Jason Pozner, MD

Now that the days of safe in-person services are returning, and thanks to consumers with pent-up buying impetus and a year’s worth of savings, the dermatology and cosmetic surgery sectors are experiencing a notable trend: The popularity of minimal to noninvasive cosmetic procedures is surging. Chief among those procedures is the patented MyEllevate light-guided suture technology for facial rejuvenation. As clients experience these innovative techniques and their significant results with negligible recovery time, they are referring their friends and coming back for more. MyEllevate has become the poster child for minimally invasive procedures. Cynosure’s recent acquisition of MyEllevate confirms the method’s arrival as the leader of this new and improved generation of technology.

The question most people ask is what is MyEllevate, and how did this paradigm shift occur in a steadfast industry like cosmetic surgery?

Gregory Mueller, MD, FACS, a plastic surgeon in Beverly Hills, California, developed MyEllevate and the ICLED light-guided suture system. The highly effective neck rejuvenation technique has minimal downtime and long-lasting results. In addition to its speedy recovery time, MyEllevate effectively treats a broad range of aging-related concerns: from excess neck fat to bulging glands and prominent platysma bands.

MyEllevate was designed very simply as a percutaneous approach to placing a neck suspension suture. Vincent C. Giampapa, MD, FACS, and Barry DiBernardo, MD, published an article in 2000 on placing a neck suspension suture during an open facelift.

 Mueller took this concept and over a 15-year period developed the MyEllevate procedure. Initial variations had issues with the depth of suture placement, which led to the light-guided approach of the procedure. He experimented with many types of absorbable and permanent sutures, finally deciding on a 4-0 braided permanent suture.

The surgeon performs the procedure in an operating or procedure room under local anesthesia or intravenous sedation of general anesthesia, according to the patient’s wishes. The approach is simplified and broken down into easy-to-learn steps.

The patient is prepped and the platysma bands, if present, are marked and injected with local anesthetic. A puncture wound is made adjacent to the bands with a specialized puncture tool and then the attachments are cleared with a “clearing” tool that is part of the ICLED kit. The rod and Suturod suture, also included in the kit, are placed deep and superficial to the band. The band is then cut by sawing the suture back and forth until the suture pulls through.

The neck is tumesced with 300 to 400 cc of standard tumescent solution. If desired, the physician can use an energy-based device internally; however, this step may be omitted.Commonly used devices include Precision Tx SmartLipo (Cynosure),

 or the Vaser ultrasonic system (Solta Medical).

 Liposuction is then performed and damaged fat is removed, and the area is additionally undermined by the liposuction cannula.

). The light is activated and placed on the rod, then the light-guided suture is placed through standardized puncture sites. The suture is tied through the first puncture site and cut. The rod is then used to help bury the knot. Finally, a dressing is applied.

The procedure is routinely performed in under 1 hour and patient recovery is swift. Patients are asked to wear a soft collar for 10 days after surgery and many resume normal activities within 48 hours.

The MyEllevate team vets all physicians before they are trained in the procedure to help maintain quality control. Physicians are asked to go to the Myellevate.com website to register and then watch a recorded procedure. Live training is available at 4 US sites and a trainer is sent to observe the physician’s first 2 cases.

The procedure has been rapidly implemented by physicians and has generated much interest from patients in recent times. An article in 

magazine brought national exposure to MyEllevate in its December 2020/January 2021 print issue, dubbing the procedure the “Zoom Lift.”8

The procedure’s popularity started with the struggle shared by many people during the early days of Covid-19, which in turn abruptly introduced the work-from-home culture. Dermatologists and plastic surgeons were suddenly inundated with requests and complaints about previously unobserved “trouble areas,” and their appointment books began to fill quickly. On a global scale, working professionals went from looking at their faces for perhaps 30 minutes each day—from a glimpse in the mirror to a quick FaceTime call and the occasional selfie—to staring at them for 8-plus hours daily on Zoom as they worked remotely. This increased, targeted focus on facial features led to many plastic surgeons’ clients scrutinizing their imperfections on an intensified level that substantially raised the demand for cosmetic procedures, including MyEllevate.

Mueller is the creator of MyEllevate. Pozner and DiBernardo stockholders in ICLED Surgical and trainers for MyEllevate.

1. Cynosure to acquire MyEllevate, innovative minimally invasive facial rejuvenation treatment. Cynosure, Inc. Press release. April 30, 2021. Accessed June 8, 2021. 

https://www.prnewswire.com/news-releases/cynosure-to-acquire-myellevate-innovative-minimally-invasive-facial-rejuvenation-treatment-301281186.html

2. MyEllevate. MyEllevate. Accessed June 8, 2021. 

3. Giampapa VC. Suture suspension technique offers predictable, long-lasting neck rejuvenation. 

. 2000;20(3):253-255. doi:10.1016/S1090-820X(00)70026-4

4. Precision Tx. Cynosure. Accessed June 8, 2021. 

https://www.cynosure.com/product/precisiontx/

5. FaceTite: minimally invasive face contouring. InMode. Accessed June 8, 2021. 

https://inmodemd.com/technologies/technologies-facetite/

6. Renuvion. Apyx Medical. Accessed June 8, 2021. 

7. Vaser ultrasonic system. Solta Medical. Accessed June 8, 2021. 

Articles

Expert physicians highlight the rise in minimally invasive procedures using the MyEllevate light-guided suture technology for neck and facial rejuvenation.

