Comprised of European Union (E.U.) countries and nations of Eastern Europe, the European market is one of the most diverse, noted professor Klaus Fritz, M.D., vice president of the German Academy of Dermatology (DDA), past president of the European Society of Laser Dermatology (ESLD) and director of two private practice dermatology and laser centers in Landau and Kandel, Germany.
“In the European region, there are no homogenous markets or trends,” Dr. Fritz expressed. “The growth in our industry differs from country to country and depends on economic situations. There is not one Europe, in that respect.
“For instance, the difference between Bulgaria and Spain is larger than between Germany and Thailand. Sweden, Germany, France and Switzerland are the engines that are moving and pulling everyone else along,” he elaborated. “In some countries, including Germany, it is mainly dermatologists and plastic surgeons that offer laser-based procedures and facial injectables.”
As reported by Hugues Cartier, M.D., a dermatologist in Paris, France, and past president of the Laser Group of the French Society of Dermatology, “Germany and England are the largest markets for aesthetics, followed closely by Italy and Spain. France, on the other hand, while being an essential market for product manufacturing in the industry, is very expensive when it comes to aesthetic procedures.”
More than ever, global politics has been affecting the market for cosmetic procedures and business in general – for instance, Spain’s recent political upheaval and the Brexit movement in the U.K.
As noted by Koenraad De Boulle, M.D., a dermatologist and director of the Aalst Dermatology Group in Ghent, Belgium, “There is definitely growth, but we see downward shifts in places like the U.K., where Brexit really does influence many markets including surgical procedures, which have been slightly declining in that country. Conversely, Spain is becoming very active again.”
Among European countries there is a singular difference from other regions due to the lack of an overarching regulatory body, such as the FDA in the United States.
“We do not need government endorsement like an FDA approval,” Dr. Fritz indicated. “We have a technical approval, the CE Mark. The use of technology does not need to be approved. It can be used under the responsibility of a board certified physician. In that regard, European practitioners are freer to use newer technologies. Also, this is the reason we have a much wider range of fillers than other parts of the world.”
Throughout Europe, much of the demand for aesthetic products is centered around lasers and other energy-based devices, such as skin tightening and body contouring systems that provide good results with low downtime.
“The absolute buzzword in Europe right now is body contouring,” noted Dr. Cartier. “I’ve been employing cryolipolysis and shockwave therapy to distinguish my clinic from others. We also combine these therapies with radiofrequency (RF)-based energy, but those treatments can take time and a lot of sessions.”
Energy-based systems can also be useful adjuncts to cosmetic dermatology procedures, stated Dr. De Boulle.
“We use devices to address areas like the horizontal lines on the neck, where no single existing procedure can achieve dramatic improvements,” he said.
“In addition, some RF devices can be good for treating the upper arms. Patients must understand they will need a number of sessions with energy-based devices, but these are generally well-tolerated. Unique techniques like CoolSculpting have been very well received, too.”
An example of a modern energy-based device designed for face and body rejuvenation is the Secret™ RF from Cutera, Inc. (Brisbane, California, U.S.). This fractional RF microneedling system offers a tailored approach to skin revitalization, combining bipolar RF energy, semi-insulated and non-insulated needles, and user adjustable settings, to stimulate and remodel collagen and address the common signs of aging with little to no downtime. The short treatment yields effective results on fine lines and wrinkles, scarring (including acne scars), stretch marks and photodamage on the face and body.
In 2018, Europe’s medical aesthetic market has been following many of the same major trends found in North America and other regions: growth driven by the increasing affordability of treatments, and significant improvements in medical devices, techniques and technologies. Adding to that are the expanding populations of aging Baby Boomers, Gen X-ers, Millennials and the up-and-coming Generation Z or iGen, with all groups increasingly aware (via mainstream television, the Internet and social media) of the latest aesthetic / cosmetic procedures and anti-aging therapies.
One of the most important changes in the market has been the increasing popularity of energy-based feminine rejuvenation procedures. These non-surgical treatments often combine energy-based devices with dermal fillers and other injectables, and are designed to address a range of sexual health and wellness-related indications.
As characterized by Dr. Cartier, “The subject of vaginal rejuvenation has been democratized and is no longer taboo, but we need to offer patients safer procedures. The subject of treatment safety was brought up again this year by the U.S. FDA saying manufacturers should produce more clinical studies.”
Dr. De Boulle amplified the concern for increased safety. “While more people are requesting vaginal rejuvenation to treat laxity, incontinence, sexual response, etc., practitioners need to know using lasers and RF devices to treat these indications is not CE marked or U.S. FDA approved,” he noted.
“There is a wild growth of procedures based on these indications, purporting to cure all kinds of different conditions,” he continued. “This is absolute nonsense. What needs to stop is people overpromising procedure results when nothing has been substantiated, clinically, by my studies or any serious follow-up.”
Despite the growing popularity of energy-based therapies, currently injectables, such as neurotoxins and fillers, are dominating the European aesthetics marketplace, according to Dr. Fritz.
“The big companies are controlling it. Merz has Belotero, Galderma has Restylane, Allergan offers Juvéderm, etc. Then there is Teoxane with Teosyal and Croma with its Princess line.”
While more than 100 hyaluronic acid (HA)-based fillers are available in Europe, “There are only three botulinum toxins,” Dr. Cartier pointed out. “We expect new toxins, in particular the ones coming in from Korea, to make a difference in the European market soon.”
Due to rapid advancements in dermal filler technology, more products offer aesthetic results previously only achievable via surgery, but at a lower cost and usually with very little recovery time.
Physicians are starting to step away from non-HA based fillers, Dr. De Boulle reported.
“Currently, you see the regulators and other authorities in all countries checking what fillers are prone to adverse reactions, such as intravascular complications,” said Dr. De Boulle.