This week in aesthetics, Dr. Suneel Chilukuri discusses the medical “gym” and nonsurgical tools and approaches for improving facial rejuvenation results, we highlight the latest skincare trends for the aesthetic practice, Dr. Amir Moradi talks HA injections for upper eyelid laxity, Cheryl Whitman explains the importance of online retail and a strong social media presence during the pandemic, and Dr. Ronda S. Farah shares how to differentiate between consumer at-home hair loss devices.

In-office muscle toning plus fat reduction sets the stage for pandemic-inspired medical gym memberships.

We cover the latest skincare trends in the consumer world to help keep aesthetic physicians in the know.

Dr. Sam Lam provides insights and updates into the latest and greatest in hair restoration methods and advances.

Dr. Amir Moradi discusses his approach to thicken the upper eyelid skin using hyaluronic acid injections.

This week, Cheryl Whitman highlights the need for practices to embrace and expand their online presence through social media sites and retail opportunities during the pandemic.

The pandemic has fueled high demand for at-home hair growth devices, making it especially important to become familiar with consumer options.

Dr. Suneel Chilukuri discusses taking nonsurgical tools and approaches that help to maintain and improve facial rejuvenation results.

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This week in aesthetics, we highlight HA injections for upper eyelid laxity, at-home hair loss devices, and more.

This Week in Aesthetics: November 23-27

The pandemic has brought with it a plethora of challenges. But it’s also created opportunity for innovative treatment solutions in the aesthetic practice.

“Body contouring continues to grow in double digits, even during the pandemic, which is pretty amazing,” says Suneel Chilukuri, MD, Refresh Dermatology, Houston, Tex.

While some people have remained dedicated to their fitness routines despite gym shutdowns and limitations, there are many who may be looking at themselves nine months later with the realization that they need some help getting back to it.

Among the muscle toning technologies available, the newest one, Emsculpt Neo (BTL Technologies, Prague), offers the unique benefit of simultaneous muscle toning plus fat reduction.

“It's never been done,” says Dr. Chilukuri. “It combines in one paddle a combination of radiofrequency at the right temperature to destroy fat—we know that's between 42 and 45 degrees consistently for greater than 20 minutes—and at the same time, it's pulsed in synchrony with high intensity focused electromagnetic (HIFEM) technology. So it's building muscle [and] destroying fat.”

Seven independent studies of Emsculpt NEO were performed using MRIs to look at animal and human histology, which isn’t typical, according to Dr. Chilukuri.

“And the results are remarkable,” he says. “Across the board with the MRI studies, we're seeing that there's a 30% decrease in fat. It's the greatest of any noninvasive body contouring technology that's out there—25% increase in muscle, and 19% decrease in the separation of the abdominal muscles (diastasis recti). And we're seeing on average, approximately two to 2.5 inches circumferential reduction of the waistline.”

The pandemic of 2020 has created a sedentary segment of the population who has found it difficult to find motivation and struggle with resulting muscular weakness and discomfort.

“That is one of the things that we saw immediately coming out of COVID when we were able to reopen our offices,” says Dr. Chilukuri, who discovered a functional use of muscle building technologies for issues including neck and lower back pain.

“We offer what we call a medical gym membership. So we know that it's a sterile surface, we know that we're cleaning everything down. And we're able to improve the core both by treating the abdominal area as well as the gluteal area to decrease back pain and improve posture,” he says.

Once patients receive muscle rehab treatment and the pain is gone, there are two ways Dr. Chilukuri advises patients to maintain it.

“Either they come in as a monthly membership, and they do one treatment per month. Or I say just come back as needed… as soon as you feel that first twinge of pain, you know something's not right, come back in. So you don't have to do a full treatment series. It's not quite as expensive either,” he says.

Dr. Chilukuri believes the functional use of muscle building technologies will continue to gain traction to address neck and back pain, but also expects it to branch out into an extension of the gym.

“I think especially if gyms continue to stay shut down, or patients are still not comfortable going to gyms, we're going to see more changes, especially in this space right now with the muscle category that's out there,” says Dr. Chilukuri.

The Aesthetic Practice-Turned Gym?

