BBI Contributing Editor

SAN FRANCISCO, California – Skin rejuvenation vied with hair removal as the most popular trend at this year's meeting of the American Academy of Dermatology (AAD; Schaumburg, Illinois), with numerous innovative products entering the market. An estimated 17,000 people attended the annual meeting at San Francisco's Moscone Convention Center to shop, buy, and sell an amazing array of aesthetic technologies. All leading manufacturers used this convention as a platform to launch new products. And many new companies debuted their equipment at this important show.

Virtually every type of energy source is being commercialized for this application, including various lasers, light sources, electrosurgery (coablation), ultrasound and microdermabrasion. These devices are generally less expensive than lasers to purchase, and can be operated by aestheticians in some cases. Thus, physicians recognize noninvasive skin rejuvenation as an economical, low-maintenance tool to generate private-pay revenues.

One of the most unique and promising approaches involves the combination of ultrasound with microdermabrasion and skin care products to treat wrinkles and stretch marks. IntegreMed (Scottsdale, Arizona) developed this system in conjunction with leading dermatologist and laser guru David McDaniel, MD. This company has licensed a patent on the process from McDaniel, and FDA marketing clearance for stretch mark treatment is expected in the near future. Priced under $25,000, this technology received a warm reception from curious dermatologists at the AAD and will likely attract companies that want to add this product to their aesthetic arsenal.

ESC/Sharplan (Norwood, Massachusetts) introduced a new line of intense pulsed light (IPL) devices to replace their previous product line. These systems are much more compact, faster, and less expensive, they feature improved operating parameters, and they have integrated a contact skin cooling method. In addition, ESC recently obtained expanded FDA clearance for permanent hair reduction and treating all skin types (including Type VI) with its IPL-based hair removal products.

The newest application for IPL technology is photorejuvenation, or non-ablative skin rejuvenation using intense pulsed light. Like other non-ablative approaches, the general theory involves the controlled delivery of energy to the skin to affect improvement in skin quality via subtle changes in collagen. However, the IPL approach also addresses vascular and pigmentation irregularities. ESC is recommending that physicians offer patients a treatment package including five sessions scheduled over four months. A typical patient charge for this treatment regimen is $2,500 – providing another source of revenues for aesthetic practices.

Candela (Wayland, Massachusetts) caused excitement and shook up the market by launching the new Vbeam vascular laser with extended pulse durations at a special introductory price of $79,500 (including a three-year, full-service warranty). Vbeam's warranty covers all service and consumables, including dye kits and DCD cryogen, for the first three years. Thus, Candela has removed many of the economic objections to owning and operating a pulsed dye laser. "Vbeam puts the pulsed dye laser into a different product category," said Paul Cardarelli, Candela director of marketing. "Now, for the price of a low-end vascular laser, you can get the proven, gold-standard PDL with the widest range of clinical applications." This new treatment approach produces a more gentle heating of blood vessels, resulting in uniform coagulation. And the ultra-long pulse duration eliminates problematic purpura associated with earlier versions of the PDL.

The first Vbeam clinical studies performed at Boston University (Boston, Massachusetts) show that, when compared to existing pulsed dye lasers, Vbeam produces equivalent if not better clinical results with little or no purpura. "Patients treated with Vbeam found the treatment less painful than with existing pulsed dye lasers, and the majority of patients experienced no post-operative purpura," reported clinical study director Steve Ugent, MD, assistant professor of dermatology at Boston University School of Medicine. Researchers believe that Vbeam also will have applications in non-ablative facial rejuvenation, based on the concept of delivering controlled thermal energy to the skin over multiple treatments.

Cynosure (Chelmsford, Massachusetts) fired back at long-time industry rival Candela by introducing a long-pulse (up to 40 ms) vascular laser of its own, but priced even lower at $64,900. The PhotoGenica V-Star laser also is a pulsed dye system; however, it comes with a one-year warranty rather than the three years offered by Candela. Several other new products were announced by Cynosure at AAD, including the Accolade alexandrite laser for tattoo removal and treatment of pigmented lesions; the Apogee 9300 alexandrite for hair removal, operating at up to 3 hertz (priced at $79,500 for the show); and an optional large-area treatment scanner priced at $14,500.

