Arguably the fastest growing segment in the healthcare field, today's medical aesthetic industry is chiefly driven by the increased acceptance of cosmetic surgery among all demographics, and the introduction of safer, more effective non-invasive treatments. Specifically, the field has seen a rising adoption of procedures among men, as well as millennials and younger generations thanks in part to the Internet, television and social media influencers.
Those entering today’s marketplace are explicitly looking for non-surgical solutions first. “Consumers are very interested in non-invasive procedures,” stated Alisa Lask, general manager & vice president U.S. Aesthetic at Nestle Skin Health (Fort Worth, Texas). “It is a big deal, meaning that there are tens of millions of consumers out there that are really interested in aesthetics. Everything is showing great growth ahead.”
According to Clint Carnell, CEO of The HydraFacial Co. (Long Beach, Calif.), “One important development is that consumers are making aesthetics part of their overall lifestyle, and they demand convenience. They understand now that no single kind of treatment fits all, and they’re intent on making cosmetic treatments part of their anti-aging regimen.”
Attitudes are changing as more people seek preventive aesthetic proce- dures at earlier ages, noted Joel Schlessinger, M.D., a cosmetic dermatologist in Omaha, Neb., and owner of one of the largest online skincare stores in the world.
“The concept of ‘pre-juvenation’ is absolutely catching on with a lot of consumers,” he said. “Physicians can do so much more for patients when we catch them early in life and not only get them on a path that is more effective, but also educate them on the proper method of prevention and the importance of it. In that way, they are oriented towards their skin and skin health earlier in life rather than later.”
Among all age groups, neurotoxins and dermal fillers remain the most popular gateway treatments, with the facial aesthetic products segment retaining the largest share of the market in 2018.
“We’re expecting the market to double by 2025. In the United States, the market penetration rate is around 6%,” Ms. Lask reported.
Rand Rusher, R.N., one of the most sought-after injection consultants and trainers in the United States (Beverly Hills, Calif.), elaborated on this point.
“BOTOX brings in both men and women, but consider how low this current market penetration rate is; there are 15 million people worldwide that have had neurotoxin treatments, and 27 million people are thinking about doing it right now. The business is growing, but growth could be faster.”
New neurotoxins from Revance Therapeutics (Newark, Calif.) and Evolus (Irvine, Calif.) are expected to hit the market beginning in 2019, offering people more choices for short- or long-term wrinkle reduction.
In addition, FDA approvals for new fillers are expected over the next year or so, stated Thomas A. Albright, president and CEO of Recros Medica, Inc. (San Diego, Calif.).
“Almost every filler that is being developed right now comes from the same basic chemical entities, which are mostly based on hyaluronic acid (HA),” he said. “While the majority of the marketplace is dominated by HA fillers, we welcome the development of other mechanisms for filling.”
One such alternative to HA-based fillers is the longer-lasting Bellafill® from Suneva Medical, Inc. (Santa Barbara, Calif.), which consists of 80% bovine collagen gel and 20% polymethylmethacrylate (PMMA) microspheres, forming a matrix that supports the production of endogenous collagen over time.
Also, in the facial rejuvenation realm, thread-lifting procedures have undergone a recent resurgence in popularity, with a handful of new and improved products that fall into one of two categories: Free-standing, barbed threads that do not need to be suspended in order to hold the lift; and, smooth or suspension threads that need to be anchored to a stable structure of the face or scalp.
Thread-lifting techniques are best when combined with fillers, in which the patient receives the immediate result of filler injections and weeks later sees the ultimate result of the threads, which have created collagen deep in the dermis to achieve the desired face lifting effect.
Another emergent market segment in aesthetics is the integration of regenerative medicine, which incorporates a host of cell-based therapies – stem cells, biologic products and platelet rich plasma (PRP) – with more traditional surgical and non-surgical procedures.
In particular, the use of PRP and stem cells has caught on in hair restora- tion procedures, as well as in fat transfer and other anti-aging regimens, noted Nikolay Turovets, Ph.D., CEO and chief scientific officer of DefenAge® Skincare (Carlsbad, Calif.).
“Regenerative medicine addresses a variety of age-related health conditions that previously had no treatments or had very poor and / or insufficient solutions. There is no doubt that regenerative medicine is penetrating the aesthetic market,” Dr. Turovets underscored.
Mr. Albright concurred, “PRP and other new techniques are infiltrating popular hair-related treatments, and demand is up in that segment.”
Skincare product formulations are increasingly employing regenerative- type ingredients, Mr. Albright added.
