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Versatility and consistency drive rise of nonsurgical devices in practice

Article-Versatility and consistency drive rise of nonsurgical devices in practice

Versatility and consistency drive rise of nonsurgical devices in practice

The most successful nonsurgical therapies tend to blend versatility, consistency and, wherever possible, the ability to be performed by medical extenders.


The Discovery Pico by Quanta System (Milan, Italy) offers up to three wavelengths – 1064 nm Nd:YAG, 532 nm and an optional 695 nm Ruby (which operates in Q-switched mode). The laser also provides peak power of 1.8 GW at 1064 nm.

Jordana Herschthal, MD, a dermatologist in Boca Raton, Fla., said she chose the Discovery Pico because it is the fastest and most versatile pico-second laser available. “It is the only picosecond laser that has three wavelengths for both pigment and tattoos.” The laser can also address skin toning and photodamage, and its fractional lens allows semi-ablative treatment of wrinkles and acne scars.

“I wanted a picosecond laser because it is the most effective laser for pigment, period,” she stated. “It is one of the only lasers that has been shown to maintain melasma effectively.”

Operating in trillionths of a second, Discovery Pico uses photoacoustic, rather than photothermal, energy to break up pigment. And, the Ruby wavelength allows the device to handle virtually every tattoo color, according to Dr. Herschthal. “Spot sizes up to 9 mm provide more power and deeper treatment than other picosecond lasers,” she said. Dr. Herschthal added that she also likes the fact that Quanta covers the multiple lasers under a single technology platform and warranty.

PICOCARE by Wontech (Daejeon, South Korea) is a novel picosecond Nd:YAG laser with dual wavelengths of 532 nm and 1064 nm. Due to the unique properties of ultra-short pulses and high peak power, along with the availability of various handpieces including Zoom, Collimation, HEXA MLA (micro-lens array) and Dye (595 nm and 660 nm), this laser enables more effective and safer treatments, in fewer applications than conventional nanosecond lasers for cutaneous lesions. These include benign pigmented disorders, multi- colored tattoos, skin rejuvenation and scars.

With the multiple handpieces and various spot sizes, Le Ngoc Diep, MD, PhD, who is the head of the dermatology and aesthetics departments at University Medical Center in Ho Chi Min City, Vietnam, says the laser allows her to target many indications. “I choose PICOCARE for nonsurgical scar treatment because it allows patients to have little downtime and less pain. The HEXA MLA can be applied to post- operative scars and acne scars without wound complications. It can focus the fractionated beam into the tissue without damaging the skin’s surface and it concentrates much higher power density at the center of each micro- beam than standard handpieces.”

The redesigned Neo Elite by Aerolase (Tarrytown, N.Y.) offers new treatment options to help address common conditions such as acne and melasma, and to provide safe treatment for patients with skin of color. Sumayah Taliaferro, MD, a dermatologist in Atlanta, Ga., needed a device that could be used safely on all skin types and address hyperpigmentation. “It is nice to have a device that is versatile and can treat multiple, different skin problems,” she shared. Along with hyperpigmentation, Dr. Taliaferro uses the Neo Elite for acne and pseudofolliculitis barbae. “I also use it for psoriasis and toenail fungus.”

The Neo Elite creates no downtime and needs no immediate preparation. “Patients don’t have to apply a topical numbing cream beforehand and sit for an hour before their procedure as with other lasers,” she noted. “The laser is so safe that many patients can continue their regular skincare regimen right up to treatment day. If they do have to stop it, they might need to just stop a few days before, rather than a whole week. With the Neo Elite, we don’t have to worry as much about adverse effects from the use of exfoliants beforehand.”

ALLURA by Sciton (Palo Alto, Calif.) is a minimally invasive form of laser liposuction that uses a slender laser probe to liquefy and dislodge fat, easing the fat removal process with smaller suction cannulas. Therefore, it requires a much smaller incision, which leads to a shorter recovery time than traditional liposuction. In addition, ALLURA’s laser energy provides controlled, targeted heating, resulting in skin contraction, a body sculpting benefit that traditional liposuction alone cannot provide. This makes it ideal for targeting small to medium-sized areas with mild to moderate skin laxity.

