Everything you always wanted to know about cosmetics
Growing innovations surface in cosmetic and regenerative medicine.
P020 – Cosmetic Dermatology Innovations: From Topicals to Injectables & Devices
One of the most comprehensive sessions of this year’s AAD Innovation Academy was the Aug. 3 session, P020 – Cosmetic Dermatology Innovations: From Topicals to Injectables & Devices. The two-hour session provided an extensive look at the subspecialty, including new advancements, novel products and therapy indications, late-breaking clinical trials, and ongoing and upcoming developments.
The experts were unanimous about the exciting evolution that’s occurring within the field of aesthetic medicine, and they predicted that the escalating demand for alternative treatments and solutions will lead to more innovation.
Session director Mara Dacso, MD, MS, FAAD, a clinical dermatologist and dermatopathologist who leads the cosmetic department at Innovative Dermatology in Plano, Texas, spearheaded the eight-person panel and closing discussion. Attendees acquired the knowledge and tools needed to return to their practice with improved, efficient, and safe strategies to treat their patient populations.
Quality over quantity
Dr. Dacso primarily focused on the shifting trend from relying heavily on hyaluronic acid (HA) fillers to instead employing bioregenerative injectables that provide natural outcomes and improve skin quality. Using Poly-L-Lactic Acid (PLLA) is not new to aesthetics, she said, but researchers have recently observed that its bioregenerative capabilities may be more profound than they initially anticipated.
Other injectable applications, such as calcium hydroxylapatite (CaHa), continue to be refined and deliver positive outcomes. Randomized trials with placebo controls and in vitro analyses have demonstrated substantial collagen stimulation and extracellular matrix support leading to continued improvement in skin quality.
“Within the last few years, sophisticated imaging and molecular laboratory techniques have helped elucidate more precise proposed mechanisms with which these agents exert their regenerative effects, leading to fibroblast activation and neocollagenesis,” said Dr. Dacso.
Other regenerative agents that she referenced included allograft adipose matrix, platelet-rich fibrin matrix, and mesotherapy using micronutrients. Patients have unique needs and differing end goals, Dr. Dacso said, which requires clinicians to customize treatments. She encourages dermatologists to remain open-minded when assessing and integrating these injectables into their practice.
A closer look at injectables and fillers
During the session, La Jolla, California, dermatologist Rawaa Almukhtar, MD, FAAD, shared updates on injectable treatments, specifically new indications for dermal fillers and botulinum toxins. For example, daxibotulinumtoxinA is an innovative botulinum toxin type A (BoNTA) formulation that is FDA-approved (DAXXIFY) to treat cervical dystonia and glabellar lines. This new drug is the first of its kind to contain stabilizing excipient peptide (RTP004) instead of human serum albumin. She said FDA approvals for additional cosmetic uses, including masseter hypertrophy and platysma bands, are expected in the future.
Dr. Almukhtar also examined the use of VYC-12L, a type of hyaluronic acid skin booster, to improve skin quality. This type of filler was part of a recent clinical study that evaluated its efficacy to treat fine lines and improve cheek skin smoothness. The session included several valuable real-world scenarios for using injectables as standalone treatments or as part of a combination therapy.
San Diego dermatologist Jameson Taylor Loyal, MD, FAAD, reviewed the range of filler products and complications that could arise during or following filler procedures. He reminded dermatologists that even when unexpected side effects or insufficient results occur, one of the most important things at hand is to have a plan for guiding patients when things go awry.
Dr. Loyal also addressed how having more choices in filler treatments can sometimes contribute to a wrong product/wrong place/wrong time outcome. He encouraged ongoing education on what products can be combined — and when — and on situations in which to avoid certain applications.
What’s the deal with exosomes?
Although it has existed for more than half a decade, exosomal therapy is still relatively new to clinical practice. Glynis R. Ablon, MD, FAAD, a Manhattan Beach, California, dermatologist and founder of the Ablon Skin Institute & Research Center, spoke on the hot-button topic and said it has proven itself worthy of experimentation and consideration. She recommends learning more about exosomes (e.g., their origin, process, and delivery) and trialing samples in office procedures.
“Complete an ablative procedure and put exosomes on one side and usual healing protocol on the other side and see if there is any difference in healing rate. I think you will be quite surprised at the outcome,” she said.
Dr. Ablon has her own exosome research study underway and is anticipating publishing her results soon. She stressed the importance of clinical trials to identify gaps in knowledge and practice, as well as to help formulate standardized protocol for exosomal treatment.
“Integrative medicine and dermatology are just gaining momentum,” she said. “I hope the FDA will see the importance of this novel technology and want to approve more clinical trials. We are touching the tip of the iceberg on what was called particle dust in 1967, but can now be used for recalcitrant ophiasis, wound healing, hair regrowth, and skin rejuvenation.”
