What is the Future of Aesthetics?

In today’s post, we host a brief discussion on the state and future of aesthetics. Course Moderator, Joel Schlessinger, MD, poses four questions to five colleagues, each with a finger on the pulse of industry as a whole:

Facial Plastics Specialist, Steven Dayan, MD, of Chicago, IL; Oculofacial Specialist, Julie Woodward, MD, of Durham, NC; and Dermatologists, Chytra Anand, MD, of Bangalore, India, Michael Gold, MD, of Nashville, TN, and Amy Taub, MD, of Lincolnshire, IL.

Schlessinger: As in fashion, trends often make a comeback. Is there anything in your office that was “old” but is becoming “new” again?

Gold: We regularly see this in our space. If you once used IPLs for photorejuvenation, you might be surprised that there are some new, very sophisticated IPLs that work faster, safer and can give you results in one to two sessions. We also are using devices more and more to treat acne in our clinic. Older devices like blue light work well but newer, short-pulsed Nd:YAG devices like the Aerolase Neo works incredibly well, is virtually painlessly for acne patients and is changing lives, so that is very popular now.

Dayan: Well, I can’t think of anything in particular, however, I would have to say that in general one thing that seems to be making a recurring visit is the Instalift sutures by Sinclair. We all know the negative experience we had with the Contour threads and it has made many of us a bit fearful of trying it again. However, colleagues in Europe and Asia seem to be really appreciating the benefits of suture lifting. And some of our most respected colleagues in the U.S. are championing it. Instalift offers an office base option to improving jowls and lax neck skin in minutes. So I think this may be a resurrected technique to keep an eye on.

Anand: For a while, peels were out of fashion for acne and it was about laser and energy-based devices… With newer peels for acne like acetic acid and combination peels, I do believe peels are back to stay.

Woodward: I know that recent fashion magazines have quoted our famous Drs. (Vivian) Bucay and (Doris) Day as reviving chemical peels. This is true. Also, I think that patients are interested in liquid nitrogen instead of expensive lasers for quick inexpensive treatment of facial lentigos. Of course, any suspicious lesion should be biopsied first.

Taub: I still like Thermage for patients who have thick or oily skin. And Pulses dye laser is still a work horse, as is IPL.

Schlessinger: What is the most underrated thing you do or use?

Taub: There are several, actually: Qs lasers for lentigines, PDT for rejuvenation, XTRAC for psoriasis, SilkPeels for acne and Bellafill for acne scars.

Anand: The microdermabrasion. Everyone truly thinks it’s just not worth it but as an add-on or prep before a superficial peel, it is excellent – especially in skin of color.

Dayan: Reducing pain, bruising and edema post-filler and neurotoxin treatment. We too often overlook the importance of mitigating these patient-related concerns. It is my opinion if we can reduce these, plus get natural results, our practices will all be busier.

Gold: Acne devices by far. We use them each and every day to treat hundreds of patients. We make their acne better faster.

Woodward: Perhaps the handheld cautery. At just $15 per unit, it is far cheaper than a disposable Colorado needle that costs $100 to use. However, the CO2 laser is by far my favorite instrument to use. Also, during surgical procedures, the art of hand-holding should never be underestimated. Our CRNAs always hold the hand of the patients and this has a calming effect that goes a long way. Also, our nurses hold hands during injections. Patients often comment on it.

Schlessinger: What is the most overrated thing you hear about these days?

Dayan: Non-surgical skin tightening . . . always a tough one to get behind.

Woodward: Several skin tightening devices have very modest results. Much of the pre-op counseling involves management of expectations, but when the right candidates are selected, these patients can be very happy with their results.

Also, in some cases cannulas are overrated for injections. These do have a good place in my practice, but they are not free from inadvertent vascular injection, and they can still cause bruising. They tend to be more time consuming and can be less precise. I sat on a recent panel of oculofacial surgeons and not one of the surgeons preferred cannulas to needles for tear trough injections.

Anand: The Pico lasers . . . I do believe in the technology but just don’t think it’s worth the price tag for the degree of improvement as opposed to traditional QSNDY lasers

Taub: Several . . . PRP, Vanquish, pico lasers and probably Sculpsure.

Gold: Fat reduction. It works in most cases but we still need better devices that work all the time. We need consistency and that, to me, is missing. And we can’t be afraid to admit that we need combination therapy. Companies say their device is the “best thing ever,” when in fact if you do a combination therapy, everything works better.

Schlessinger: What do you think is the next big thing?

Dayan: I think PRP will have its day.

Gold: While I think it is currently overrated, I do think fat is the next big thing: painless if possible, consistent every time and working with both us and RF to make it work. Cryolipolysis is also popular and will remain popular, but we need to make it even better; shorter treatment times, minimal AEs – all of this will be coming.

Woodward: I’m interested in learning more about neck elevating sutures such as the ICLED. And I’m looking forward to learning something new at CSF!

Anand: Lipolysis by injection using PPC & DC is the next big wave for sure . . . At the moment in the U.S. there is approval for submental area only, whereas in Europe and Asia we use it on body areas too.

Taub: Suture lifts and hair restoration with growth factors.

What do you think of the state and future of aesthetics? Do you agree or disagree with the points made in this conversation? We invite you to share your thoughts below!