MyEllevate Reinforces Trend of Minimally Invasive Procedures 

Moxie is slang for having guts or attitude. And it pretty much sums up Sciton’s new fractionated 1927 nm thulium device called Moxi.

U.S. aesthetic surgeons are finding the 1927 nm wavelength is a rising star in facial rejuvenation. It’s a great option for patients who don’t want the more aggressive treatments but are looking for a treatment that will address their photodamage with little to no downtime.

There is growing demand for fractional facial resurfacing, according to recent statistics. 

 reported in its 2019 statistics that micro-ablative resurfacing (fractional resurfacing) experienced the largest increase among selected nonsurgical procedures, rising 71.9% from 2018 to 2019. Member surgeons reported performing 66,275 fractional resurfacing procedures in 2019. There was a 2% uptick in nonablative laser skin resurfacing procedures from 2017 to 2018, according to the latest statistics by the 

. Members of that Society reported doing 433,533 Fraxel or similar procedures in 2018.

While the newest 1927 nm laser on the block is Sciton’s Moxi, which is part of the company’s new small mJoule platform, there are other popular 1927 lasers for facial rejuvenation. Among them, the first that was commercially successful in this space, the Fraxel Dual 1550/1927 (Solta Medical). Lutronic Aesthetic has the LaseMD ULTRA, a non-ablative fractionated laser. Solta Medical’s Clear + Brilliant offers the Permea handpiece, a thulium 1927 nm.

I’m gaining experience with the Moxi and think it fills an important niche, giving us a new wavelength that results in minimal downtime. It’s an affordable treatment and is especially good for treating pigment or photodamage.

Compared to the hybrid fractional laser Halo (Sciton), which delivers both ablative and non-ablative wavelengths to the treatment area, Moxi offers less downtime, a better price point and noticeable results. In my experience, it also offers slightly better outcomes for pigment than Halo.

Halo delivers the 1470 nm wavelength for coagulation and the 2940 nm wavelength for ablation. Looking at histology slides, Halo treatment causes fairly aggressive dermal and epidermal injury. With Halo, patients get a great result by day 4, after going through a healing period of a few days when they don’t look their best.

We conducted a small study at Sciton looking at why some prospective patients decided against Halo treatment and found the most common reason was price. Most practices charge from $1500 to $2000 for Halo. Sciton looked at this as a business opportunity to introduce a procedure that was less expensive with less downtime but still efficacious. That’s why the company introduced its 1927 nm laser.

The device features different settings from 5 mJ to 20 mJ. Looking at histology slides for Moxi, there’s less tissue injury than with Halo. Most dermal pigment sits at the epidermal-dermal junction, so even at the low setting of 5 mJ or 10 mJ, you’re going to be able to treat most of the pigment and can go deeper if you want.

Providers can select among three preset levels or a manual mode with the device. Level 1 is at 5 mJ to 10 mJ, which reaches 5% to 10% density with four or five passes. Level 2 is at 10 mJ to 15 mJ at 10% to 15% density with four or five passes. The skin renewal setting is level 3. Its energy setting is 20 J/cm, with 20% coverage and six passes.

I administer the treatment under topical anesthesia. Be sure that you and your patient wear eye protection.

The procedure typically takes between 10 and 20 minutes. In Florida, performing Moxi is within the scope of practice of aestheticians, so my aesthetician will soon be offering it, too.

I had the procedure on my face and was impressed with how little time it takes and how dramatic the results were considering such limited downtime. While patients’ skin might be a little red after level 1 or 2 treatments (nothing they can’t hide with a little makeup), those that have level 3 might have a day of downtime.

While most patients notice results after one treatment, we usually do a series of up to three for optimal outcomes, including reduction in pore size. The price point for Moxi is at about $500 for a series of up to three treatments. The total disposable cost is about $50. And patients get a significant reduction in UV damage without missing a beat.

I use it as a full-face treatment. It’s new, so we’re still playing with some of the parameters and have been using it on the less aggressive side so far.

Providers can buy the mJoule platform with or without BBL.

I’ve used Moxi in combination with Halo but prefer to do it along with BroadBand Light (BBL), which according to Sciton, is the world’s most powerful intense pulsed light (IPL) device. The combination targets more of the pigmented lesion without adding downtime.

This 1927 nm laser is a great option for patients during the COVID-19 post-shutdown period. The last thing people want to do right now is sit in the house to recover after this pandemic. They want to get out. Moxi is one of those options that allows them to do that and will help their skin look refreshed and rejuvenated.

Boca Raton, Fla., plastic surgeon Jason Pozner, M.D., is on the Aesthetic Authority’s editorial advisory board and Sciton’s Medical Board and works closely with the company on new product development.

According to Dr. Jason Pozner, Sciton’s Moxi fills an important niche as an affordable photodamage treatment with minimal downtime. 