Palomar Medical Technologies (Burlington, Massachusetts), which believes that super long-pulses in conjunction with contact cooling improve hair removal efficacy, has developed the science and the technology to prove it. Only one year after divesting its LightSheer diode technology to Coherent (Palo Alto, California), Palomar re-entered the diode-based hair removal market with another diode system. The new SLP 1000 diode laser delivers more that 100 J/cm² of 810 nm laser energy at up to 3 pulses per second, with pulse lengths ranging from 200 ms to 1000 ms. This compact tabletop system weighs only 25 kg. It uses a contact SheerCool cooling handpiece developed by Palomar that delivers a 10-mm spot size to the skin. SLP is priced at less than $70,000 and is intended for treatment of any skin type. In addition, SLP can be used for vascular procedures by adjusting the output parameters.

Patent licensing also represents a productive business development pursuit for Palomar. Based on some fundamental skin cooling patents which Palomar licensed exclusively from Massachusetts General Hospital, this company has locked up 7.5% sublicensing arrangements with Coherent, Laserscope (San Jose, California), and Iridex. Going forward, Palomar plans to license every company that incorporates skin cooling with hair removal technology.

Diomed (Andover, Massachusetts) has developed a family of compact diode laser systems for various aesthetic applications. These products range from a low-power, low-price model A-100 for the treatment of superficial telangiectasia to the A-400 for large-area hair removal. These systems are being sold internationally while Diomed establishes distribution partnerships in the U.S.

Asclepion (formerly Aesculap-Meditec), now a public company on the German Neuer Markt, introduced the MeDioStar high-power diode laser for hair removal. Its design seems to address all the shortcomings of previous-generation diode lasers for hair removal. This laser operates at a 4 hertz pulse repetition rate (4 pulses per second), delivers an energy fluence of 60 joules per square centimeter in a 12-millimeter spot, and incorporates a skin-cooling handpiece. Optional features include a 16-mm handpiece and a contact cooling approach is used to compress the skin and enhance efficacy. The list price of MeDioStar is $89,900.

Long-pulse laser technology is a definite trend at this time, with all types of lasers expanding their treatment range and efficacy in this way. At least three manufacturers have commercialized long-pulse YAG lasers for hair removal and vascular treatment. These include Altus Medical (Burlingame, California), with the CoolGlide system; Laser Aesthetics (Auburn, California), with the Varia laser; and Laserscope, with Lyra. Both Altus and Laserscope recently obtained FDA marketing clearance for hair removal with their products, while Laser Aesthetics is pending. In the near future, we can expect more long-pulse YAG lasers for hair removal to enter the market as manufacturers take the opportunity to utilize this relatively mature laser technology for new applications.

Continuum Biomedical (Livermore, California) is under new management and making a strong effort to reclaim market share. This company, which has a large installed base of YAG and erbium aesthetic lasers, exhibited a full range of products at the AAD gathering. These included: the 3J CB erbium laser, priced at $60,000; the high-power MedLite IV YAG for multiple applications including hair removal, tattoos, and vascular, priced at $95,000; and the SparklePeel microdermabrasion unit priced at $18,000.

Coherent Medical Group upgraded its popular LightSheer hair removal laser product line with the model XC, which has a larger spot size (12 mm) and longer pulse width (100 ms) than previous models. According to the company, these features allow users to safely treat patients with darker skin types and to increase the speed of treatments. Coherent also surprised the industry by adding a SkinScape microdermabrasion product line. This is the first non-laser aesthetic treatment device ever offered by a company that has established the largest installed base of medical lasers in the world over the past 30 years. "SkinScape gives us an opportunity to expand our customer commitment beyond lasers to yet another valuable procedural tool," said Phil Tusa, vice-president of Coherent's aesthetic business unit.

Likewise, several laser companies have added microdermabrasion devices to their product repertoire recently as this low-cost technology has almost eliminated sales of skin resurfacing lasers over the past two years. According to market research conducted by Medical Insight (Mission Viejo, California), an estimated 8,000 microdermabrasion units will be sold worldwide this year, generating more than $100 million in equipment revenues. In addition, consumable abrasives and related skin care products will provide at least another $50 million of annual sales for suppliers.

Unprecedented economic prosperity, an aging population, and practices seeking to expand private pay aesthetic services, all bode well for the continued growth of microdermabrasion treatment volume. The American Academy of Cosmetic Surgery (Chicago, Illinois) conservatively estimated that more than 400,000 microdermabrasion procedures were performed in the U.S. last year. However, this relatively new skin rejuvenation technology, which has several benefits vs. lasers and traditional chemical peels, has not yet been embraced by the largest segment of the medical community.

"Until now, about 80% of microdermabrasion has concentrated on the face," said Joe Kenis, vice president of sales and marketing at Derma Genesis (Laguna Hills, California). "But we need to move off the face, such as onto the chest and back. This certainly opens up the market." Derma Genesis has five microdermabrasion models in the field, ranging from an entry-level, price-competitive unit to a digital, premium-priced system. "Our goal is to introduce products that will really free the physician market from insurance revenue," Kenis explains. The company has deliberately focused on the medical market vs. the spa/salon market. "Physicians don't want to compete with the beauty parlor," Kenis said.

