Lisette Hilton

Part 1: Paul Nassif, MD: Building a Successful Skin Care Brand

Women’s use of facial skin care products rose in 2020, according to The NPD Group, a market research company.

22% of U.S. women reported changing their skin care routine because of the pandemic.

“Most are washing or moisturizing their face more often than pre-pandemic; one-third have expanded their routine to include more products; and the majority of those using more products intend to stick with their new routine when things normalize,” according to an NPD press release.

Cleansers and moisturizers, and treatments such as exfoliators/scrubs and masks saw the biggest boosts in use since 2019.

Women are more likely to research skin care products online before purchasing, according to NPD.

Released in 2019, the NPD Women’s Facial Skincare Consumer Report noted that nearly half of women surveyed prefer to research products online prior to buying them in store, citing online reviews and ratings, as well as social media influencers, as their sources of information.

Engaged consumers are looking at ingredients and want transparency, according to the NPD Group.

“…46% of facial skin care users report purchasing products free of sulfates, phthalates and/or gluten, representing a 6-point uptick over the past 2 years. In addition, more than half of women look for skin care products made from organic ingredients. The report also found that brands making a public commitment to ingredient transparency have become top of mind for consumers, with several of the more well-known transparent brands ranking among the Top 25 in highest awareness-to-purchase conversions,” according to an NPD press release.

22% report changing their skincare routine due to COVID-19. NPD Group. Press release. September 10, 2020. Accessed May 3, 2021. 

https://www.npd.com/wps/portal/npd/us/news/press-releases/2020/more-u-s--women-are-using-facial-skincare-products-today--reports-the-npd-group/

Empowered consumers want clean ingredients and brand transparency from skincare products. NPD. Press release. August 14, 2019. Accessed May 3, 2021. 

https://www.npd.com/wps/portal/npd/us/news/press-releases/2019/empowered-consumers-want-clean-ingredients-and-brand-transparency-from-skincare-products/

Articles

Women’s use of facial skin care products saw a significant rise in 2020 due to the COVID-19 pandemic, according to The NPD Group, a market research company.


2020 Skin Care Trends

Beverly Hills facial plastic surgeon Paul Nassif, MD, FACS, of NassifMD Plastic Surgery in California, knows how to create a successful brand. His image alone creates awareness with anyone who has tuned into E! Entertainment’s 

Among his many claims to fame, Nassif developed and markets NassifMD Dermaceuticals. He shared strategies for building a successful skin care line with colleagues during the April 17 International Society of Aesthetic Plastic Surgery (ISAPS) Business School.

Launching a skin care line is not easy, according to Nassif.

“This is more of a long-term investment, and really if you are going to do this you need dedication and, of course, a lot of money,” he says.

Aesthetic physicians and surgeons have different reasons for creating proprietary skin care lines.

“You have to think about, ‘What is my endgame? Am I doing this because it is a passion project of mine? Am I doing this as a source of passive income?’” he says. “I did this for my patients because when you do surgery, what happens to [the quality of the] skin? Nothing. If you have surgery plus great skin care…it makes your surgery look better.”

Regardless of the reason, says Nassif, the goal of creating a skin care line should be to develop great products because repeat business is the key to long-term success.

“You can always get someone to buy the product, but the question is, are they going to keep using it? That is why the product has to be fantastic,” he says.

Science and testing should be the foundation of any physician-developed skin care brand. That includes developing thoughtful formulations, as well as formal and informal testing and feedback.

“I chose to individually formulate each product to ensure control of ingredients, potency, and efficacy, and to tailor each [product] to my patients’ needs and input,” he says.

Proper product testing is a time-consuming endeavor, but necessary. For his line, Nassif worked with chemists to achieve efficacy and potency for each product, whether it was designed for the face, neck, under eyes, nose, or other areas.

“There are probably 7 to 8 different tests that you have to do with your chemist,” Nassif explains.

Nassif’s skin care products went through laboratory testing, consumer perception studies, before and after studies, hydration studies, skin pathology testing, and Visia (Skin Analysis System; Canfield Scientific) studies. He also funded clinical trials that incorporated side-by-side visual comparisons. Additionally, he received qualitative and quantitative feedback from friends, colleagues, patients, and staff.