Assistant clinical professor of plastic surgery at the University of Louisville, Marc J. Salzman, MD, said that his patients are 100% happy when they choose ALLURA over competitors. Many patients with submental fat ask about injectable deoxycholate treatments, “but when I explain to them that they are going to have 40 little shots, they look at me with their eyes wide open,” he said. Patients also reject the swelling and soreness associated with deoxycholate, Dr. Salzman added, and the fact that it takes three months to see final results.

Sculpting treatments

Combining the unique properties of helium plasma with the efficiency of a proprietary RF waveform, Renuvion by Apyx Medical (Clearwater, Fla.) delivers even, controlled energy with exceptional precision. Melinda Lacerna, MD, a plastic surgeon in Bradenton, Fla., chose Renuvion because she was looking for a way to tighten and rejuvenate skin without cutting.

Rather than spending $180,000 for a device that can only tighten one body area, she can use Renuvion to tighten the face, arms, body and abdomen, and for skin resurfacing. In the latter area, the device’s RF-split helium cold plasma capability is impressive, she said. “It is beyond the results of a CO2 laser, which is currently the gold standard for deep facial resurfacing,” she reported.

Even though the Renuvion heats tissues enough to promote new collagen synthesis and cause skin tightening, the helium cools the tissue, so skin does not burn. “You can use it on a facelift skin flap, underneath and on top, safely without burning the skin or causing necrosis.

You don’t get striping like I used to get sometimes with CO2 lasers. It is always ‘wow’ results,” she emphasized.

truSculpt flex by Cutera (Brisbane, Calif.) is an innovative muscle-sculpting device that offers personalized treatments based on patient fitness level, body shape and goals. With Multi-Directional Stimulation (MDS), the device deploys a unique method of electrical muscle stimulation to target specific muscle groups using three treatment mode options to strengthen, tone and firm the abdomen, buttocks and thighs.

truSculpt flex offers a Prep mode for patients who don’t work out regularly, as well as more intense Tone and Sculpt modes. “There are many different options to stimulate the muscle, which constantly keeps the muscle thinking, if you will, to achieve more definition or body contouring,” said facial plastic surgeon Michael D. Somenek (Washington, DC).

Instead of non-targeted electromagnetic energy, truSculpt flex uses 16 very specifically placed handpieces to deliver energy directly to targeted muscles, he explained. Considering the number of areas the device can treat, plus the ability to delegate the procedure to an ancillary staff member, its return on investment ranks among the highest for all his devices. “truSculpt flex is a very successful device for delivering muscle sculpting or body sculpting in a very consistent manner.”

The EMSCULPT by BTL (Boston, Mass.) helps women and men build muscle and sculpt their arms, abs and legs. Additionally, the device offers the first non-invasive buttock toning procedure. This is made possible by the non-invasive HIFEM procedure, which induces powerful muscle contractions not achievable through voluntary contractions.

“With so many body shaping technologies becoming available it is sometimes hard to decide which treatment to go with, and which treatments actually work,” said Dandy Engelman, MD, a Manhattan-based dermatologist and Mohs surgeon.

However, EMSCULPT is the first and only non-invasive body shaping procedure to address both muscle and fat, she pointed out. “It goes beyond waistline reduction and elimination of fat cells to strengthen muscles as well.” In one 30-minute session, EMSCULPT induces approximately 20,000 supra-maximal muscle contractions, which is equivalent to 20,000 sit-ups.

In addition to muscle toning, BTL offers EMTONE, which simultaneously applies thermal (RF) and mechanical (targeted pressure) energy to treat all major contributors of cellulite. “This revolutionary combination allows the treatment to address all major contributing factors to cellulite, making it the first and only effective solution for cellulite with no down- time,” Dr. Engelman stated. Additionally,EMTONE has no body-mass index, body type or skin color restrictions.

