Sponsored by Aesthetics Biomedical Inc. 
This innovative device, recently awarded the coveted ELLE Future of Beauty Award, brings forward an industry-first ultrasound imaging and photo mapping modality. This enables users to visualize the dermis, epidermis and tissue layers for precise, targeted deposition of radiofrequency (RF) energy while microneedling. Other new features further enhance the basic technology’s capabilities considerably, offering unmatched precision, versatility and treatment personalization.
By marrying these two well-understood technologies, Aesthetics Biomedical has developed a device that is creating an entirely new category for energy-based devices – personalization. And, according to the NewBeauty State of Aesthetics report, 85% of NewBeauty BeautyPass Members stated that they would be more interested in receiving minimally invasive treatments, like Vivace Ultra, with the addition of ultrasound guidance. This will provide a more precise and personalized experience for the patient.*
This device can stand alone or adjunctively take treatment results to the next level, said board-certified plastic surgeon Gregory Buford, MD, medical director of BEAUTY by BUFORD (Lone Tree, Colo.). “Vivace Ultra is about taking existing technologies and getting better results, which is what aesthetic practitioners like myself are committed to every day,” he elaborated. “I have a 100% cosmetic practice where we perform surgery, but also offer less- or non-invasive options, which I think is essential for a well-rounded practice. This was obviously something that I could bring on and market to my patients confidently. Not only would they get great results, but they would also be able to do it comfortably. This gives me the ability to take my surgical results to the next level and also address other areas where patients want results, but they do not necessarily want surgery.
“I do a lot of chemical peels and injectables, but there is a huge gap between those and face or neck surgery,” continued Dr. Buford. “Many patients do not want that or even a CO2 laser, but they are in need of something that provides efficacy and is more aggressive. Tolerability is vitally important because we want patients to come back for their full course of therapy, and if you are doing multiple treatments, it is helpful if they want to come back!”
Vivace RF microneedling is designed to stimulate the natural production of collagen using a minimally invasive RF delivery technique. “The technology associated with this device is cutting edge, providing a virtually pain-free, simple and effective treatment,” said board-certified dermatologist, Marie Hayag, MD, who is the owner and medical director of Fifth Avenue Aesthetics located in New York City, N.Y. The combination of microneedling with RF heat stimulates collagen not only in the superficial layers of the skin, but also deeper in the dermal layers. “This ensures the most comprehensive results. Results are both im[1]mediate and improve over time with multiple treatments, while being safe for all skin types. As part of my own aesthetic skincare routine, I treat myself every month with Vivace.”
Rachel Reyes-Bergano, DO, medical director of Contempo Aesthetics (Pasadena, Calif.), mentioned that “Vivace is not only extremely safe, effective and versatile but it is also exceedingly easy to learn and use. We have multiple providers in our office and the training felt almost seamless.
Aesthetics Biomedical is also exceptional at collecting information from users and giving regular updates about changes in recommended settings for different indications, so the support is excellent. It has been a game changer in our practice, a real workhorse, and almost all patients choose Vivace over other microneedling alternatives and even other treatments. We have a nurse dedicated to Vivace and it is in use throughout the day.
According to Dr. Reyes-Bergano, savvy patients know more about possible side effects today than ever before, but rest assured that Vivace Ultra’s customizability makes these easier to avoid. “With the adjustable settings and ultrasound visualization, we can carefully choose depths to avoid things like post-inflammatory hyperpigmentation (PIH) or unwanted atrophy of facial fat pads. This will allow us to easily alleviate the concerns of patients during that initial consultation.
“The legacy Vivace has been a great starter treatment for patients new to aesthetic medicine, and I think Vivace Ultra will be even more so because it is safe, user-friendly, ‘approachable,’ and less intimidating than other devices may be,” Dr. Reyes-Bergano added.
Jennifer Stieber, NP, founder of SLK Clinic (Nashville, Tenn.) has been using the legacy device for three years. “RF microneedling is the new gold standard for skin rejuvenation, skin tightening and dermal remodeling, but with current technology, clinicians must estimate treatment depth based on a variety of patient factors. Though this has not hurt our ability to get impressive results, the pre-existing RF microneedling devices on the market do not deliver the heat energy optimally,” she noted. “With the new development of ultrasound visualization, we will be able to improve safety because we will be able to better mitigate potential issues like downtime or PIH, plus this allows us to achieve superior outcomes because we will be able to deliver energy at optimal depths. The ultrasound handpiece can also be used to visualize blood vessels; for example, giving users the ability to confirm the path of the angular artery prior to nasolabial fold filler injections.”