During the ISAPS Business School presentation, Nassif shared images from a Visia study that had 30 participants. In the study, patients wearing fluorescent makeup cleansed their face using soap and water on one side of the face and his NassifMD Detox Pads on the other to remove dirt, makeup, and residue.

“[My detox pads were] 108% more effective than soap and water,” he says.

Although companies do the actual testing for providers such as Nassif, it’s the providers who foot the bill, he says. He also commissioned a perception study in which 32 participants wrote down what they thought about products.

Providers should highlight before and after images for each product, he says, noting that consumers look to these transformations when deciding what to buy. In his presentation, Nassif showed before and after images of his Deco-Lift and Peri-Orbital Complex products.

“What I focus on here is the luminosity and glow. I look at the color and the crow’s feet and also…at the lifting ability,” he says. “This is from a key ingredient called Vin-upLift, that gives immediate temporary hydration and lifting.”

Formulating products with key ingredients that may not be widely available but are backed up by science to suggest they work is important for product differentiation. Nassif describes the Vin-upLift ingredient as “a unique tightening ingredient that is derived from Swiss ice wine,” on his website NassifMDskincare.com.

“Your ingredients have to be excellent,” he says. “You have to have the science behind the different products.”

Nassif uses many avenues to reach his target audience for skin care products, including TV shopping and e-commerce. His product line is featured on HSN in the United States and international shopping channels such asTVSN in Australia, QVC UK, and TSC in Canada.

As for e-commerce, Nassif markets the brand on the NassifMDskincare.com website and also sells the line on additional websites. The brand has its own Amazon.com consumer page.

The skin care line has a large social media presence, with advertisements on popular platforms and lifestyle websites, such as PopSugar. Social media marketing is a conduit to reach specific demographic groups, he says, adding that it is also important to use online influencers and their high-profile engagement.

Brick and mortar is a separate conversation, according to Nassif, who only briefly touched on having product conversations with Ulta Beauty Inc and Sephora, in his ISAPS presentation. On-air skin care sales, coupled with a robust online and social media presence, helps to educate buyers, develop brand awareness, fuel sales, and build an international viewership, he says.

Of course, Nassif’s practice also generates product sales. His practice integrates skin care into surgical treatments, and the skin care line also supplements his medical spa and aesthetic treatments.

Creating a skin care line involves dedication, product testing, clinical trials, marketing, sales, and yes, a lot of money. 

Paul Nassif, MD: Building a Successful Skin Care Brand

Skin care companies are marketing regenerative topicals featuring stem cells, exosomes and platelet-rich plasma (PRP). 

But do they work? And is skin care using stem cells, exosomes and PRP safe?

 asked experts in the regenerative skin care space for answers.

“There are no products that contain stem cells in over-the-counter skin care,” said Amy Forman Taub, MD, medical director of Advanced Dermatology, in Lincolnshire, Illinois. “There are companies that have cultured media [growth factors extracted] from these cells, but these products have not been proven to be more effective than what we currently have from cultured media, i.e., growth factor products from prenatal or perinatal tissue.”

The use of stem cells in skin care has taken a decade to evolve with the early issues of stem cell sources, such as embryonic vs adult stem cells, and the requisite clinical studies to demonstrate consistent efficacy, according to Lawrence A. Rheins, PhD, chief scientific officer at Aesthetics Biomedical in Phoenix, Arizona, creator of SoME skin care.

“A few years ago, there was interest in using botanical stem cells for skin care products. Frankly, I do not understand how that would work,” Rheins said. “Those stem cells are not going to get into the skin. [Plus], how physiologically relevant are botanical stem cells with human skin? Adipose adult stem cells are finding a significant growing role in aesthetic medicine including facial rejuvenation….”

According to Taub, exosomes are non-cellular and may be able to lyophilize, but research is in the early phases. In other research, Mayo Clinic investigators reported on Science Daily that purified exosomal product, known as PEP, an off-the-shelf, room-temperature-stable exosome, can heal wounds that do not have adequate blood supply in single exosome application.

Safety concerns are a hurdle for using stem cells and exosomes in skin care. The FDA regulates stem cell- and exosome-containing products.

 While exosome-containing products are available in the marketplace, some companies that make them have received FDA warning letters, according to Rheins. These FDA safety concerns could limit the commercial potential of exosome-containing skin care topicals for the near term, he said. 

