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A year in review: Taking a look back at 2019 and a look forward to 2020

A year in review: Taking a look back at 2019 and a look forward to 2020

2019 was an exciting year for body sculpting, a time focused on selfies and social media and a year of cosmetic self-reflection, driven by the controversy around buttock augmentation and the breast implant recall. 

So, what will 2020 bring? We asked aesthetic physicians and surgeons to share their thoughts on this past year’s highlights and what’s to come. Here’s what they had to say.

Social media frenzy

Social media continues to drive change in the aesthetic industry and will into 2020, according to plastic surgeon Christian Subbio, MD, of Subbio Plastic Surgery in Philadelphia. 

Dr. Subbio, who has been honing his use of social media for years, says there are two things that fuel social media’s success for providers and patients, alike: authenticity and distinction.

“Authenticity is a highly valued commodity on social media these days. It is about being honest, having integrity and being yourself because even though it is social media, patients get to know you. They get to know your personality,” he said.

Distinguishing yourself from the rest of the pack is becoming more difficult, Dr. Subbio added.

“With more physicians, nurses and physician assistants on social media, it is harder for patients to pick out someone that really resonates with them,” he noted.

“Distinguish yourself from your competitors by showcasing a different skill set, showcase a technology or something that makes you different from everyone else to keep you front and center in patients’ minds.”

Dr. Subbio is looking forward to continuing to learn about social media and new platforms, including how the TikTok platform progresses in 2020. 

Muscle stimulating devices 

Muscle stimulating devices continue to break the mold. EMSCULPT from BTL (Boston, Mass.), transformed the body sculpting game in 2019, and Sachin M. Shridharani, MD, a Manhattan-based plastic surgeon, is excited to see what similar emerging technologies will offer in 2020. 

Technologies to improve overall stimulation of skeletal muscle – specifically, CoolTone from Allergan (Irvine, Calif.) and EMSCULPT – have revolutionized Dr. Shridharani’s body contouring practice. However, he has learned that while these devices are in high demand, picking the right candidate and considering combination approaches are paramount to the success of treatment. 

Muscle stimulating devices can be winning treatments for patients that need a functional boost, according to Dr. Shridharani. “Patients who may not be the best cosmetic candidates for EMSCULPT or CoolTone because they have subcutaneous fat over the muscle will get a functional benefit,” he said. “Patients who I’ve treated will come in and say, ‘I may not be seeing as much definition as I’d like because I have a little bit of fat there, but I feel so much stronger – my core, my back. I don’t feel as tired.’”

Thin patients that don’t have much muscle tone or definition, but want it, are great candidates for the muscle stimulating treatment, Dr. Shridharani added.

Combination treatment is often ideal for cosmetic patients who are aesthetic perfectionists and are focused on minimal fat and a sculpted look. Dr. Shridharani may use off-label Kybella (Allergan) to melt away the fat over a portion of the abdomen, followed by CoolTone to improve muscle quality and get a better outcome. “I’m also using CoolTone after liposuction,” he said.

Heidi A. Waldorf, MD, a dermatologist in Nanuet, N.Y., said she uses EMSCULPT to boost the buttocks, flatten the abdomen and sculpt the upper arms. “This is a therapy that we didn’t have. We could reduce fat and improve skin tone, but there are times when only the muscle can make a difference. It is like we can now build in shapewear without surgery,” she said. 

The coming year will allow providers to hone use of these devices, including how many treatments are optimal, as well as the ideal length of intervals between treatments. 

“We always have the clinical trial data, but how we do it in our own practices is usually what leads to the best outcomes, so, I’m looking forward to experimenting further,” Dr. Shridharani said. 

Radiofrequency in the mainstream

Radiofrequency (RF) technologies are becoming standard tools in the skin rejuvenation armamentarium, according to Las Vegas-based cosmetic surgeon Edward M. Zimmerman, MD.

“We are applying non-invasive RF nose to toes – unipolar and bipolar devices for non-invasive skin and tissue tightening; slightly invasive RF microneedling for skin tightening, texture and scars; and minimally invasive subdermal RF and RF helium plasma for more profound tissue tightening,” said Dr. Zimmerman who will soon be part of an FDA-approved trial using RF helium plasma (J-Plasma from Apyx Medical) for skin resurfacing.

Dr. Zimmerman predicts invasive and non-invasive RF technologies will become more recognized in 2020 for their ability to tighten and rejuvenate skin.

“The nice thing about these devices is they are colorblind. You (or the patient) don’t have to wear eye protection. And, they can do marvelous things to all skin types in terms of tightening tissue,” he said. 

Providers are also learning new combination approaches with time, including combining RF with topical platelet-rich plasma (PRP) immediately after treatment to improve outcomes, according to Dr. Zimmerman.

Safety concerns

Safety concerns about breast implants and the Brazilian Butt Lift (BBL) procedure will continue to snowball in 2020, according to Tim Sayed, MD, a La Jolla and Newport Beach, Calif.-based plastic surgeon.

