According to board-certified dermatologist Kim Nichols, MD, founder of NicholsMD (Greenwich, Conn.), with the medical aesthetic market continually accelerating and the demand for non-invasive aesthetic procedures continuing to rise, it is important to stay up to date with new research and studies on new and treatments and technology.
What’s Notable – According to the Experts
In November 2022 AviClear by Cutera (Brisbane, Calif.) announced that their laser device has been FDA cleared, and Health Canada approved to treat mild, moderate and severe acne. “We recently introduced AviClear to our practice,” Dr. Nichols reported. “The 
device is safe on all skin types (Fitzpatrick I-VI) and targets and suppresses the sebaceous glands. With this kind of technology, we are slowly phasing out the need for prescription medications.”
When it comes to injectable treatments and products, Dr. Nichols highlighted JUVÉDERM VOLUX™ XC from Allergan Aesthetics. “This highly cohesive, hyaluronic acid-based gel filler is the first and only FDA-approved filler for jawline definition,” she noted. “In addition, a new category of ‘skin boosters’ are in the pipeline for approval, which are gentle dermal fillers designed to be injected into the most superficial layer of the dermis for hydration and prolonged stimulation of collagen production. Introducing products like this to the market showcases how innovative the aesthetic world continues to be.”
Alexander Rivkin, MD, cosmetic surgeon and founder of RIVKIN Aesthetics (Beverly Hills, Calif.), is globally recognized for providing state-of-the-art nonsurgical aesthetic treatments and sees an expanded future in another biostimulating product – Renuva® (MTF Biologics). “Renuva looks interesting. It is an injectable adipose matrix that stimulates your own adipose cells and is somewhat comparable to fat grafting without having to harvest. Currently, it is an off the shelf fat grafting injectable,” he clarified.
At the same time, Dr. Rivkin explained that he was not surprised with the removal of Qwo (Endo International) from the market. “I am glad to see the removal of faulty technology while anticipating the implementation of better 
quality technology.”
Benjamin Caughlin, MD, a double board-certified facial plastic surgeon in Chicago, Ill., finds that many of the current fillers can achieve similar outcomes, but he is excited about the long-lasting effects of the daxibotulinumtoxinA-Ianm injectable, DAXXIFY, that will be available in 2023. “This is a long-lasting neurotoxin and probably the hottest one that has been FDA approved – the approval is significant in that it lasts six months, and it has been shown to last up to nine months in some cases.
Dr. Caughlin also validated the resurgence of threads taking place. “I do think there is some filler exhaustion among patients, so they are looking at other options, like thread lifts. One of the biggest benefits of today’s threads is the rigid structure the lift provides, while the volume component and collagen stimulation are also added benefits.”
Doris Day, MD, a board-certified dermatologist in New York City, N.Y., who specializes in aesthetic dermatology, finds limited use for thread lifting in her practice. “I use smooth and twisted threads for acne scars and find they work very well for that. I also use threads for skin tightening/smoothing of the stomach; it is a niche therapy but I can achieve excellent results with careful patient selection and treatment,” she reported.
The Art of Combination Treatments
Today, aesthetic medicine is considered an art form by many physicians who are showing that combining skill with creativity can provide patients with ideal aesthetic outcomes. Aesthetic specialist Kaveh Karandish, MD, of PCH MedSpa (Newport Beach, Calif.), is a big fan of combination therapies. “Each modality has certain strengths and weaknesses and the art for us as providers is to masterfully combine the best options with best lasting outcome for each client.”
Rahi Sarbaziha, MD, CEO at Dr. Rahi MD (Beverly Hills, Calif.) has made it her mission to create ideal solutions for cosmetic rejuvenation by mastering the art of using combination treatments. In her experience, treating patients strategically with a combination of radiofrequency (RF), microneedling and threads can be used to help improve facial contour and skin quality. “In 2023 the consumer will have access to many nonsurgical options, and it will be important that the provider can educate patients and staff on the differences between all of the devices on the market,” she expressed.
Dr. Day finds that combination treatments using devices and topicals are ideal to treat a wide range of patient concerns. “I always create a specific topical to apply right after treatment. I use growth factors, exosomes, topical Sculptra (Galderma) and hyaluronic acid, and create a unique formula for each patient to optimize outcomes and minimize recovery times. It has been a game changer for my patients.”
