BBI Contributing Editor
Spurred on by an aging population determined to turn back the clock, a number of novel skin treatment technologies are competing for consumer acceptance.ThermaCool is a radio frequency device from Thermage (Hayward, California) that cools the epidermis while depositing deep and intense heat deeper into the skin. "Depending on the size and type of the electrode, and the amount of energy applied, you can direct sustained heat to almost anywhere you desire," said Suzanne Kilmer, MD, president of the American Society for Laser Medicine and Surgery (Wausau, Wisconsin). Heat is placed deeper into the skin to help tighten up collagen fibers and possibly even target fascia. In effect, ThermaCool can achieve a brow lift effect, for example. "We use the term Thermalift," Kilmer said. "We're also looking at tightening up abdominal skin."
Patients with moderate-to-severe acne (with or without scarring) benefit as well. "The device can really have an Accutane effect," she said. On the other hand, "there is a fairly significant amount of pain," noted Kilmer, who applies an anesthetic cream and oral analgesics. Cryogen spray also is delivered before, during and after the application of heat. "We're working on better pain control," she said. In addition, overall results "are more unpredictable compared to laser resurfacing. But there is little or no downtime."
Richard Fitzpatrick, MD, a dermatologist in private practice in Encinitas, California, said ThermaCool provides "a safe, nonsurgical means to tighten skin. The regions where it is having the most impact in my practice is the lower cheeks, jawline and anterior neck. It is similar to a lower facelift." He also noted that the technology is at a stage "where no one has found the ideal settings or treatment protocol. I don't anticipate a set number of sessions. Some patients seem to respond very well in a single session, while others have taken as many as three sessions. There definitively is a spectrum of response, ranging from very subtle to dramatic."
Electron microscopy studies demonstrate ThermaCool has interaction with fibrous sheets as deep as 4 mm or 5 mm underneath the surface of the skin. "It's a much deeper treatment that anything else we have," Fitzpatrick said, adding: "It's also a much deeper pain for the patient than surface-type burning." Therefore, he is careful to remind patients that they need to endure some discomfort. For patients who are not tolerant of discomfort, he recommends placing anesthetic cream under occlusion for a few hours prior to treatment.
Besides treating the face, Fitzpatrick sees enormous potential for ThermaCool in treating the breast, buttock, elbow and knee. "These are areas that women often complain of wrinkles or loose skin," he said. "Currently, we don't have any significant treatment for these areas. If we can perform a nonsurgical breast lift, I believe this will be a huge advancement. Combining it with liposculpture seems a natural fit."
Environ Cosmeceutics North America (Mashpee, Massachusetts) is a distributor for Environ Skin Care Systems in South Africa, founded by renowned plastic surgeon Dr. Desmond Fernandez, who practices in Cape Town. The Medical Roll-CIT (collagen induction therapy) is a patent-pending instrument using collagen channeling. The instrument, comprised of microneedles on a roller head, is rolled on the skin using local or topical anesthetic. "When the instrument is applied to the skin, it creates channels into the dermis," said Carol Trow, director of Environ Cosmecueticals North America. "These cause keratinocytes and fibroblasts to produce numerous growth factors, which induce collagen without any damage to the epidermis." The Medical Roll-CIT lists for $220 and is sold only to physicians. One roll can be used on the same patient two to three times. "Results are softened fine lines, tightening of the skin and restored elasticity, thickening of the skin, reduction of the appearance of scarring and reduction of pigmentation marks," she noted. Treatment sessions range from 10 minutes to an entire hour, depending on the area treated. Environ also offers the Cosmetic Roll Kit for home use that creates natural collagenesis. "The roll allows for increased penetration of vitamins into the active layers of the skin by creating microscopic holes," Trow said. The kit lasts two to three years and costs around $550.
The Futur-Tec from Ageless Aesthetics (Littleton, Colorado) is a comprehensive anti-aging face and body machine that relies on ultrasound for skin exfoliation, microcurrent for wrinkles, vacuum for lymphatic drainage and healing light for blemishes. Marketed to aestheticians, the Futur-Tec is suitable for day spas and other skincare centers. The machine lists for $12,900, which includes two days of training. "With the Futur-Tec, there is better tone and texture of the skin, decreased blemishes, as well as softening of lines and wrinkles, after a single treatment," said company president Shannon Britt. Packages generally range from six to 10 sessions. Facial treatments are weekly.