Ms. Stieber also expects to see some improvement in total office time for patients, adding, “Vivace Ultra is able to save patient treatment data via the cloud, allowing the practitioner to easily recall patient files to guide subsequent treatment sessions.” She also welcomes additional user friendliness, “The new device offers more speed, which will reduce in-office time for the patient and save overall time from the clinician’s end, which increases throughput and return on investment (ROI).”
Celebrity cosmetic dermatologist Paul Jarrod Frank, MD (New York City, N.Y.), uses Vivace RF microneedling all over the body. “In my two main offices in New York, the machines usually run all day with providers treating different indications, because it is a very versatile device. This popularity has necessitated me to have more than one machine per office.”
The keywords of safety, effectiveness and comfort are joined by a fourth – personalization – and virtually all of the new features move capabilities toward this end. “Ultimately, it is the patient outcome and experience that matters the most, and this new device delivers on those fronts,” Dr. Frank stated. “The Vivace Ultra incorporates more personalization through a variety of modalities and needle set sizes that will deliver excellent results for the body. This, combined with ultrasound visualization and photomapping will allow for me, as an aesthetic practitioner, to account for a variety of factors that affect skin quality and thickness between individuals such as age or anatomical location. The ultrasound visualization allows us ideal accuracy and confidence, delivering further personalized treatments for superior outcomes.
Zoe Diana Draelos, MD, a board-certified dermatologist in High Point, N.C., verified the calibration accuracy of the device’s ultrasound component in a recent clinical trial.** Subjects (n=30) included five healthy representatives from each of the six Fitzpatrick Skin Types (I-VI), with three ultrasound measurements taken on 31 different anatomical locations at baseline and at six weeks. Investigators concluded that the imaging was highly accurate, reproducible and dependable. No adverse events were recorded.
“My favorite aspect of the device is its versatility of settings,” said Dr. Frank. With the new Vivace Ultra, one can choose needle insertion depth between 0.5 mm and 4.0 mm at 0.1 mm steps and power modulation from levels one to ten. One can also adjust pulse width between 100 ms and 1,000 ms at 100 ms increments, and four unique delay speeds to optimize time between pulses. “Most devices currently allow control of depth and power only, and for depth it is something like one-, two-, three- and four-millimeter range. This allows for a true individualized approach during each treatment. When you are dealing with various treatment protocols, you are talking different depths and settings for each, also adjusted for the individual patient.
“Another feature you do not see in competing technologies is adjustable pulse duration,” Dr. Frank continued. “This is a very important aspect because it is not just about how much energy is delivered, but how fast it is delivered over a long period of time. When we talk about lasers this is called pulse ‘width’ or ‘duration’ and these terms are applied generally. For Vivace Ultra this is another very useful adjustable parameter; when you are treating certain indications, for example, you may want to deliver the energy over a long period of time.”
Vivace Ultra also offers both insulated and non-insulated needle sets. “What that does is bring out the artistry in the practitioner by giving us a more extensive set of tools and options for treatment. When we understand the dynamics of RF energy deposition with and without insulation, we can direct the tissue remodeling at different depths differently with broader strokes or more finesse, depending on what we are looking at,” explained Dr. Buford.
“The choice of insulated versus non-insulated needles is valuable because it changes the way the energy diffuses in the tissue, from the surface down to the tip, or just surrounding the uninsulated tip of an insulated needle,” Dr. Frank added. “With that, plus the three different needle sizes, it is easy to see just how far ahead this technology has gone from even the legacy Vivace RF Microneedle device. Combining the adjustability of key treatment parameters, plus the addition of the ultrasound 
visualization, establishes Vivace Ultra as the most advanced microneedling technology, by far.”
“Safety, quality of outcomes, and the treatment experience are part of your branding, and that is super critical,” Dr. Buford noted. “If someone gets a good result across the street, but gets great results and a better experience with me, they are going to stay with our practice and tell their friends. A good experience coupled with great results equals trust and confidence which patients will not stop talking about. That is why we invested in the Vivace brand and look forward to Vivace Ultra.”
