Meeting Expectation and Demand with Novel Energy-Based TechnologiesMeeting Expectation and Demand with Novel Energy-Based Technologies

Energy-based technology and treatments are core components of aesthetic practices but deciding which to offer can be challenging. Trust is a valuable currency, and a reputation for reliability – of devices and the companies themselves – is invaluable. In this sea of uncertainty, experts agree that one company has earned an “A” in commitment to practitioners and patients alike.

Sinclair North America (New York, N.Y.) has brought together a unified portfolio of nonand minimally invasive technologies with broad appeal to aesthetic practitioners, especially in the modern climate favoring less invasive treatments and more natural-looking outcomes. According to oculoplastic and cosmetic surgeon Sheila Barbarino, MD, founder and medical director of Barbarino Surgical Arts (Austin, Texas, and Redondo Beach, Calif.), “I love being a surgeon but over time, I have embraced non-invasive technologies, as they complement and feed my surgical practice. Patients over the last decade gravitated more and more toward the nonsurgical, less-invasive modalities because they are more effective than ever,” she explained. “They have much less risk with less recovery and downtime while maintaining natural-looking results. Occasionally, patients may not be ready, or good candidates, for surgery.”

Two Key Aesthetic Trends

“We have seen two key trends in aesthetic medicine,” affirmed Anil Rajani, MD, a specialist in minimally invasive aesthetic medicine and aesthetic training, and founder of RajaniMD (Portland, Ore.). “There has been a strong move toward more natural results and a focus on the subtler ‘glow’ of skin. This has affected how we use injectables, for example, so we are using product in different ways, and in conjunction with topicals and superficial therapies. The other has been going on for decades: The desire for results with less risk, downtime and inconvenience, but with the modern twist brought about by social media. In addition to wanting more lateral-looking correction, they are afraid of bad experiences and outcomes. Thanks to social media, five or ten bad experiences can scare away 200,000 people. Sinclair technologies fit these [trends] perfectly because they are minimally invasive, safe and effective. They give beautiful, natural looking results with treatments you can scale to patient needs or desires, or easily use with other therapies. Downtime and recovery are minimal, and risk is exceptionally low.”

“Their full spectrum of devices works well together and with other modalities,” added founder and director of the Cosmetic Dermatology Center in McLean, Va., Nicole Hayre, MD. “For instance, I may use the V-FR handpiece on the V-SERIES for fractional radiofrequency (RF) facial skin treatment but use technologies on the Préime DermaFacial for maintenance. Or I may combine EnerJet pneumatic injection with Préime.”

Needle-Free with EnerJet

EnerJet is almost as exciting for physicians as it is for patients, providing needle-free pneumatic injection capabilities with incredible utility. It is most commonly associated with scar remodeling,^1-2 dermal thickening^3-4 and what is known as the kinetic lift – the strategic implantation of compounds (usually hyaluronic acid, or HA), which will plump local tissue for an additional lifting effect elsewhere.^5-6 Although literature support for the device goes back more than a decade, recent years have seen significant additional focus from researchers. “Non-painful, no downtime regenerative treatments are where all of aesthetics is going,” according to Dr. Barbarino.

“Nobody likes a needle even if they are not needle phobic. We see minimal bruising without significant swelling, downtime or pain. Fear of needles and pain is a true barrier for patients.”

Dermatologist Mark Nestor, MD, PhD, director of the Center for Clinical and Cosmetic Research and the Center for Cosmetic Enhancement (Aventura, Fla.), had the first EnerJet device in the U.S. “We first looked at using its pneumatic technology for injecting triamcinolone to treat scars, which worked well, but we quickly noted the potential for aesthetic application,” he began. “We tried several different products, especially crosslinked hyaluronic acid, with very good results. This opened a whole world of opportunity. We are still using the device after quite a few years, and I expect to continue using it enthusiastically.”

The device, Dr. Nestor explained, uses air pressure to drive compounds into the skin in a specific area sealed off at the tip of the handpiece. “It creates penetration without significantly compromising the dermal barrier. There may be some therapeutic effect from the process of driving the product into the skin, but the most profound result comes from the intradermal and subdermal implantation of product. Settings can be adjusted to account for the viscosity of the product being implanted and target depth.”

“EnerJet is a wonderful technology because it puts patients at ease when you say there is no needle involved. You can almost see the relief wash over their face,” commented Dr. Hayre. “They get excited about the technology.” Dr. Hayre regularly uses the device for kinetic lifting. "We can insert product along the temples and hairline, almost totally hiding what we are doing along hair-bearing areas. My patients walk out looking untreated, but they look lifted. It is a great treatment when someone comes in and says they forgot they have a major social event coming up.”

Dr. Barbarino agreed. “I regularly use it for the face, neck, décolleté and all over the body. It is the perfect treatment coupled with HA for improving skin texture and hydration without injections. As a provider, the best part is that you do not need to numb the patient, and you can treat them quickly with minimal recovery time.”