“It is still a growing and evolving space. Some of the newest topicals include growth factors, plant-based stem cells and other cell-based solutions that may play a big part in physician-dispensed skincare,” he said.
Although these new therapies show promise, “Stem cells and PRP are messy areas,” said Mr. Carnell. “The jury is out on the mix of aesthetics and regenerative medicine, but a lot of companies are watching this space.”
Increasingly, PRP is being used in combination with microneedling, another in-demand treatment, in order to drive HA fillers and other formulations into the dermis.
“As for microneedling and transdermal systems, these are emerging,” Mr. Albright commented. “Whether it integrates radiofrequency (RF)-based energy, is automated or the manual roller type, many practices report that their staff loves to do microneedling. I expect we will see improvements in these types of delivery technologies. A better way to deliver products transdermally is definitely not too far off.”
“Microneedling is absolutely an exciting new area,” Dr. Schlessinger maintained. “The application of RF-based microneedling, along with other modalities, is already being used to improve treatment results. The question of whether or not PRP is going to become mainstream is unresolved, but every indication is that it will, over time.”
Due to this demand, microneedling devices are definitely growing more sophisticated. A recent example, SkinPen® from Bellus Medical (Dallas, Texas), holds the unique distinction of being FDA-cleared and is clinically proven to improve the appearance of facial acne scars.
Due to this demand, microneedling devices are definitely growing more sophisticated. A recent example, SkinPen® from Bellus Medical (Dallas, Texas), holds the unique distinction of being FDA-cleared and is clinically proven to improve the appearance of facial acne scars.
Microneedling systems are not limited to handheld pens. The Vivace from Aesthetics Biomedical (Phoenix, Ariz.) is a big box RF-based platform that addresses facial wrinkles and fine lines, and also performs contouring and tightening of the face, neck, hands and body by stimulating the production of collagen.
Mr. Carnell pointed out that, for practices, the latest approaches to energy-based fat reduction and skin tightening are more likely to offer some of the biggest opportunities. “We are still seeing a huge interest in body shaping.”
In response to that interest level, more manufacturers have developed multi-functional, energy-based aesthetic platforms that offer a wide array of treatments.
InMode Aesthetic Solutions’ BodyFXTM body contouring procedure delivers a minimally invasive, RF-based lipolysis procedure that reportedly bridges the treatment gap between non-invasive and surgical outcomes. In addition, the firm’s EmbraceRFTM system addresses subdermal adipose tissue remod- eling, targeting skin laxity via sub-dermal RF and underlying fat coagulation.
Another body shaping treatment, TightSculptingTM from Fotona (Dallas, Texas), is a fast, safe and effective non-invasive alternative to laser lipolysis with no consumables or patient downtime.
While most energy-based body shaping products specialize in remod- eling and recontouring the dermis and underlying structures, a new system, EmsculptTM from BTL Aesthetics (Marlborough, Mass.), uses high-intensity, focused electromagnetic energy (HIFEM) to tone muscle in the abdomen and buttocks, building new muscle mass (increased tone and muscle definition), in addition to performing fat reduction via lipolysis. This pain-free procedure is unique in the industry.
“Emsculpt is a paradigm shift in reducing fat and building up muscle,” said Mr. Rusher. “And unlike some products that are pushed out into the market without much documentation, Emsculpt was introduced with several clinical studies and scientific data backing up the technology.”
Upgrades to existing energy-based platforms and the introduction of new devices for other aesthetic treatments abound, as well.
For instance, the recently released TritonTM workstation from InMode Aesthetic Solutions (Lake Forest, Calif.) offers hair removal procedures via concurrent emissions of Alexandrite, diode and Nd:YAG wavelengths. This distinctive combination allows practitioners to address all skin types and tones with a single device platform.
Then there is the new ARVATITM system from Thermi, an Almirall company (Dallas, Texas). This device improves upon Thermi’s RF technology with emission of continuous RF waves that employ an enhanced 50 W capacity system, along with intelligent software, electrode recognition and a con- trol algorithm that integrates with the various Thermi modalities, such as ThermiTight®, for body shaping procedures, ThermiRase®, ThermiSmooth® Face and the feminine rejuvenation device, ThermiVa®.
Non-surgical feminine rejuvenation procedures, such as those performed using ThermiVa, are one of the fastest growing in-office therapies. However, there has been very little in the way of studies or trials that validate their safety and efficacy.