"There are a lot of players in the business right now," said George Maguire, executive vice president and co-owner of DermaMed (Media, Pennsylvania). "But we are different from most because we have not reverse-engineered. We have control of our crystals." In addition, "all of our competitors have a very small filter that causes a lot of the clogging." In contrast, the filter for DermaMed's MegaPeel "has a volume capacity that is at least 100 times greater. We're able to perform 30 to 40 procedures without having to change the filter," Maguire said. Maguire said the ideal candidate for microdermabrasion is someone "with fine lines, pigmentation or sun damage. We've all sat on the beach when we were younger. People are going to continue to develop sun damage whether they're out of the sun or not." Acne can also be effectively treated by microdermabrasion. Furthermore, general practitioners, internists and OB/GYNs are now purchasing units. "The patient is looking for good results with the least amount of downtime as possible," Maguire said. "In many cases, within two hours you're pretty much back to normal."

"The medical market has opened up to aesthetics so much in the past few years," said Isabel Dassinger, executive vice president at Slimtone USA (East Rutherford, New Jersey). "Within the next few months we're going to introduce other equipment that uses electromuscular stimulation for both the face and the body. Some of these systems and units require FDA approval and are classified for medical use only." The most recent advancement for Slimtone's Diamond Microdermabrasion Turbo system, which debuted last November, is the availability of completely disposable canisters for used crystals and a large-volume container for new crystals. "It is also a unit that really can combine microdermabrasion and dermabrasion," Dassinger said. "In the beginning, we were all looking at microdermabrasion as simply a resurfacing treatment. But we now realize it has an effectiveness below the surface. This 'micromassage' action below the skin alters the skin cells so you have nourishment, oxygenation and cleansing."

Diane Carrier is president, CEO and cofounder of ExcellaDerm (Rancho Santa Margarita, California). The company recently signed an agreement with Coherent to manufacture and privately label its California Peel and Beauty Peel microdermabrasion units. "They were impressed with our reliability and our 90-degree direct particle bombardment handpiece," Carrier said.

As for future advancements, "of course, we're always striving to develop a better product," Carrier noted. "But I don't think a great microdermabrasion machine is going to be one with oxygen or salt attached to it. There are so many weird things out there now." Nonetheless, Carrier envisions a bright future. "I think it will grow. I see it becoming acceptable in many different medical arenas," she said. However, over the next two years, she feels the industry will consolidate to only "three great companies. It's not just the machine, it's usually the integrity of the organization as well. You need to be able to answer the concerns of the customer."

Carrier also advocates stricter FDA guidelines for microdermabrasion. She said that leaving the industry like it is will result in its demise. "There are so many companies that are not registered with the FDA. They are in it for a quick buck," Carrier said. "If we weren't so far down the food chain with the FDA, we could actually have a much more credible product."

Regardless, microdermabrasion "will continue to grow for at least the next five years. We have barely scratched the surface, no pun intended," said Pat DeJacma, vice president at Aesthetic Lasers (Annapolis, Maryland). "The salon and spa market is growing by leaps and bounds every month. This procedure is catching on like wildfire among consumers." Her company's Power Peel 2000 M is the latest medical version, DeJacma said.

Two areas of customer concern have been identified by Aesthetics Lasers: exposure to the aluminum oxide crystal and the ease of use. "We're trying to make changes that will make our unit more user-friendly," DeJacma said. She acknowledged, though, that some of the competition "is attempting to change the abrasive medium. So anything other than aluminum oxide needs to be tested for effectiveness. But we are satisfied that the aluminum oxide is safe and we know that is it effective. Aluminum oxide has unique properties that make it the ideal abrasive."

Mario Barton, managing partner at IntegreMed (Scottsdale, Arizona), begs to differ. The company's DermMaster microdermabrasion unit uses sodium chloride – table salt – as its abrasive medium. Barton said scientific testing has shown sodium chloride to be a more efficacious agent than aluminum oxide. "Sodium chloride is also non-toxic, unlike aluminum oxide," he added. "Sodium chloride doesn't have the potential hazardous characteristics that aluminum oxide possesses ... the possibility of inhaling this stuff and for it to end up in the lungs is fairly high," he said. "There are over 30 peer-reviewed papers that suggest aluminum oxide may be hazardous. On the other hand, salt is harmless. So it's an easy choice."