An arsenal for treating hair loss
Another prominent area of cutting-edge innovations is non-surgical treatment alternatives for patients who suffer from hair loss. Neil S. Sadick, MD, FAAD, FAACS, FACP, FACPh, a New York City dermatologist and founder of Sadick Dermatology, said hair restoration options include anything from platelet-rich plasma (PRP) techniques or ultrasound-mediated drug delivery to low-level laser therapy (LLLT) or fractional laser applications that form microscopic channels to stimulate hair growth. Other developments include stem cell-derived exosomal therapy to regulate hair growth or hair stem cell banking to plan for future revolutions.
“In the next decade, exosome therapy is poised to become a mainstream treatment option for hair loss, with established guidelines and regulatory frameworks in place to ensure safety and efficacy,” Dr. Sadick said. “As more clinical trials and real-world data accumulate, the confidence in exosome therapy will continue to grow, leading to wider adoption and potentially revolutionizing the field of hair restoration.”
Extensive research plays a large role in the growth and depth of available — and forthcoming — solutions for the range of hair loss diseases and causes. For instance, he said PRP therapy has proven effective in clinical alopecia trials, demonstrating an increase in hair density and volume. LLLT shows scientific indication to stimulate follicles and support hair growth in a means that is non-invasive and pain-free.
“The importance of these advancements lies in their precision, non-invasive nature, and ability to target hair follicles, provide concentrated growth factors, offer personalized long-term solutions, and explore novel regenerative pathways — all aimed at effectively and safely addressing various forms of hair loss,” Dr. Sadick said.
A shapely solution
A popular, progressing trend in cosmetic dermatology is non-surgical body contouring — or sculpting, which Morgan BriAnne Murphrey, MD, MS, FAAD, said has moved more toward a holistic approach than simple fat-targeting methods. Dr. Murphrey is a dermatologist at Massachusetts General Hospital in Boston. Newer modalities address additional concerns, such as targeting the dermis to regenerate collagen, underlying musculature to tone and reduce the appearance of cellulite, and the epidermis to smooth creping skin.
“Body contouring is nuanced in that patients have heterogenous complaints,” said Dr. Murphrey. “By approaching different layers, more concerns can be addressed.”
According to the American Society of Plastic Surgeons, more than 600,000 minimally invasive cosmetic procedures occurred in 2022. This is a 77% increase from 2019, reflecting the increased post-pandemic interest in this area. Body contouring can frequently be tied to weight loss, she said, so it is important to consider what, if any, weight loss medications a patient is taking, such as popular GLP-1 agonists.
With great progress comes great protection
San Diego dermatologist Raheel Zubair, MHS, MD, FAAD, homed in on energy-based treatment innovations that are fulfilling previously unmet needs of people with skin of color. These include:
- Focal point technology, which combines precision lasers with high-resolution imaging to minimize scarring, discomfort, and risk of hyperpigmentation.
- Radiofrequency microneedling devices that have been updated with electrical and temperature monitoring systems to improve safety and deliver effective results.
- New 1726 nm laser to effectively treat acne while preventing scarring and post-inflammatory hyperpigmentation (PIH) — the two leading side effects of dermatologic treatments in skin of color, according to Dr. Zubair.
- New 2910 nm erbium fiber laser used for ablative resurfacing reduces pain, diminishes thermal damage, and accelerates recovery.
“In the future, we need to create more solutions to treat dermal pigment and scar tissue while avoiding injury to the dermal-epidermal junction, which plays a critical role in the development of post-inflammatory hyperpigmentation,” he said. “If we can develop technologies to strengthen and heal the junction, perhaps we could make skin resistant to PIH. Our ability to predict which patients are at risk for poor outcomes and complications with energy-based devices must also be improved.”
… And great responsibility
Doctors are likely one of the quickest groups to admit how much technology and the internet have altered their profession. Scottsdale, Arizona, dermatologist Karan Lal, MD, FAAD, concluded the session by evaluating the impact of social media and the metaverse on the field of dermatology, particularly in the realm of aesthetics.
Within dermatology, which is driven by visual results, Dr. Lal conjectured that social media has and will continue to transform the experience for practitioners and patients alike. He said it is essential that dermatologists be present and active in the online space to become the prominent, most-reliable source of skin information.
Online engagement presents a unique opportunity to connect with and educate communities of people, particularly minority populations who, in a recent study, admitted to feeling underrepresented in this area, said Dr. Lal.
“[Dermatologists] can easily contribute to this disparity with more patient before-and-afters of diverse backgrounds and by talking about how certain diseases impact these populations differently,” he said.
Dr. Dacso agreed on the significance of providing public awareness of dermatologic conditions and safe cosmetic practices. She said it can also be “a dynamic forum for sharing best practices, engaging patients, and encouraging dialogue surrounding aesthetic procedures.”
“Dermatologists are truly the gatekeepers to improving skin health and wellness, and we should be the ones championing these treatments,” Dr. Dacso said.