The ZWavePro, and the new ZWaveQ, by Zimmer MedizinSystems (Irvine, Calif.) transmit powerful sound waves into tissues. The energy then spreads out radially. The body responds with enhanced metabolic activity in the form of lymphatic drainage and increased blood flow, said Zimmer. Results include improvement in the appearance of cellulite and, for other body contouring procedures, improved results with easier recovery.

For the past seven years, Gordon H. Sasaki, MD, a plastic surgeon in Pasadena, Calif., has been using the radial pulse wave technology, both as a standalone and as an adjunctive procedure, in all aspects of his practice – not only the skincare area, but also the device area, injectables and the surgical area,” he indicated.

Dr. Sasaki most frequently uses the Zimmer devices after cryolipolysis to speed up the treatment response. “It results in a large number of patients returning for additional treatments. It is not the kind of treatment where they say, ‘It was so bad I don’t want to come back,’” he shared. Moreover, this non- invasive treatment can be delegated to RNs, medical assistants or surgical technicians.


After excelling in more than 90 validation studies to ensure safety for both the patient and provider, SkinPen by Bellus Medical (Dallas, Texas) helps leading physician-directed providers grow their businesses by setting the standard for profitability, efficacy and safety. The procedures are short, comfortable, minimally invasive, work for all skin types and require little to no downtime. As a result, 90% of subjects in a clinical trial said they would recommend SkinPen treatments to friends and family.

Suneel Chilukuri, MD, a Houston-based cosmetic and dermatologic surgeon, is impressed that Bellus was the first microneedling manufacturer that took the trouble to procure FDA clearance for its device. “I want to make sure we stay within the lines of what we’re supposed to be doing. To be able to get that approval and make sure it is safe for the public is a pretty rigorous process,” Dr. Chilukuri said. “We can use it on any type of scarring anywhere on the body, most commonly on the face and neck. Those are home runs.”

Dr. Chilukuri’s additional applications include long-term and post-surgical scars, anti-aging treatments, hair growth (without PRP) and drug delivery. “The device’s entry cost is so low, I literally recommend it to everybody,” he added.

Vivace by Aesthetics Biomedical (Phoenix, Ariz.) stimulates the natural production of collagen and is shown to be effective in alleviating facial wrinkles and fine lines, as well as tightening and toning the face, neck, hands and body. Results appear immediately and improve over time.

According to Michael DeWolfe, MD, a Chicago-based plastic and reconstructive surgeon, “Aesthetics Biomedical has figured out the best way to deliver radiofrequency (RF) treatment. Vivace is a needling procedure that penetrates skin. It creates channels, to not only stimulate collagen production, but also allow introduction of healthy products into the skin. The benefit of Vivace is that it is heat- derived, along with the mechanical injury, so you basically get collagen stimulation on steroids.”

Vivace avoids laser-associated down- time because the needles bypass the skin to create deeper heat. “With 31 settings based on needle depth, light sources and other parameters, Vivace allows tailored treatment for everything from anti-aging to acne and scars,” he added.

Topical skincare

Aesthetics Biomedical also offers SoME+ PRP, a personalized topical platelet-rich plasma skincare product line for take-home use. “It is the most natural thing you could possibly put on your skin because it comes from you,” Dr. DeWolfe expressed.

DefenAge by Progenitor Biologics, LLC, (Carlsbad, Calif.) is a potential alternative therapy or adjunct to other therapies that treat the inflammation associated with acne and scar formation. According to the company, patients were enrolled in a manufacturer-conducted split-face study with a vehicle control, and results have been very impressive. The firm says it is only about one-third of the way through, but so far rapid resolution of acne or reduced severity of breakouts has been observed, especially in patients with chronic acne. The company is very excited about these outcomes, because for those patients, there is a serious quality-of-life issue, and DefenAge seems to provide relief.

