As we begin another new year, aesthetic medicine continues to be propelled forward by new developments and evolving trends. With the rise of social media and a plethora of scientific and practical breakthroughs, 2019 is sure to be an exciting year filled with promise.
While social media has changed marketing and delineated the divide between generations, cultural shifts have brought previously taboo topics, such as sexual health, to the forefront.
Powerful forces within our own bodies are being harnessed to regenerate and restore. The doctor-patient relationship is changing, as is the system itself, driven by social, governmental, economic and industrial factors. R&D is bringing new and exciting technologies to bear, which seem right out of science fiction, whilst proven and popular techniques and technologies are being further refined.
As aesthetic medicine has become more accessible to and accepted by the average consumer, the patient base has expanded. In addition, affordability and media exposure, specifically the rise of social media, has coupled with development and refinement of modalities providing less aggressive, but effective therapies that stave off the need for more drastic measures.
All of these changes have contributed to the wider age range of patients seeking aesthetic enhancements. Understanding the significance of generational aesthetics will prove critical to our industry in all aspects, including creation of a wider potential patient base, evolution of technology and changing the ways in which you market to and communicate with patients.
Shrewd practice owners know they must strategically offer treatments that appeal to different generations and market them accordingly.
“The term ‘prejuvenation’ has been coined to describe the increasing use of small, subtle, less aggressive, minimally or non-invasive therapies to slow the appearance of aging in younger patients,” said Joel L. Cohen, M.D., director of AboutSkin Dermatology and DermSurgery in metropolitan Denver, Colo.
Millennials, or Generation Y (born between 1980 and 1995), are more comfortable with – and expect – an ‘experience,’ as well as a result. They seek solutions and digest information quickly. Their relative youth and resilient skin make them ideal for less aggressive therapies and any level of body contouring.
Conversely, older patients and baby boomers need more aggressive therapies and respond to more traditional marketing.
However, the bulk of patients in a practice will be from Generation X (born between 1965 and 1979). These patients are more media savvy and skeptical, but in a prime position to benefit from a variety of therapeutic options.
The most recent addition to the aesthetic patient population is Generation Z, also known as the iGeneration (mid 1990s to mid 2000s). This group may seek body contouring and milder therapies. They are most comfortable with the Internet, open to new ideas and treatments, and hungry for information, while being put off by more traditional marketing.
While it is still early in the game, the use of adipose-derived stem cells (ADSCs), platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM), stromal vascular faction (SVF) and growth factors are being applied safely and effectively in a myriad of ways, both as stand-alone therapies, as well as to enhance results and speed healing after other treatments. The number and variety of products and applications is growing exponentially, almost faster than science can keep up.
Experts agree that regenerative medicine holds a tremendous amount of potential to dramatically transform the future of aesthetic medicine by changing the way physicians approach anti-aging and other indications. Examples include, autologous products that implement the use of a patient’s own cells in surgical products, products that utilize amniotic fluid, epithelial growth factors and stem cell tissues, as well as adipose stromal connections. Other sources include cord blood, bone marrow and stem cells for the heart.1
Injectable neurotoxins are the backbone of aesthetic medicine, with Botox Cosmetic from Allergan, Inc. (Irvine, Calif.), being largely responsible for the explosive growth of the aesthetic industry. For years there have been three main neurotoxin offerings in the U.S., but this is about to change, according to Dr. Cohen. Three competitors are on the radar and the potential market is still huge.
After overcoming FDA-clearance hurdles, Evolus (Newport Beach, Calif.) is expected to disrupt the current market as an aesthetic-only neurotoxin that is as good as rivals, but most likely offered at a much lower price. While the product has received a lot of backing by KOL physicians, some of these KOLs also are investors in Strathspey Crown/Alphaeon, which is a 50% owner of Evolus. Despite this detail, the buzz is still growing.
Revance Therapeutics, Inc., (Newark, Calif.) has completed Phase III trials on the long-acting neurotoxin product DaxibotulinumtoxinA for Injection (RT002) for the treatment of glabellar lines. The product is in clinical development for a broad range of aesthetic and therapeutic indications, including glabellar lines. Data presented by industry luminaries throughout 2018 strongly supported the product’s potential of longer duration.
In addition, Croma-Pharma GmbH (Leobendorf, Austria) has partnered with Hugel, Inc. (Seoul, South Korea) to bring Botulax to the U.S. market soon, along with its unique saypha brand of HA-fillers and family of PDO threads.
“These are all type-A neurotoxins, with some variations in formulation, so I expect some heavily-marketed differentiating features, such as price and studies on longevity,” said Dr. Cohen, who has been an investigator in trials of all three of these new neurotoxin products, but is not an investor in Revance Therapeutics.
“Patients are becoming more comfortable with the concept of injectables — even from a younger age, so the market is growing significantly. Thus, there are certainly opportunities for new players, products and procedures,” Dr. Cohen said.
Collagen restoration is another popular characteristic being offered by many soft-tissue augmentation agents, such as poly-L-lactic acid (Sculptra, Galderma Laboratories), but lesser known products, such as Polycaprolactone (PCL) fillers (Ellansé, Sinclair Pharma, plc), take it to the next level. Ellansé is touted as a high viscosity, easy-to-inject biostimulator with a longevity outcome that relies on a specific neocollagenesis effect.
“We’ve been talking about fillers inducing collagen stimulation for a long time, and there have been studies in the literature, but now we are seeing more specific pathways and mechanisms of action reported to explain this,” Dr. Cohen stated. “There is definitely something to it, with both established and emerging biostimulatory fillers.”
Integrative customized care
In aesthetics, integrative customized care denotes a modified approach to patient care that comes with unique benefits, said Farhan Taghizadeh, M.D., medical director of Arizona Facial Plastics (Scottsdale, Ariz.). This concept marries the whole-person approach with multi-vector treatment, some of which may seem to fall outside the purview of aesthetic medicine at times.
“A healthy lifestyle is better medicine than anything we can prescribe,” Dr. Taghizadeh pointed out. “Diet, exercise, and supplementation when necessary, can go a long way to improving health and allows patients to maximize results.
“Everyone knows that lifestyle profoundly affects health, healing and aging,” he continued. “Consider the role of inflammation, which we’re learning more about every day. And what better example is there of the opportunity to affect outcomes with a healthy lifestyle than among body contouring patients?”
Lifestyle coaching, plus the use of combination therapies, especially non- or minimally invasive therapies, is a big part of this approach, but it is more than that.