Ageless Aesthetics also offers the Biotec, a combination of microcurrent and galvanic current designed for nonsurgical facelifts, body treatments and general skin improvement. The device lists for $9,900 (again with two days of training). For a facelift, approximately 10 one-hour treatments over a one-month period are recommended. "Depending on skin type, results can range from a minor improvement in softening of lines and wrinkles to a profound, almost facelift effect," Britt said. "We believe that after a series of treatments, patients often turn back the clock 10 years."
Microcurrent alone or in conjunction with other technologies "has shown good results without the need to introduce harsh abrasives, such as crystals used in microdermabrasion," Britt noted. "There is concern about the long-term effect of aluminum crystals on both the client and practitioner." In addition, "one of the most astounding things about microcurrent are the results achieved after only one treatment," he said. "This is not technology that takes four to six treatments to see noticeable improvement."
In October, the CoolGlide family of aesthetic lasers from Altus Medical (Burlingame, California) received FDA clearance for the treatment of wrinkles, including periocular and perioral. The 1064 nm Nd:YAG Vantage "successfully treats wrinkles, plus patients have noticed an overall improvement in their skin tone including a reduction of pore size, improvement in textural smoothness and a dramatic reduction in facial redness," said Bruce Russell, MD, a dermatologist in private group practice in Beaverton, Oregon. "The overall appearance is healthy, young and vibrant." The Vantage's dynamic range of operating parameters and minimally invasive wavelength also is suitable for unwanted leg and facial veins and removal of hair.
Phytobiodermie from Phyto Distribution (Fort Lauderdale, Florida) is part of a skincare line of natural products that originated in Switzerland. "These products are based on the energetic principles of traditional Chinese medicine, such as acupuncture," said company president Jon Canas. "Basically, we are working with energy as well as matter when we do treatments." Phytobiodermie works with the energy of light, and colored light in particular. "Light is a very pure form of energy. And as we use different colors, they harmonize with certain conditions of the skin," he said. The firm's Chromapuncter machine retails for $4,000 and involves light passing through dichroic filters. "These filters provide for a very pure energetic light," Canas noted. "The specific vibrations of each color is the potent agent." Five sessions are ideal, spaced at two- to three-day intervals. Sessions typically last from one hour to one hour and 20 minutes. "Even after only one session, there is an improvement in toning, firmness and lifting," he said.
Stephen Mulholland, MD, a cosmetic plastic surgeon in private practice in Toronto, Ontario, has developed the Pan-G Lift, a procedure that simulates many effects of a facelift without a knife. "It's like joining a fitness club for your face," he said. High-voltage electrical current and resistive tensile loading of fascial muscles combine with high-frequency ultrasonic cavitation forces. The 10-week program, twice a week, consists of roughly 45-minute sessions. "You can end up with between 4 mms and 9 mms of brow elevation and 40% to 50% elevation in the cheek and neck," according to Mulholland. The Pan-G Lift was cleared by the FDA last August for muscular fascial therapy and epidermal-dermal therapy. The device, known as M.E.D.U.C.E. (muscle epidermal dermal ultrasonic cavatational electrical system), is produced by Pangerminal Systems (Clearwater, Florida). It can operate up to 100 milliamps and lists for $69,000. "In the future, I expect a lot more DNA-based therapies such as topical stem-cell therapies that will be blended with or without light to turn the clock back," Mulholland said.
The Cryoprobe ($1,300) from Belgium uses liquid nitrogen in gas form (nitrous oxide) that is stored in small cartridges and placed in a pen-shaped container. "To emit the gas, a doctor simply has to press the container," said Pat Lam, vice president of Skin Care Consultants (Toronto, Ontario), which distributes the device. "The Cryoprobe can remove a large variety of skin disorders, such as capillaries, skin tags, keloids and warts," Lam said. One treatment, or a maximum of two, is recommended.
Skin Care Consultants also distributes the Lamprobe ($3,900), which combines high-frequency current with radio-wave frequency. "Different-sized probes are used to remove skin lesions," Lam said. Similar to the Cryoprobe, the Lamprobe can also remove plaques on the eyelid and treat sebaceoushyperplasia.