Facial Sculpting & Rejuvenation Advancements
Dr. Caughlin noted a change he is seeing in the facial rejuvenation demographics. “Facial sculpting is a different population, with an average age of 28 to 35 now. They want to change the way their face looks not just counter the age, so we have to use different techniques and modalities to get there,” he explained. “Buccal fat is a huge trend righ
t now for facial sculpting because it is a relatively safe procedure. It is filed under surgery, but it is done in the office while the patient is awake in just 30 minutes. This treatment requires an incision inside the mouth, and we remove that deep fat pocket from the inside of the mouth. There is some controversy, though because as one ages you lose that superficial fat.”
According to Scott Gerrish, DO, founder of Gerrish MedEsthetics (Vienna, Va. and Scottsdale, Ariz.), one of the newest technologies on the aesthetic scene to treat fine lines and wrinkles includes micro-core technology. “It is like a punch biopsy that takes a small circle of skin out, but the holes are so small that it heals without a scar. One
treatment can remove 5% to 7% of the skin, so it is basically a fractional facelift,” he reported. “Ellecor® by Cytrellis is a micro-core device that received clearance last summer, but they could not build it because they had supply chain issues. Venus Concept is coming out with a robotic micro-coring device AI.ME™ that I believe just received clearance a few weeks ago.”
Microneedling continues to advance with recent updates to leading products. First up, Aesthetics Biomedical® Inc., offers a novel approach to clinical precision and treatment delivery with the introduction of the Vivace Ultra™ Uniform RF Microneedling device. It uses linear array ultrasound technology to visually map the skin, allowing users to develop personalized treatment in each layer of the skin, delivering robust efficacious clinical results for patients.
According to Gregory Buford, MD, a plastic surgeon in Lone Tree, Colo., “as aesthetic practitioners we previously had to estimate thickness of skin and underlying tissues in an effort to determine best treatment settings. The addition of ultrasound to the new Vivace Ultra eliminates the guesswork and allows us to perform a superior treatment in a safe and effective manner.”
The new Profound Matrix™ RF microneedling platform from Candela (Marlborough, Mass.) is a multi-
application system that features the Sublime™, Sublative™ RF, and all-new Matrix Pro™ applicators to treat fine lines and wrinkles, build collagen and deliver a marked improvement in overall skin appearance and texture.
Dr. Gerrish uses the device for acne scars, wrinkles of the face and neck, and treating loose skin on the arms and the stomach. “The beauty of the Matrix is that Fitzpatrick skin types I-VI are all candidates, so we can treat darker skin types and get some skin tightening with this device. Without the Matrix, we would be limited to technologies such as laser to effectively lift and tighten skin, which would rule out some skin types,” he expressed.
Next, the DP4 Microneedling pen from Dp Derm (Miami, Fla.), is FDA cleared for treating facial acne scars, offering a dedicated scar treatment setting that is unique to the market. In addition, the DP4 is a fully digital device combining Bluetooth, radiofrequency identification (RFID), dual power and turbo-cut battery systems to offer fast and efficient microneedling treatments. With the ability to create up to 1,920 micro-channels per second, large areas can be treated faster, with exceptional outcomes, minimal discomfort and downtime. Each 16-needle cartridge features multiple anti-contamination seals, and an integrated RFID chip which allows for continuous calibration to ensure precise, reliable and drag-free needle penetration.
Medical aesthetic practitioners can continue to depend on VIOLA (Brea, Calif.) PDO threads to serve their thread lifting needs in 2023 with the newest in their collection, the PDO 5D Fix Coglyft. It is a 360° multi-cog thread that 
allows the dispersed force of the cog to lift the skin tissue in the opposite direction of gravity and fix it in place after the procedure to prevent migration of the thread. Dr. Karandish shared his experience with VIOLA threads; “They now have a more robust double blunt tip product for better neck tightening, and the 19G molded threads now come in 70 mm, which is a better fit for certain areas, especially for performing any reverse vector threading.”
AgeJET from NEOconcepts (Lewis Center, Ohio), is a non-ablative, anti-aging, skin regeneration therapy that requires just one treatment to realize significant improvement without surgery or downtime. Nitrogen plasma is produced by stimulating nitrogen atoms with ultra-high frequency energy to produce a thermal plasma burst that penetrates into the dermis. This unique technology treats 100% of the dermal architecture compared to only fractional areas of skin with lasers. This allows the user to provide a far more effective treatment without the worry of ablative complications. These characteristics make it the ideal modality to treat sensitive areas around the eyes.