Hair restoration expert, Samuel M. Lam, MD, facial plastic surgeon, Dallas, Tex., provided an overview of what’s new in hair restoration at the 2020 Annual Meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). These are his insights for the 10 areas covered in his presentation, “Hair Update: Latest and Greatest.”

In terms of follicular unit extraction (FUE), graft survival is better today than it was in 2018, says Dr. Lam. In fact, he says they survive nearly or as well as strict grafts. Why? New generation hybrid punch technologies, including Harris Hex Punch, Devryoye Hybrid Punch, and the Trivellini Mamba Punch.

“These hybrid punches have two big benefits. One is a set of huge rotational energy. They're just a gentle, gentle oscillation method that treats the graphs very well. The second thing is that they have a flared punch, so there's a blunt front, and a sharp edge on the side. So, it cuts sharp, but it bluntly touches the graph without much damage.”

Men don’t want to risk side effects with topical finasteride, says Dr. Lam.

“There's still a risk of side effects, but it's greatly diminished without an oral component. You still can get incredibly good results with topical finasteride.”

Addressing hair loss shouldn’t be left to medical therapies alone, says Dr. Lam.

“I think …nutritional supplementation can truly help people with hair loss.”

Scalp micropigmentation (SMP) can help hide scars and be used for central density, especially after a hair transplant, says Dr. Lam. SMP can also create a shaved scalp look.

“Scalp micropigmentation is your friend and done well by good artists, not just someone that has just been trained overnight to do this.”

From overplucked eyebrows to what Dr. Lam calls “unattractive Mark Groucho-style tattoos,” eyebrow transplant is the hardest thing to do well, he cautions, and recommends only working on eyebrows after spending 5 to 10 years performing hair transplants first.

“4.5x magnification loupes are huge for eyebrows and have been a game changer in how I do it. We must make those angles tight and low. This is the absolute hardest thing to do.”

Dr. Lams says he performs female hair transplant for patients with hair loss from chemotherapy, brain surgery, and high hairlines.

“Female hair transplant is a huge part of my practice for traction alopecia cases, for chemotherapy loss. Hairline recession [also] occurs with aging.”

7. The Rise of Frontal Fibrosing Alopecia (FFA)

A type of scarring hair loss linked to sunscreen use, frontal fibrosing alopecia (FFA) may look like conventional hair loss, says Dr. Lam, but it’s very different.

“[It] is a type of scarring hair loss that has been linked to sunscreen use. And oftentimes if you just stop the sunscreen, some of this can be reversed… Graphs that are transplanted may not survive well. [FFA is] one of those things that I highly encourage you to really research and understand before you begin to do transplants because if you transplant this, you will fail. It will be not the right thing for the patient.”

Dr. Lam says facial hair transplants can involve beard FUE as corrective surgery to replace bad hair transplants on the scalp and for a sparse beard itself.

“Facial hair transplants are huge, especially beard-to-beard transplants… this is something I do quite a few of, taking beard from underneath the chin and migrating it up to the face.”

More than simply a hair transplant procedure, this is something that deserves an entire lecture to discuss, says Dr. Lam. Notably, it’s something that can help to address gender fluidity and other specific requests or needs.

“You can get really nice transplants, especially for someone that may either have undergone female feminization surgery or is contemplating that.”

Dr. Lam explains bioenhancements as “fertilizers that help hair grow better,” and it’s one of his favorite subjects, he says.

“To me this is the reason that my grafts are growing so much faster and better…. I think part of the reason, besides good technique, [hair transplants] survive so well is using all these different formulas of hypodermis salt, ATP, ACell and PRP.

Dr. Lam is the course director for the 12th annual Hair Transplant 360 workshop: A Comprehensive Hair Transplant Course: FUT & FUE Hans-on Course, July 23 and 24, 2001 in St. Louis, Mo.

“It’s a great course for you to learn how to learn a lot about how to do this,” he says. “It’s hands on, which is the key.”

10 Hair Restoration Trends

Skinbetter Science Solo Hydrating Defense Men

Created with men in mind, this light moisturizing gel-cream offers antioxidant protection with the company’s patented WEL by Skinbetter technology against the effects of UV radiation, blue light, and pollution-induced oxidative stress. According to the company, 96% of users report overall improvement of the skin in as early as four weeks with once daily use.