In addition, some of the manufacturers have made unsubstantiated mar- keting claims about their products. As a result, in July 2018, the FDA issued warnings to several companies demanding they prove that their therapies actually work.
“The feminine rejuvenation market is large, there are 36 manufacturers out there with no clinical data,” Mr. Carnell pointed out.
“Safety has to be paramount in this particular space. This has not been suitably achieved yet; however, I think this will change now that the FDA has stepped in and mandated clinical testing. We’ll see how that market continues to run now that it is receiving a heightened sense of regulatory scrutiny.”
Along with the intensified demand for feminine rejuvenation procedures, so-called male sexual rejuvenation is now trending, as well. “Following this trend of female rejuvenation, men are finally realizing there are new methods for thickening, lengthening and making their genitalia more attrac- tive,” said Mr. Albright.
“Most of those treatments are experimental at this point, and we can only surmise what direction it will head in the future,” he continued. “Baby Boomers will likely take advantage of this development, and I expect there will be a lot of innovations that will attract all generations of men.”
As noted in years past, the industry has been seeing an increasing number of men seeking aesthetic procedures, with some clinics and medspas claiming that over 30% of their clientele is male.
In the facial injectables segment, for instance, “There has been a 50% increase in neurotoxin injections among men and a 40% increase in minimally invasive procedures,” noted Ms. Lask. “The growth potential in the male segment is significant.”
As treatment protocols continue to diverge among men and women, young and old, the generational nature of aesthetic treatments has become more obvious.
While the larger patient demographic continues a natural shift towards millennials and younger generations, the older groups, such as Gen-X and Baby Boomers, continue to grow but at a slower rate. In fact, recent studies revealed adults under 45 are nearly twice as likely to consider aesthetic procedures compared with those over 45.
“We are starting to see patients in the 25- to 45-year-old age range spending a lot more money than they used to, and they are much more comfortable coming into an aesthetic practice compared with the traditional demographic, which is in the 45- to 65-year-old range,” stated Edward M. Zimmerman, M.D., a cosmetic surgeon in Las Vegas, Nev.
Additionally, younger patients entering this market have different expectations compared with, say, Baby Boomers.
For Lori Robertson, R.N., M.S.N., F.N.P.-C., owner and clinical director of Skin Perfect Medical in Brea, Calif., her experience has shown that the 20- and 30-year-olds, even the millennials, know exactly what they want.
“They research online, talk with their peers on social media, and then walk into your office knowing you and your practice in advance, as well as the kinds of services you offer,” she shared. “This is a fresh development that is really changing the face of aesthetics. They trust you right off the bat without even meeting you, as opposed to a 50-year-old patient that isn’t into social media and who requires a traditional consult to explain things.”
Another facet of medical aesthetics in transformation relates to patient care in general, which is becoming more holistic in nature. “We need to appraise the patient as a whole unit,” expressed Dr. Zimmerman.
“We are physicians trained in facial plastic surgery or dermatology or other specialties, where traditionally we have not evaluated the whole person, but rather just the face, the breast, the buttocks, etc., as standalone parts. Instead, we need to start looking at the human being in total,” he explained.
“It is not just about wrinkles, facial fillers and body parts,” Dr. Zimmerman continued. “We need to consider what is going on below the belt, body composition, etc. Lately, we’re hearing more and more about optimizing hormones for older patients, so that they can have a better response to the procedures that we are giving, as well as increased longevity.”
Cutting edge diagnostic imaging can go a long way in helping practitioners identify patients’ therapeutic needs.
For instance, the Mediscope Bodystation from FotoFinder Systems, Inc. (Columbia, Md.) is an advanced solution for consistent photo documentation of virtually any aesthetic, medical or surgical procedure. The system’s Laser Liner controls offer consistent patient positioning at baseline and follow-ups; and, the unit’s Proposer feature enhances consultations with procedure protocol and skincare product recommendations.
With new technologies, holistic approaches, a reliable stream of new patients in the millennial and younger demographics, and growing acceptance of aesthetic procedures, “Most practices are doing well,” noted Mr. Carnell.
“There is a lot of expansion going on with physicians and corporate chan- nels. The consumer is dictating where and how they want to get treatments done, and the providers are adapting to this new reality. It is very healthy for the industry.”
In Mr. Albright’s opinion, “It is a happy marketplace. If you do a really good job with your patients, then they tend to stay with you for a long time. And there is not a lot of governmental or regulatory scrutiny if you do things well.
“For all the above reasons and more, aesthetics is a very good field in which to run a medical business.”
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