Issues around implant safety have been fueled by the FDA’s recommendation for Allergan to recall its textured breast implant devices, which use a texturing technology called Biocell that has been associated with a rare form of lymphoma cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in a small number of patients worldwide, according to Dr. Sayed.

Allergan has since recalled the implants. 

“Now we’re seeing patients who have no symptoms of any concern who are concerned that they might develop this rare form of cancer and they would like to have their implants removed. We are also seeing patients presenting with clusters of various constitutional symptoms that are being termed for the lack of a better medical name breast implant illness,” he said

According to Dr. Sayed, providers are trying to find a balance between respecting and honoring patients’ concerns, without adding to unnecessary panic around implants, in general. 

“We have to be careful when we see these patients not to promise improvement in any symptoms and to help them understand that there are likely to be significant aesthetic compromises, considerations and tradeoffs that they have to be willing to accept if they make the decision that they want to live without implants,” Dr. Sayed said. 

Years into the scrutiny of the BBL procedure, Dr. Sayed said controversy about whether aesthetic providers should offer BBL will continue into 2020. 

As would be expected, plastic surgeon groups have developed BBL guidelines to help providers avoid serious complications and death. 

“The most important recommendation being to avoid injection into the gluteal muscles when doing the fat transfer,” Dr. Sayed said. “Florida just passed a statute that has actually banned the injection of fat under the muscle fascia in the gluteal region. I think in 2020 there is probably going to be additional legislative action taken that may reduce enthusiasm of some surgeons to do the operation. Despite this, the demand, I think, is increasing.”

Off-face rejuvenation

2019 has been about rejuvenation off the face, Dr. Waldorf reported. “The very treatments that aesthetic physicians have long used to rejuvenate the face are now becoming in-demand body treatments. 

“We’ve used Sculptra (injectable poly-L-lactic acid) from Galderma and Radiesse (calcium hydroxylapatite) from Merz Aesthetics, for the neck, chest, arms and buttocks for years,” Dr. Waldorf pointed out. “But now increased patient awareness means increased patient demand.” 

Shino Bay Aguilera, DO, a dermatologist who practices on Las Olas Boulevard, in Fort Lauderdale, Fla., teaches Sculptra techniques worldwide. He uses the injectable to rejuvenate and feels the aesthetic profession under-appreciates Sculptra’s versatility. He uses it off-label to rejuvenate various body areas, including to build the buttocks, smooth knees and arms and to condition chest skin. Dr. Aguilera said he also gets great results treating cellulite with Sculptra.

“The correct techniques for usage and dilutions needed specific to a procedure are not yet fully understood by injectors to get the fullest benefit from its various abilities. This is why I teach aesthetic professionals about Sculptra techniques. I see Sculptra becoming even more widely used and understood in 2020 and beyond,” Dr. Aguilera said.

A better solution for cellulite 

Improving cellulite with injectables and devices has become more a standard of care, Dr. Waldorf indicated. 

“We now have the Emtone (BTL), which combines monopolar radiofrequency with mechanical pressure to target both dimpling and skin laxity,” Dr. Waldorf said. 

Moreover, “It can be used alone or bundled with hyper-dilute fillers, subcision and PDO [polydioxanone] threads if desired,” Dr. Zimmerman indicated.

Both Dr. Waldorf and Dr. Shridharani look forward to the potential approval of Endo International’s investigational injectable collagenase clostridium histolyticum (CCH) treatment for cellulite on the buttocks.

“I trademarked the term ‘surgery in a syringe,’” Dr. Shridharani said. “I feel like so much of what we’re doing right now is learning how to do surgery in a syringe. I’m doing Kybella with body contouring. I’m doing jowls with Kybella. Now, we’re going to be able to treat cellulite with an injectable as well.” 

Newtox? 

In 2019 we saw the FDA approval and subsequent launch of Jeuveau (prabotulinumtoxinA-xvfs) from Evolus (Newport Beach, Calif.). Dr. Waldorf is hopeful that 2020 will usher in approval of a new toxin – one that does something different. “When Revance Therapeutics’ investigational DaxibotulinumtoxinA for Injection (DAXI) comes out we might finally have a longer lasting toxin,” she stated. 

Aesthetics gone digital

Dr. Sayed is increasingly using simulation software – some with virtual and augmented realities – to help patients visualize potential results of surgery. 

For example, a plastic surgeon can scan a patient’s body using an iPad to get a photo realistic model of the body; then manipulate it to look as it might after a cosmetic procedure. The patient could then wear high-tech goggles to look at her or his potential new body from different angles. 

“We have to be careful to use these as educational tools and not promise results or have patients expect that these are guaranteed,” Dr. Sayed said. “But the technologies really do have a wow factor for patients.” 

For Dr. Subbio, it is not a single aesthetic technology that excites him most about the coming year, but rather the openness and willingness to change what he might have been comfortable with in 2019 and prior. 

“Every year I try to do something different. I try to learn a new technique. I try to travel to visit another physician or nurse to learn from them or travel to attend of conference. Each year is not about settling into a routine; it is about finding new things, trying new products,” he noted. 

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