Theraderm’s Anti-Aging Lip Complex creates soft and healthy lips without the discomfort that comes from a usual plumper. Designed to reduce the appearance of wrinkles and fine lines around the mouth, the daily lip treatment includes avocado oil to soothe and vitamin E for hydration, without any parabens, gluten, menthol or camphor.

The Aftermask is specifically designed to cover only the parts of the face affected by daily COVID-19 mask wearing where sweat and bacteria build up. Fragrance-free, cruelty-free, and nutrient-dense, the mask contains aloe leaf extract, cucumber fruit extract, burdock root extract, hyaluronic acid, hemp seed oil, lemon peel oil, and lavender oil to heal and cleanse.

VI DERM’s Retinol Age-Defying Moisturizer uses glycolic acid to drive cell turnover and retinol to repair skin cells and generate new collagen. Infusing retinol with THD Ascorbate, the only form of Vitamin C that penetrates the dermis, this moisturizer allows for fast-acting correction of skin discoloration, according to the company. Other key ingredients include azelaic acid to reduce current and future breakouts and green tea for anti-aging benefits.

This three-step at-home skin treatment kit uses stem cell science to stimulate cellular regeneration and lift and tighten facial skin, according to the company. The kit includes Intensive Allograft Skin Serum, a rechargeable and reusable StemCell Revive Pen, and a 30-day supply of Hyaluronic Essence Ampoules for daily application. The kit is also available in a commercial grade for medical spas.

We cover the latest skincare trends in the consumer world to help keep aesthetic physicians in the know. 

Skincare for the Aesthetic Practice

At the recent 2020 American Academy of Facial Plastic and Reconstructive Surgery (

) virtual meeting, Amir Moradi, MD, facial plastic and reconstructive surgeon, Moradi M.D., San Diego, Calif., discussed his approach to thickening thin, crepey upper eyelid skin with hyaluronic acid injections.

Upper Eyelid Treatments: Using Hyaluronic Acids to Improve the Thickness of Upper Eyelid

,” Dr. Moradi discussed a study he conducted that examined the results of injecting micro-doses of a low hydrophilic HA filler (primarily Restylane) both deeply and superficially into the upper eyelid. Results suggest that this is an effective approach in patients in their 30s who may not need a blepharoplasty yet.

He also found that after a year post-HA injection, the HA could still be seen over the muscle and in the orbicularis oculi muscle.

Dr. Moradi emphasizes the need for gaining an extensive knowledge of the anatomical area before attempting treatment due to the high volume of vessels and related ocular risk.

Videos

Dr. Amir Moradi discusses his approach to thicken the upper eyelid skin using hyaluronic acid injections. 

HA Injections for Upper Eyelid Laxity

Online Retail Has Increased Exponentially During The Pandemic And The Trend Will Continue.

Over the past few months, the retail world has turned upside-down. With many businesses temporarily closed due to the world-wide pandemic, on-line retailing has become even more prevalent. “I expect the growth in online shopping to continue after the pandemic has ended. Consumers have realized how convenient it is to do things from the comfort of home,” explains Cheryl Whitman. What this means for your practice is that to achieve success, you must embrace doing business virtually. Promote your brand across a variety of social media channels, such as Facebook and Instagram. Make YouTube videos, offer Webinars, and make sure your practice website is up-to-date, easy to find, and easy to buy from. Your website should be search engine optimized and formatted for access by mobile devices. Offer a variety of payment options such as net banking, credit/debit card, PayPal, Apple Pay, Google Pay, etc. Provide consistently great customer service. Personalize their experience and reward loyalty with special promotions, spa dollars, gift certificates, etc. Design personalized promotions for patients based on their buying history. Everyone likes to feel special and by making existing patients feel special, you will not only retain them, but your practice will benefit from their repeat business and their referrals.

This tip is adapted from “Beautifully Profitable, Forever Profitable,” by Cheryl Whitman.

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This week, Cheryl Whitman highlights the need for practices to embrace and expand their online presence through social media sites and retail opportunities during the pandemic. 