The use of a patient’s own PRP growth factors in personalized skin care is an area that has gained rapid momentum in recent years, with the clinical science to show its safety and efficacy, according to Rheins.

SoME, which features patients’ autologous PRP in a serum mixture for topical application, is proven to be stable and able to keep growth factors alive.

Autologous PRP is safe, according to Taub.

"[SoME] is stable for 3 months, if refrigerated,” Taub said. “PRP is great for healing, so this could afford some correction of damage, but this does require drawing your patient’s blood and spinning it down to extract the PRP.”

According to Rheins, SoME took a different approach in product development.

“We are not taking stem cells. We are not taking synthetic exosomes. We are using the body’s own autologous physiological growth factors,” he said. “Consumers want personalized and more individualized skin care products. There is nothing more individualized or personalized than your own growth factors.”

Aesthetics Biomedical has patented is a way of preserving platelet function over 90 days in SoME products, Rheins said. 

After centrifuging the blood, the physician drops 3 ml of the patient’s PRP into the prepared SoME serum bottles. The patient takes the 3 bottles home in a supplied mini refrigerator and uses the product twice daily for the next 90 days. 

“It’s the unique physiological electrolyte base formula of 23 ingredients that provides us with the opportunity to keep the platelets stable,” Rheins said. “The change in temperature, going from the small refrigerator to air temperature to skin temperature, causes platelet activation, and the granules inside the platelets begin to degranulate to release hundreds of the growth factors including exosomes… which are small enough to get into the skin. The patient puts the bottle back in the fridge and the platelets basically go back into a senescent state.”

Scientific journals published two studies on SoME in recent years. Investigators of the first study, published in 2019 in the Journal of Cosmetic Dermatology, studied 20 female and male subjects 30 to 60 years of age in a single-site, investigator blinded, vehicle controlled, split-face study to look at the effect of the PRP-containing serum vs the serum alone on facial photoaging. Study results showed the serum contained stable PRP for 90 days, and PRP-treated facial skin biopsies showed improvement in skin architecture and upregulation for collagen type I with concomitant upregulation of mRNA for collagen after 8 weeks of topical use.

In the second study published last year in the Journal of Drugs in Dermatology, investigators reported that platelets remained viable for up to 120 days in a refrigerated cosmetic base serum vehicle. The product demonstrated clinical, histological, light, and scanning electron microscopy endpoints to demonstrate a mechanism of action leading to PRP facial benefits. PRP kits of 20ml and 60ml volumes for topical PRP were shown to be equally efficacious.

Aesthetic providers typically use SoME alone for facial rejuvenation to improve the appearance of fine lines, sun damage, hyperpigmentation, and sallowness. However, professional aesthetic practices are increasingly using SoME for post-treatment care following radiofrequency microneedling or other invasive devices, including various lasers, to assist in the healing process, according to Rheins.

“SoME has been on the market for 2 years and no one has complained of any irritant or allergic reactions,” he said. “… the physiological electrolytes of SoME provide additional product safety.”

Vivian Bucay, MD, Bucay Center for Dermatology and Aesthetics, San Antonio, Texas, discussed the evolution of topical growth factors using SoME skin care.

According to Bucay, dermatologists and other aesthetic physicians are using PRP for several indications, so integrating the PRP process into skin care is seamless for many. While some patients come in specifically to get their blood drawn and spun for SoME skin care, others might be coming in for PRP injections for hair growth or to be used post-laser resurfacing, she said.

“The real innovation [in the case of SoME] is this serum actually keeps the platelets stable for 90 days,” Bucay said. “I use it. I still believe in using topical antioxidants. I still use a retinol in the evenings. I use a sunscreen. This is adding something else to [skin rejuvenation], and it is super well-tolerated.”

SoME, according to Bucay, represents the trend toward personalized skin care, which has become increasingly more accessible over the years. 

However, it is not yet mainstream, according to Taub, who coauthored the review “Stem Cells in Dermatology and Anti-aging Care of the Skin,” published in Facial Plastic Surgery Clinics of North America.

“… it seems cumbersome to utilize the tissues of our own bodies for skin care products because the extraction process is difficult. There is the need to extract fat, bone marrow or blood,” Taub said. “Until those processes become easier, it’s unlikely for those to be mainstream skin care products.”

