touted as adequate or approved injectors and this alone could be a reason to switch to a new company that might provide a better value for the core injector (dermatologist, plastic surgeon, oculoplastic and facial plastic),” Dr. Schlessinger says.
Cellulite Options Go Mainstream
Dr. Schlessinger says Cellfina (Ulthera) is his number one pick for treating cellulite.
"But I still feel the public has no clue that cellulite is essentially a problem that is treatable,” he says. “Clearly there are areas where Cellfina can’t be used — the banana roll area and more severe cases of cellulite — but it truly is something that has made a huge difference in many people’s lives and has long-term if not extraordinarily long-term results.”
Dr. Schlessinger says he thinks new cellulite treatments in 2019 could help push these options to the mainstream.
At-Home Device Demand
Dr. Schlessinger says the DermaFlash 2.0 (DDK DRTV), which is the next generation of the popular DermaFlash at-home device that exfoliates and gets rid of peach fuzz, should be a big seller in 2019.
Soon, the company plans to introduce a similar technology using radiofrequency for medical practices, which can be used alone or in conjunction with the at-home DermaFlash 2.0, according to Dr. Schlessinger.
He’s also excited about the new at-home NuBody device (NuFace). It’s an FDA-cleared microcurrent device that helps tone and firm body skin. NuBody has a potential effect on the appearance of cellulite, according to Dr. Schlessinger.
“These devices seem to capture the public’s imagination,” he says.
Philip R. Langsdon, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
The public’s increasing reliance on social media images continues to create illusions about what can actually be achieved. And they often turn to nonsurgical options to when, in certain cases, that may not be the right choice, Dr. Langsdon says.
"With that trend, there are more people who undergo nonsurgical treatments and only later discover that fillers cannot actually provide the same results that can be obtained with a facelift. You can’t lift sagging tissue by using fillers or various machines,” Dr. Langsdon says. “So, the public is becoming more aware. For instance, they’re beginning to understand that if you have sagging tissue, you’re going to have to have surgery. If your face is deflating, you’re going to need some volume from somewhere, whether it comes from off-the-shelf fillers or fat. And they’re learning that the wrinkles aren’t going to go away with any of these treatments, you’re going to need some sort of resurfacing procedure, such as a laser or chemical peel. To make it even more complicated, there are various kinds of lasers and peels that provide different results.”
Young Patient Expectations
There is increasing demand among younger patients for light chemical peels, laser and light treatments and filler and neuromodulator injections. More young patients, according to Dr. Langsdon, also are coming in for surgical rhinoplasty. Aesthetic surgeons should be sure to set realistic expectations because many young rhinoplasty patients have unrealistic expectations.
Patient Review Concerns
"I think there is a growing concern among providers about patient responses and ratings,” says Dr. Langsdon.
While he says that he doesn’t know how the problem might resolve in 2019 and beyond, Dr. Langsdon says there are no safeguards that help to ensure the reviews are credible and reflect reality. And they can unfairly tarnish doctors’ reputations.