When Michael H. Gold, M.D., medical director of Gold Skin Care and the Tennessee Clinical Research Center in Nashville, Tenn., talks about what’s new in energy-based devices for the aesthetic practice, he underscores evolution.
What’s old is new
According to Dr. Gold, some companies are focused on giving their hair removal devices a facelift. “The 800 nm to 810 nm diodes have always been popular, but today they’re more powerful and more expensive, and targeted to the spa environment where there’s no physician base,” Dr. Gold said.
Dr. Gold considers these changes “clever,” and part of a positive trend for aesthetic physicians.
Product engineers have also “figured out how to make treatments even more efficacious by having 755 nm or 1064 nm in the same handpiece, or the same box, so we can do multi-wavelength treatments on the same patient. I think this is really exciting,” he said.
In addition, these combination devices work well on skin of color.
“Combinations of 810 nm and 1064 nm work really well on skin of color because 1064 nm is the safest for skin of color. But if you can get a little bit of 810 nm, which is the best for hair removal, you achieve improved efficacy,” he reported. “It is giving us another high-end advantage to what’s already out there.”
In Dr. Gold’s experience, the popular 810 nm diode device has become much more sophisticated, so practices still using devices from 10 to 15 years ago should consider replacing the old with the new. Something that is faster, safer and works a little better, he said.
The biggest hurdle for aesthetic physician practices is that patients have become accustomed to a relatively low cost for laser hair removal, so they’ll have to educate patients that while the newer treatments are more expensive, they’re better for them.
Picosecond lasers deserve more than a peek
Rather than shrinking into the background while other, newer technologies are being introduced, picosecond lasers are actually getting better at treating tattoos and pigment, in addition to wrinkles and acne scars, Dr. Gold indicated.
“Picosecond lasers all have fractionated handpieces, and these fractionated handpieces are good for wrinkles and acne scars. Thus, we are seeing an evolution in picosecond lasers as far as indications and applications,” he said.
The advantage with picosecond lasers is everything clinicians do with this technology happens faster. “When you’re talking pico, being fast and efficacious works every time,” Dr Gold noted. “I think those devices have been shown to be safe. I like that concept,” he added.
Body contouring and tightening
The biggest demand for energy-based devices remains with the body – fat removal, body contouring and skin tightening – said Dr. Gold.
Particularly, radiofrequency (RF) devices for skin tightening, work well and have improved, Dr. Gold stated. Hands-free RF skin tightening devices might soon hit the U.S. market, he said.
In addition, some of the newer technologies, such as EmSculpt (High-Intensity Focused Electro-Magnetic) from BTL, treat the skin, fat and muscle. Dr. Gold predicts that more of these types of devices are going to become available.
“Being able to remove fat, tone the muscle and tighten the skin is no longer a far-fetched idea,” he said.
There are several strong contenders in the device-based fat reduction arena as well, including the cryolipolysis-based CoolSculpting from Allergan, laser-based SculpSure from Cynosure and the monopolar RF-based truSculpt from Cutera. The key, according to Dr. Gold, is to deliver energy deep enough so that it makes a difference, but won’t hurt the patient or surrounding tissues.
Thee or four years ago, the reports about truSculpt were that it was ineffectual, but now it seems to have been modified and is effective. Sculpsure works and CoolSculpting will receive some upgrades and advances to it to make it better,” Dr. Gold shared.
“Not only are we looking at fat reduction for the abdominal area, hip, flank and thighs, but also for the neck and arms. But, Dr. Gold stresses that, “it is important to remember that when you do any kind of fat reduction with any of these devices, whether it is ultrasound, RF, whatever it may be, you still need to tighten skin a little bit.”
What about sexual health?
Energy-based feminine rejuvenation might have taken a hit from the FDA due to a lack of proven efficacy and safety science, but that’s slowly changing, Dr. Gold revealed.
“We are committed to figuring out what the best devices are and how they best work,” he said.
“The interesting thing is at the last couple of meetings there has been talk that cosmetic physicians are getting into the world of treating erectile dysfunction (ED) with things like shockwave devices,” he continued. “The thought is that if a clinic offers feminine rejuvenation, why not offer ED treatments? While this is going to be a clinic-to-clinic decision, the data is starting to show that it really does work.”