Taub said she believes the future revolves around understanding regenerative processes in the skin. Currently the most advanced products that use a messenger to stimulate dormant stem cells in patients’ own skin to action is Defenage [Progenitor Biologics], which utilizes proprietary defensins.

“In the future I do think we will be able to synthesize specific growth factors in the correct amount and mixture that will do more than mimic healing. Exosomes are promising as these are small packets of acellular signaling proteins and could be developed for anti-aging. And yes, we need to make sure that these products do not also stimulate carcinogenic cells,” Taub said.

1. Mayo Clinic. Preclinical discovery triggers wound healing, skin regeneration. Science Daily. Release. April 28, 2021. Accessed May 13, 2021. 

https://www.sciencedaily.com/releases/2021/04/210428132936.htm

2. Consumer alert on regenerative medicine products including stem cells and exosomes. FDA.gov July 22, 2020. Accessed May 13, 2021. 

Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes | FDA

3. Draelos ZD, Rheins LA, Wootten S, Kellar RS, Diller RB. Pilot study: autologous platelet-rich plasma used in a topical cream for facial rejuvenation [published online ahead of print, 2019 Jul 26]. J Cosmet Dermatol. 2019;18(5):1348-1352. doi:10.1111/jocd.13088.

4. Wooten S, Draelos ZD, Kellar RS, Rheins L. The role of platelet homeostasis in a novel topical PRP formulation. J Drugs Dermatol. 2020;19(12):1215-1218. doi:10.36849/JDD.2020.5495.

5. PRP topical skin care. Aesthetic Authority. May 3, 2021. Accessed May 13, 2021. 

https://www.aestheticauthority.com/view/prp-topical-skin-care

6. Taub AF, Pham K. Stem cells in dermatology and anti-aging care of the skin. Facial Plast Surg Clin North Am. 2018;26(4):425-437. doi:10.1016/j.fsc.2018.06.004.

Experts evaluate the efficacy, safety of regenerative skin care products.

Regenerative Skin Care Realities

Part 1: Advances in Body Contouring Technology

Joshua A. Lampert, MD, a plastic and reconstructive surgeon at Lampert MD in Miami, Florida, says his favorite tools for body contouring in 2021 are the power-assisted liposuction device and the new finer fat grafting harvest cannulas. Today’s state-of-the-art fat harvest and processing systems help ensure low-pressure fat harvesting and help avoid exposure to the ambient air, he says.

Although harvesting fat using smaller cannulas with narrower diameters and lower pressure suction takes longer, Lampert believes high pressure liposuction causes fat cell rupture. “This optimizes fat survival and improves overall body contouring outcomes,” Lampert says. “What has changed more recently with body contouring is that we are no longer just looking at where we can remove volume, but where we can also replace it. Fat grafting is more reliable than it was in the past and often gives us an additional tool in contemporary plastic surgery that was not utilized as frequently years ago.”

One example of how Lampert uses fat grafting is in breast augmentation for women who do not want implants or want their implants removed.

 “During this time, we have found that we can obtain much better results using fat grafting at the same time as implant removal in order to augment the breast for many of these patients. The fat harvest also adds improvement to the body contour where patients have troubling fat deposits,” Lampert says.

Using a combination of modalities can further optimize results, he says. “Often, after [surgical] skin tightening procedures and excess fat removal, devices such as the Emsculpt machine can help further define the body contour through muscle hypertrophy growth,” Lampert says.

Published animal models show a greater percentage of fat survives when the harvested fat is placed in a small hyperbaric chamber, he says.

 “I think this is very interesting as MRI-documented fat grafting survival has demonstrated improved survival with the refinement of technique,” Lampert says. “In the future, we may get to a point where we can do a 1-to-1 correction, meaning all the fat that we graft or the majority of it survives. Currently, it is estimated that anywhere between 40% to 60% of fat that is grafted will survive in a healthy patient that does not smoke.”

Lampert reports no relevant or financial disclosures. Chilukuri is a consultant for BTL Industries and InMode Aesthetics. 

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https://bodybybtl.com/solutions/emsculpt/

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Shoshani O, Shupak A, Ullmann Y, et al. The effect of hyperbaric oxygenation on the viability of human fat injected into nude mice. 

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Joshua A. Lampert, MD, highlights power-assisted liposuction devices and new finer fat grafting harvest cannulas to help avoid exposure to ambient air.  