The DefenAge Clinical Power Trio kit includes 24/7 Barrier Balance Cream, 8-in-1 BioSerum, and 2-Minute Reveal mask. The three-step regimen keeps it simple. “It doesn’t replace anything that a patient is already using – it just enhances whatever they are already using,” said facial plastic and reconstructive surgeon Gregory Chernoff, MD.

“It is rare in our practices that something new comes along that truly makes a big difference,” Dr. Chernoff continued. “I have offices in Indianapolis and Santa Rosa, Calif., and in both places, I have trouble keeping DefenAge on the shelf.”

Threads / suspension sutures

Rejuvn8 Aesthetics (Liverpool, N.Y.) is the trusted provider of hundreds of medical aesthetic practices utilizing its proprietary FDA-cleared polydioxanone (PDO) threads. As the sole supplier of Rejuvn8 PDO threads (K190245), Rejuvn8 Aesthetics can help physicians grow their practices with training and device support. According to the company, the training courses are customized to the needs of your individual practice and guaranteed to ensure you are getting the best possible results with your thread services.

For Dina BenDavid, DNP, MS, FNP-C, owner of Divine Med Spa on Martha’s Vineyard, the level of training provided by Rejuvn8 Aesthetics, which included intensive hands-on training at her practice, is unparalleled.

Dr. BenDavid switched to Rejuvn8 three-and-a-half years ago after trying several other threads that were not providing the lift that she and her patients expected. Unlike fillers, Rejuvn8 threads address both textural changes and volume loss, she said. After Dr. BenDavid places threads to boost tissue structure and support, more than 50% of patients don’t even need filler.

In addition, “The profit margin associated with PDO threads is anywhere from 400% to 1000% higher than it is for fillers, depending on the type of threads used and how the provider prices it out,” Dr. BenDavid added.

Facial injectables

Introduced in 2017, Restylane Refyne and Restylane Defyne from Galderma (Fort Worth, Texas), are FDA-approved to smooth smile lines and laugh lines. They are the only fillers designed with Galderma’s unique manufacturing process, XpresHAn Technology, which creates a smooth, injectable gel that can give the skin a natural, soft look and is proven to maintain natural movement in the lower face.

“What is unique about Restylane Refyne and Restylane Defyne is the expression technology,” said Charles M. Boyd, MD, MBA, a facial plastic and reconstructive surgeon in Birmingham, Mich. “In layman’s terms, that just means it is more flexible than some of the other hyaluronic acids.”

Stiffness or viscosity is important for lifting areas such as the cheek, “but that is not what patients want around the mouth because you want it to look very natural and move like our mouth – including the lips and smile lines – normally does.” After treatment, patients’ expressions look normal, particularly on video, he expressed.

Both Restylane Refyne and Restylane Defyne have been used outside the U.S. under the name Emervel since 2011, so safety and efficacy are well- established with more than one million treatments worldwide. Results are clinically proven to last up to 12 months.

What is the most successful nonsurgical therapy in your surgical practice?

Erez Dayan, MD

“Between young patients who are good candidates for facial injectables and older patients who require excisional procedures lies a large gap from the late 30s to early 50s. In this group we’ve more recently had success with minimally invasive and non-invasive devices. In particular, I use a lot of InMode RF-based devices for tightening and resurfacing, as a stand-alone or in combination.”


“Patients come in desiring results with the least amount of downtime. RF is the best way to tighten skin without surgical incisions. It is not equivalent to a facelift, but results are 30% as good, without scars and downtime.”

Regina Fearmonti, MD

Renuva, the off-the-shelf adipose alternative to autologous fat. It stimulates adipogenesis vs. collagenesis, and serves as a scaffold for adipocyte deposition. I use it in the dorsal hand, midface and temporal fossa to replenish volume. It can also correct liposuction irregularities and partial breast defects.


Renuva offers the most fulfilling and unique uses. There is nothing else like it. Results are instant and continue to evolve over the first few months following injection with the onset of adipogenesis. I have not had to retreat areas that have been fully corrected and I have noted patients often return for more in different sites, as satisfaction has been high.

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