DermaV, a dermatology workstation from Lutronic (Billerica, Mass.), delivers its 1064 nm wavelength at optimal fluence and the correct pulse width to safely eliminate unwanted vascularity and pigmented lesions with minimal to no downtime. Smart cryogen delivery provides skin cooling to reduce patient discomfort.
Amy Forman Taub, MD, a dermatologist and founder of Advanced Dermatology and Skincare Boutique (Lincolnshire, Ill.), shared that DermaV is a workhorse for her practices. “We have used a pulsed dye laser for many years, but the DermaV has cleared some resistant patients of rosacea. It provides a powerful 1064 laser for more stubborn or larger vessels, and unique microsecond pulse durations that allow for efficacy with very tiny vessels,” she explained.
The Continuing Trend of Body Contouring
In 2023 aesthetic physicians and practitioners can expect an array of exciting devices and technologies to expand and upgrade their body contouring treatments.
Sheila B
arbarino, MD, an aesthetic plastic surgeon with practices in Austin, Texas and Redondo Beach, Calif., told us that one of the hardest working machines in her office is the UltraSlim by Ward Photonics (Cocoa Beach, Fla.). “The demand for weight loss is huge right now in my practice so patients come in daily to take off inches everywhere without any divots or pain,” said Dr. Barbarino. Touted as the only non-invasive device that is FDA cleared for immediate fat loss, the UltraSlim produces a high-powered red light to stimulate lipid metabolism. “I was surprised at how powerful this technology is. The results from my UltraSlim machine for weight loss and skin tightening have been impressive. I also use it after all of my treatments, and my patients see a significant reduction in recovery time from surgery and procedures.”
MedixSysteme AG (Ruggell, Liechtenstein) has updated their UltraContour NG device with U.LIFT, a new feature that gives access to updated software for the treatment of cellulite. UltraContour NG combines thermal action of intensive sound waves, a mechanical partition of the fibrous septae and stimulation of the lymphatic drainage. Ultrasound boosts collagen regrowth to induce softer skin on the treated area and reduce the “orange peel” skin effect.
For Evsen Altunay, MD, a dermatologist in Istanbul, Turkey, liposuction was the only option for unwanted fat deposits, but now she can get the results her patients are looking for with the UltraContour NG. “This non-invasive, quick procedure is an asset for our busy patients,” she said. “We also combine it with technologies that develop muscle to provide our patients with the muscular, lean appearance that they dream of.”
Topical Technologies
Aesthetic treatments that involve injectables can cause distress for some patients due to pain or common complications like swelling, inflammation or bruising at the injection site. Fortunately, TargetCool™ by CoolHealth (Austin, Texas) will elevate the patient experience with compressed CO2 for topical skin cooling, combined with breakthrough technology that allows physicians to control the amount and duration of cooling. Elizabeth Geddes-Bruce, MD, a dermatologist in Austin, Texas, uses it in her practice. “This device helps elevate my practice by providing comfort while reducing side effects that can be a concern 
for patients,” she shared. She added that because there is no need for the patient to wait for numbing cream to work, she can quickly add on other treatments such as a filler injections and increase revenue while saving time.
Topical skincare products are enjoying a surge in technology with products like MELA BRIGHT [C+] by Alphascience (Paris, France). Their NextGen® technology has managed to fully stabilize cysteamine along with the only completely stabilized L-ascorbic acid, according to dermatologist Serena Mraz, MD (Vallejo, Calif.). It is clinically proven to be effective against skin discoloration and without the concerns of hydroquinone or corticosteroids. “Due to the combination of high efficacy, tolerability and safety, it is a first line agent for patients with melasma and other causes of dyschromia such as sun damage and post-inflammatory hyperpigmentation,” Dr. Mraz noted. “It is suitable for daily use as well as in combination with in-office procedures such as microneedling, laser treatments and chemical peels.”
Revision Skincare’s (Irving, Texas) new D·E·J Daily Boosting Serum™ is a powerhouse antioxidant blend formulated with patented sunflower sprout extract technology that has been clinically proven to impact the visible effects of glycation on the skin. Board-certified dermatologist David Goldberg, MD (New York, N.Y.), says it has been 20 years since such an innovative product has hit the market. “D·E·J Daily Boosting Serum represents a totally novel skincare product. We have used antioxidants and retinols for years with the focus on new collagen production, but D·E·J Daily Boosting Serum goes to the mitochondria; the portion of cells that give us energy,” he elaborated.
