Contemporary Cosmetic Surgeons Need One Eye on Trends

Sep 1, 2008

Cosmetic Surgery Times

The FDA has cleared some laser assisted liposuction devices, but the technology, in general, remains in the pioneering mode, according to Dr. Sadick.

"We are looking for the optimal wavelengths. Is it 930, 1064, 1320 or a combination of those?" Dr. Sadick suggests. "Newer advances in this area include more powerful, faster machines, and combinations melding aspiration technologies in one handpiece."

 
While it appears in studies that the laser-assisted approach might result in less bruising and post-operative discomfort, as well as a greater degree of skin tightening than traditional liposuction, there are still questions about to what degree.

"The exact amount of skin tightening is now the subject of several ongoing studies including one in our research center," Dr. Sadick reports. "Within the next six months, we should have more objective, quantifying information on the amount of skin tightening associated with this."

Companies in this area include Cynosure, CoolTouch, Palomar Medical Technologies and Syneron.

BETTER RECORD KEEPING

Not everything "trendy" falls under the device category. Cosmetic surgeons have dabbled through the years with electronic medical records but until now the technology was not as integrative as these practitioners would like, according to Dr. Quatela.

Newer software, by companies such as NexTech, have developed medical records technology that has seamlessly integrated photograph archiving and the ability to display high-quality photographs on computer screens.

Photography archiving is becoming more important in cosmetic surgery practices because outcomes research data will soon become very instrumental in performance measurements by governing organizations.

"This outcomes data is also going to be used by certifying bodies. Eventually, it will be used by licensing boards so that the most significant thing is maintenance of licensure will be directly tied to outcomes research, and without good electronic medical records you cannot produce that kind of data," Dr. Quatela says.

The other advantage of archiving of photographs is that physicians can with a click of a mouse bring up high-quality, highly detailed patient photographs during consults, post-operative appointments and other patient visits.

"The minute that you post a picture that is large, highly detailed and quickly accessible on the medical record, you can have a conversation that is complete and clear to the patient," Dr. Quatela says. "The way that I see my practice changing this year, is going electronic, adding large-screen monitors in every patient room, and when I walk in the patients' pictures are up on the monitors."

HONORABLE MENTIONS

Skin tightening and anti-cellulite technologies are blossoming, doctors say.

Ulthera offers focused ultrasound that deeply heats the dermis for skin tightening. The idea, according to Dr. Sadick, is to provide more focused heating of deep tissue, for improved results over broad spectrum light or Thermage.

"But comparison studies compared to those other technologies are not yet in place," Dr. Sadick says. "Again, this is a novel approach to skin tightening that hopefully will deliver more consistent results than we have been able to achieve with radiofrequency and light-source technology."

Thermage cellulite technology includes a new tip that covers larger areas and offers deep heating, which appears to be effective for cellulite, according to Dr. Sadick.

"Thermage definitely works for skin tightening. All these technologies that remodel can give you somewhat variable results. But the next pioneering frontier is for whole-body rejuvenation and there are Thermage body tips and Thermage cellulite tips in initial studies ... that show there is efficacy in terms of improvement."

The SmoothShapes cellulite technology device is a combination of a diode laser, a light source and suction massage, according to Dr. Sadick.

"It should improve cell metabolism, lymphatic drainage and blood flow and, given the suction and massage, push fat cells, which normally belong in the subcutaneous compartment back into their normal compartments," Dr. Sadick explains. "It is still an early technology but the results look promising and the company is getting ready to do more sophisticated studies. Initial studies show there is, after a series of eight treatment sessions, somewhere between 40 percent and 50 percent improvement in terms of the topography of cellulite."

 BOTOX ALTERNATIVE

Facial plastic and reconstructive surgeon James Newman, M.D., developed Glabellar furrow relaxation (Advanced Cosmetic Intervention, Centennial, Colo.), which involves bipolar radiofrequency (RF) ablation of the corrugator and procerus nerves.

"The thought process is that we know that nerves are really sensitive, meaning that if you tweak, tug or stretch them, they do not work for a while. ...if you could electrically stimulate the nerve [that moves a muscle] so that it would not function for a year or more...then you can effectively do the same thing as with Botox," Dr. Quatela says. "The technology is out and is commercially available."

 
FILLERS WITH A FACELIFT

New fillers are flooding the market, but the novelty is more in cosmetic surgeons' approach to using them.

"I think that we have, as a discipline, relatively underappreciated the role that soft tissue volume plays in facial rejuvenation," Dr. Biesman says.

Dr. Quatela says that surgeons on the cutting edge have talked more in the last five years about volumization and the need for fillers as an integral part of a facelift.

"...when you treat aging, you cannot just treat texture or lifting, but you really have to treat the loss of volume in the face with fillers or fat injections," Dr. Quatela says. "The trend is toward more longer-acting fillers and more use of fat injections and it being a routine part of an aging face treatment plan. We are not using a syringe to fill in a few lines [as we did in the past]. Now, we are using three or four syringes to restore volume."

Disclosures

Dr. Quatela reports no relevant financial interests.

Dr. Sadick has done research for Cynosure and Reliant Fraxel (now Thermage