Currently, Dr. Nestor sees the broadest application of the technology for scars of different types and basic aesthetic treatment of the skin, inserting product to treat fine lines and wrinkles or otherwise improve skin quality, for example. “Outside of the aesthetic possibilities, the treatment of atrophic stretch marks is the most interesting application for me right now because the bottom line is that there are not a lot of great therapies for that, and we have had great results.”

"A woman I saw had a facelift years prior and wound up with disfiguring keloids completely around her ears,” Dr. Hayre shared. “Traditional intralesional corticosteroid injections did nothing. We used EnerJet to insert product and after one session she came in fighting back tears because not only did it look better, but the pain she had been experiencing – which she had not shared with me during the consultation – was almost completely gone. She was just over the moon. We continued her series of treatments and the improvement was substantial.”

Dr. Nestor is also looking at using EnerJet for the insertion of platelet-rich plasma (PRP). “The more diffuse but less invasive insertion of PRP using EnerJet would be highly appropriate for indications such as treating hair loss. We have been using PRP to stimulate hair regrowth so this would be a much better, less painful method compared to injection into the scalp.”

As a needle-free system EnerJet is designed to administer various medicines and vaccines to the body using a high velocity jet of fluid that penetrates the skin. “This requires further study, but the concept is very sound, given the current use of PRP for this application and the capabilities of EnerJet,” stated Dr. Nestor.

Versatile Skin Therapy: Préime

“As someone deeply committed to integrating medical aesthetics into a patient’s overall health and self-care, I am genuinely excited offering Préime DermaFacial treatments at JECT,” stated Gabby Garritano, PA, founder and chief executive officer of JECT (New York, N.Y.), a family of six practices specializing in facial medical aesthetics that emphasizes a minimally invasive, holistic approach. “It complements our approach at JECT, allowing our clients to effortlessly blend cutting-edge skincare into their daily lives while achieving remarkable, visible results.”

Ali Grean, PA-C, a medical aesthetic provider and director of safety and training for JECT (West Hollywood, Calif.), explained that Préime’s five technologies represent a wellrounded skin treatment, known collectively as the Préime DermaFacial. “Skin is a large part of our first impression, it can project our overall health, and its function and quality are vital to our lives. One can seek injectable fillers and neurotoxin regularly, but treating the skin takes that result beyond the next level. We can harness one or all to address the surface with the hydrodermabrasion, microdermabrasion and ultrasound handpieces; the RF handpiece for deeper collagen remodeling; and the microcurrent therapy handpiece for enhancing strength and tone of facial musculature to restore youthful function and support for the face, naturally,” she explained. “It really depends on the patient’s individual needs but that is the beauty of Préime. You have five distinct modalities all serving the same purpose of treating the skin.”

The gentle suction of hydrodermabrasion is coupled with a proprietary four-step product infusion course (Cleanse, Purify, Nourish and Rinse), which is engineered to cleanse and purify, promoting clearer and healthier skin as well as removing dirt, excess oil and impurities.

Microdermabrasion, with its VibroX treatment pods, infuses a proprietary serum (with multiple active ingredients) and exfoliates. “Local blood circulation and oxygenation are also enhanced for maximum skin health,” noted Ms. Grean.

“VibroX integrates vibration and red lightemitting diode (LED) light to improve skin tone and texture,” Dr. Rajani added. “Vibration plus red light has well-known effects and is used all over the world. With the infusion of the serum, we produce what is called the Bohr effect, where CO₂ microbubbles signal to the body that more oxygen is needed, thereby increasing oxygen delivery. We are rapidly learning more and more about how effective oxygenation can be for improving skin.”

Microcurrent therapy uses low-level electrical current to stimulate facial muscles to restore a patient’s natural contours to functionally lift and support facial structure. The RF therapy component specifically penetrates to induce deep collagen production and cell turnover, relying on the well-known thermal effect of non-invasive RF on skin. “The ultrasound handpiece is a surface treatment using sound waves to enhance the permeability of skin to nourish and moisturize,” Ms. Grean remarked, “driving transdermal absorption of the proprietary serum as a final step.”

Patient comfort and satisfaction with results are massively appealing to both patients and practitioners, according to Dr. Barbarino. “It is amazing how Préime provides a thorough facial so comfortably, regardless of which or how many technologies you choose to use. There is nothing else like Préime. It is one of the few things in aesthetics that I am really excited about right now. There are many good facials out there, but they do not stand out like Préime, which can treat from the surface down to the muscle. My master aesthetician, Betty Boyd, has been performing aesthetic facials since 1978, and has used everything. She agrees that this is the best thing she has ever used.”

Préime is not only a powerful and versatile addition to any practice, but it can also be a practice builder, according to Ms. Grean, because it is popular and works well with other therapies. “JECT opened the first clinic in New York City in 2019. Since then, and through the COVID-19 pandemic, the practice has grown to six clinics across the U.S.,” she shared. “In a sense, our practice revolves around injectables, but Préime and its five modalities work incredibly well with virtually every treatment we offer. The patient trust and outcomes we achieve make it easy to educate patients on what Préime has to offer. Its versatility and safety make it good for any patient regardless of skin type, age or ethnicity with minimal adjustments to the treatment protocol in certain situations. We can use one or all five technologies, sometimes on the same day as other treatments depending on the situation. Patients love it and so do we!