EXOVEX by Exocel Bio (Doylestown, Penn.) continues to invest in research and development to bring the most cutting-edge exosome products to the market, with new and exciting innovations in the pipeline. Their flagship product, EXOVEX, is specifically designed for topical application in conjunction with facial or scalp microneedling and energy-based devices for accelerated recovery time and enhanced treatment results. Harvested from chorionic Placental Mesenchymal Stromal Cells (pMSCs), EXOVEX is produced through a patent-pending nine-step manufacturing and testing process that guarantees consistent, highly potent and fully intact active exosomes. EXOVEX products include a mixture of precision growth factors, peptides, cytokines and mRNA to topically target damaged skin and hair cellular structures.
Kimera Labs (Miramar, Fla.)
continues to innovate and impress with products that contain 10x the ribonucleic acid (RNA) content of competitive products. According to aesthetic specialist Azza Halim, MD, of Sanctuary Medical Center (Newport Beach, Calif.), Kimera’s exosomes bring down inflammation and speed healing time by 50%. “Their technology is unique, being a cell-free isolate of exosomes that are produced by a master cell line of neonatal mesenchymal stem cells originally isolated from rigorously screened placenta,” she reported. “These exosomes can be applied and used with any laser or microneedling treatment without requiring a blood draw as with PRP. Enhanced results and treatment response allows me to deliver results to my patients with half the number of treatments needed when using PRP alone.”
Revolutionary Aesthetic Devices
Air-Tite (Virginia Beach, Va.) has established a partnership with Trinnovations LLC to distribute its CuraCator device. This FDA Class 1 medical device accessory is designed and developed to meet the need for hands-free, needle-free, controlled application of products to the skin, providing a solution that alleviates safety concerns and risks of product waste or contamination. “CuraCator controls the application of exosomes or PRP after microneedling or laser resurfacing,” said Janine Hopkins, MD, who is the president and owner of Trinnovations. “With CuraCator, there is less waste of therapeutic products compared to dripping and wiping them onto the skin. There is more PRP or exosomes to use for an add-on treatment to another area like the scalp or chest.”
ARTAS® iX by Venus Concept (Toronto, Ontario, Canada) is an intelligent hair transplant platform. Douglas Burka, MD, the chief surgeon at the Mane Center for Advanced Hair Restoration in Chevy Chase, Md., has been involved in hair restoration for almost a decade. “ARTAS iX allows the surgeon to pinpoint donor hair follicles limiting graft transections with micron level accuracy. This is done significantly faster than any human can harvest donor follicles thus limiting graft out-of-body time, increasing yield, and improving graft survival once implanted,” he pointed out. “It allows for graft implantation which limits follicular handling and minimizes trauma to the grafts in the implantation phase of hair transplant. It also enables detection of the patients’ natural terminal hairs avoiding damage to those natural hairs and spacing the implanted hairs in a pattern to maximize the patient’s final density.”
Advanced Patient Assessment
Designed, engineered and manufactured in Europe, the Observ® skin analysis system from Sylton (Ann Arbor, Mich.), is now available in the U.S. It is a skin diagnostic imaging tool that reveals deeper layers of skin, not typically visible with the naked eye. Physicians can generate nine high-
definition (HD) pictures within seconds to provide compelling consultations and make informed decisions f
or personalized treatment plans to increase client satisfaction and clinic profitability. The system takes advantage of current technology with an easy-to-use app, while before and after pictures will show true and honest apple-to-apple comparisons.
Plastic surgeon Benoit Hendrickx, MD, PhD (Brussels, Belgium), has helped develop the ARtery3D device, the first large-scale application of augmented reality (AR) in medicine. The rise of cosmetic injections has also increased the risk of complications due to the variability of arterial anatomy. This device uses AR based on a single MRI with no need for a contrast injection. Images are converted into an AR image that is visualized on an iPhone screen, and the depth of a vessel can be indicated using a slider bar on the phone screen. Insight into the arterial anatomy of patients can greatly reduce serious co
mplications such as blindness or skin necrosis.
With the introduction of technologies that allow a greatly expanded treatment portfolio covering almost any arena and a majority of demographics, indeed, the future does look bright for the world of aesthetic medicine in 2023.