The safe use of topicals with microneedling is a longstanding practice, to say the least. Like many practitioners, Ms. Stieber utilizes the newly created microneedle channels to infuse topicals that nourish skin, maximize recovery and optimize results. “We use our own custom infusions but also rely on Vivace’s proprietary peptide serum, which helps to lighten discoloration as well as reduce inflammation and redness, which contributes to lowering downtime,” she said.
“Many of my patients in their late 20s and 30s utilize this technology as a preventative measure to offset the natural age-related loss of collagen and elastin,” Dr. Hayag reported. She also likes to incorporate platelet-rich plasma (PRP). “It is a great way to improve recovery and results. The synergistic 
effect can continue for months after the patient’s RF microneedling treatment.” Aesthetics Biomedical’s unique customized SoME® Skincare, made from autologous PRP, is also perfect to use at home to enhance recovery and provide its own boost to skin.
The various features of Vivace Ultra also help streamline treatment planning, data collection and recordkeeping session-to-session. Joie Tavernise, LE, owner of JTAV Clinical Skincare (New York City, N.Y.) serves a busy professional clientele and relies on Vivace to provide outcomes that help her business thrive in a fast-paced, competitive environment. “The first-to-market ultrasound visualization not only helps us target the right depth of treatment, but we can also record and refer to the photos, our settings, and more. Which, along with the patient photos, help us keep the process moving smoothly and accurately. When a client comes in and we want to schedule treatments, this will allow us to collect all the data and see how their treatment has gone so far. This means that we can take photos and create the best plan with clinical results they are looking for, building on each session from a complete dataset of previous work,” she said.
These kinds of options appeal to those looking for a last-minute treatment before a special event, and nothing beats what Vivace Ultra will bring to the table. “We have rapid treatment, patient comfort, and virtually no downtime,” Ms. Tavernise explained. “Our clients depend on our ability to provide fast, comfortable treatment with little to no downtime and that attracts them as much as the results. It is exactly what they want. The device is so safe and easy to use that with the added visualization, we expect even greater outcomes and may double our ROI from this device. Vivace Ultra will surpass anything we have ever offered.”
Another key new feature, Vivace Ultra’s HIPAA-compliant secure cloud connectivity, is not completely new to the medical realm but will likely soon become the standard in our era of increased need for data privacy and medical records regulation. “This not only respects the privacy of patient data and meets the evolving need to keep data secure,” Ms. Tavernise shared, “it also adds a layer of comfort to our VIP clientele whose concerns for these things are even greater.”
According to Dr. Hayag, the Vivace Ultra is more than a refinement of existing technology, but a giant leap forward in energy-based therapies. “Vivace Ultra is a unique marriage of two important medical technologies that redefines what is possible with RF microneedling and treatment personalization within the space,” she said.
The treatment of the body is the next big thing for this technology, and according to Dr. Buford, Vivace Ultra can do it. “I am excited about the prospect because we have plenty of post-surgical and nonsurgical patients who have laxity but are not good candidates for a tummy tuck, or simply do not want to go there yet. I believe they would benefit greatly from this kind of safety and efficacy, with ultrasound visualization. It could stand alone but I am also eager to try it with other modalities which I think could enhance results enough to justify their adjunctive use in the clinical setting.”
Dr. Frank has exceedingly high hopes for the ubiquity of Vivace Ultra. “When I speak to my residents, I tell them Vivace RF Microneedling is certainly one of three or four must-have devices when you go out to practice for yourself, and Vivace Ultra will exceed that. It treats almost every indication that you would want for the broadest range of cosmetic patients, meaning of all adult ages and colors of skin, and it is a relatively mobile solid-state device that ends up paying off very, very quickly. These are highly important for any practice,” he mentioned.
As practices adopt the technology, Aesthetics Biomedical continues to stand alongside their physician partners. “We really value our partnership with Aesthetics Biomedical, they are the best of the best,” Dr. Hayag said. “With their partnership and marketing support, our brand value has surpassed our competition. We are fortunate to have their whole team supporting us. They want to see us achieve our goals and excel – that is something you just do not get with everyone.”
Vivace Ultra is intended for use in dermatologic and general surgical procedures for electrocoagulation and hemostasis.
References:
* Data on file. NewBeauty State of Aesthetics Powered by Beauty Engin
**Publication pending