“We have approximately 20 PA- and NP-level providers between our six locations (in New York, Florida and California), each of them have to complete JECT Academy, a rigorous training program aimed to maximize their skillset as well as indoctrinate them to our high brand standards and emphasis on safety and efficacy,” Ms. Grean continued. “Our goal is to be accessible so we can marry our innovative patient-based approach with our expertise to exceed the patient’s individual aesthetic and health goals. Préime has been a huge part of that success as a key component to our armamentarium, giving us a versatile and powerful, multifaceted skin therapy we can tailor to the individual patient. Virtually any aesthetic practice would benefit from what Préime DermaFacial has to offer.”

Versatile RF Technology: V-FR

Sinclair’s versatile V-SERIES platforms (V10, V20 and V30) bring tried-and-true frontline technologies together efficiently. Each system is an RF-based multi-technology platform, with V30 being the most advanced overall. The innovative V-FR treatment handpiece brings fractional RF capability and more to all of the V-SERIES platforms. According to Dr. Rajani, who was involved with FDA trials for the V-FR, “First off, RF is colorblind, and that is very important. What we are also talking about here is keeping RF focused properly to avoid unnecessary superficial thermal effect, but also avoid heating subdermal fat in the face because we want to maintain naturally occurring volume.”

The answer, he continued, is SVC technology (which stands for switching, vacuum and cooling). “This enhances safety and patient comfort but allows for the more thorough therapeutic delivery of energy as well,” Dr. Rajani commented. “The ‘switching’ component features what is called the Smart Heat pulse; the target area is given volumetric heating before the fractional pulse. This lowers skin impedance for more selective heating of target tissue by the RF current, while using less energy, so the effect is greater, but discomfort is reduced.” Another aspect of the switching function is the modulation of RF penetration by switching paired fractional electrode rows at differing distances, which controls depth of penetration with three settings: shallow, medium and deep.

Bringing tissue into the treatment tip, the vacuum function ensures effective and consistent coupling with the tissue. This has several key benefits, according to Dr. Rajani. “First, it minimizes the chance of burning due to bad coupling. Second, there is a significant reduction in discomfort because of the vacuum pressure. Lastly, the consistent, stretched nature of tissue presentation to the electrodes ensures symmetric disposition of the fractional RF pattern.

“The cooling function protects the epidermis,” Dr. Rajani continued. “This allows for deeper and more targeted energy delivery because you do not have to be as concerned about superficial transmission of energy. This improves comfort, reduces the recovery period and minimizes the chance of post-treatment adverse events.”

Dr. Hayre uses the V30 platform and was also involved with FDA trials. “It is my go-to for acne scarring with skin types IV-VI. It is also nice for what I might call ‘non-ablative resurfacing,’ using fractional RF to rejuvenate skin texture and tone,” Dr. Hayre remarked. “Like all Sinclair technology, it is quite easy to use, works extremely well and is exceedingly dependable. It is one of the things I love about working with the team. Aesthetic companies in this industry sometimes push too hard to bring something to market when it is not ready or the science behind it has not been adequately explored. I do not see that with Sinclair.”

Sinclair’s partnership mindset and collaborative mentality is also evident in their training program, which includes marketing as well as clinical and practice development. “Their training program is handled by wonderful people who are always a pleasure to deal with,” Dr. Hayre emphasized. “They know the ins and outs of their devices, the science, practice management and marketing so they have great ideas for promoting your capabilities and bringing patients into practices.”

References:

1. Kim BJ, Yoo KH, Kim MN. Successful treatment of depressed scars of the forehead secondary to herpes zoster using subdermal minimal surgery technology. Dermatol Surg. 2009;35:1-2.

2. Vinshtok Y, Cassuto D, Belenky I. Pneumatic delivery of hyaluronan for skin remodeling: a comparative review. J Drugs Dermatol. 2020;19(2):170-175.

3. Levenberg A, Halachmi S, Arad-Cohen A, Ad-El D, Cassuto D, Lapidoth M. Clinical results of skin remodeling using a novel pneumatic technology. Int J Dermatol. 2010;49(12):1432-9.

4. Naranjo Garcia P, Vinshtok Y, Lopez Andrino R, Cohen N. E  cient treatment of upper-lip rhytidosis by pneumatic administration of hyaluronic acid. J Cosmet Laser Ther. 2019;21(6):346-348.

5. Mashiko T, Abo Y, Kuno S, Yoshimura K. A novel facial rejuvenation treatment using pneumatic injection of noncross- linked hyaluronic acid and hypertonic glucose solution. Dermatol Surg. 2015;41(6):755-8.

6. Espinoza L, Vinshtok Y, McCreesh J, Tyson J, McSorley M. Kinetic energy-assisted delivery of hyaluronic acid for skin remodeling in middle and lower face. J Cosmet Dermatol. 2020;19(9):2277-2281.