Beauty Essentials Present and Future w/ Dr. Joel Cohen

PA049 with joel cohen Beauty Essentials Present and Future.txt
Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "Beauty Essentials Present and Future." Dr. Bass, we've discussed various aspects of aesthetic treatment and beauty care in our podcast. What's the idea behind this episode?

Dr. Lawrence Bass (00:34):
There are some treatments that are beauty essentials, components of maintenance and rejuvenation that almost everyone needs sooner or later, and that will have a major impact on your appearance. Then there are new entries to the marketplace, things that are really innovative and not just a new and slightly improved version of something that's already on the market. My guest and I are going to touch on a few of these. Finally, there are research projects that are working on the next big breakthroughs. So let me introduce our guest. Joining us again on the podcast is Dr. Joel Cohen, who's a dermatologist in the Denver area. He is an international authority on new technologies in aesthetic medicine, being very active in clinical research and lecturing and teaching on what's coming next. Dr. Cohen, welcome.

Dr. Joel Cohen (01:37):
Thank you very much, Larry.

Dr. Lawrence Bass (01:40):
We both agree that resurfacing is one of those beauty essentials. Tell our listeners why.

Dr. Joel Cohen (01:48):
If people really want to see improvement in lines and wrinkles that are etched in the skin, resurfacing is really key to that success. And we do have multiple modalities that we can use from chemical peels to injectable agents to microneedling, to radiofrequency microneedling. But really resurfacing is the key to seeing success for etched lines and wrinkles that are small and thin versus that are large and deep. That whole spectrum is going to improve.

Dr. Lawrence Bass (02:26):
And as I said, I completely agree with this notion. My view is that if you're doing work on rejuvenation, you're trying to restore your appearance and you leave behind the lines and wrinkles, you are never going to have your best appearance. You're always going to look significantly more aged. It's a major component of what makes you look older. So it's essential to chase that as part of any beauty plan. Separate from that, I think what's appealing about resurfacing, as you alluded to, is this ability with modern technologies to really range up and down the scale from very light to very heavy and predictably everywhere in between, depending on how much aging change you're showing. In other words, what you need and depending on how much recovery time and what kind of treatment is going to fit your lifestyle. So that's essential given that we have to squeeze this into everybody's busy work and social schedule.

Doreen Wu (03:39):
Okay, so I see why resurfacing is a beauty essential with the broad scope of things, concerns, issues that can be treated. But what else is so powerful about this approach?

Dr. Joel Cohen (03:51):
You know, I think that resurfacing is a complement to the many different technologies and different procedures that we can do for our patients. But if we break things down to really early concepts, wearing sunscreen, trying to prevent sun damage in the form of pigmentation, trying to prevent the changes that happen with losses, some of the support networks of the skin from sun damage that really causes those lines and wrinkles is really key to an overall plan that is comprehensive for patients to think about over the course of many years.

Dr. Lawrence Bass (04:29):
And you know, as we said, there are light options, but sometimes bigger treatment is more worthwhile. I've done a significant amount of full field resurfacing that's a laser treatment where the surface of the skin is vaporized off leaving a raw surface over a hundred percent of the surface area that needs treatment. This is in distinction to fractionated treatments, which we also use commonly where only a percentage of the surface area is stripped off that provides faster healing but also predictably less improvements. So for folks with well-established lines a very durable and very substantial degree of wrinkle clearance can be obtained with full field resurfacing and that's become faster, easier, more reliable with some of the newer technologies that really let us be very precise on tissue depth and and degree of thermal effect in the tissues.

Dr. Joel Cohen (05:46):
One of the devices that I'm most excited about is actually the UltraClear laser. It's a new laser that was FDA cleared in December of 2021, and the company really has been innovative. This is a laser that really allows multiple different modes to be used. So as Dr. Bass is describing, having patients with more downtime, there's also the ability to have patients with very, very little downtime. So one of the early modes is called the 3D miracle mode, where there is almost no discomfort. So you don't actually even need topical anesthesia unless you want to use it. The treatment takes 10 or 15 minutes, there's some burning and sting for a few hours and patients are just dry and pink for a couple days. So it's really a weekend recover and it's meant to be done in a series of treatments. So for people who it's not reasonable for them to take any time off of work or any time off social engagements, they can do these over the course of many weekends.

(06:56):
And then for people who have more downtime, we can use this particular laser, the UltraClear on different modes to treat with more settings and more density and different parameters to actually treat in a face some of the lines that are etched in the skin. And you can take it all the way up to a point where traditional fractional blade of lasers, fractional erbium, or fractional CO2 are done. And then for people who really have a major event coming up and they really want to have major improvement with just one treatment, usually just one treatment and they have the flexibility for a week plus downtime in terms of the skin healing, that's when I moved to another type of laser like the Sciton JOULE X for full field heavy resurfacing.

Dr. Lawrence Bass (07:51):
And I think that raises another interesting point. If you have a lot of established aging changes, then it may be worthwhile proceeding with a little bit more aggressive treatment that involves a little bit of downtime. However, if you're not there yet, this is a wake up call to think about some lighter treatments on a periodic basis to really for stall and delay the the time that you're going to get to showing heavy aging changes. So if you do some light treatments with little or no downtime now and keep things cleaned up, it will be a good while before you have to contemplate going ahead with a more aggressive treatment.

Dr. Joel Cohen (08:44):
Agree. I think that this is really just preventative. We all go to the dentist a few times a year. We get our teeth cleaned, we try to floss all the time and be really conscious of really good overall hygiene when it comes to the oral area. And when it comes to the skin, we have to think about using sun protection, using skincare with the right ingredients and thinking about procedures that really fit our schedule. And then I always talk to patients about goals. Is their goal to see improvement in pigment improvement in redness or lines and wrinkles? And then we tailor these types of laser therapies to those specific parameters.

Doreen Wu (09:22):
In the episode title, we alluded to the future. What are a few of the new innovations that our listeners should know about?

Dr. Joel Cohen (09:29):
I'm excited about multiple new devices that we have on our office that we actually participated in the clinical trial for over the past couple years. So I mentioned the UltraClear laser is really exciting and the reason it's different is because it allows a shorter pulse duration. So for example, a laser may have a pulse duration of 50 milliseconds and even though that's a really short period of time, you start to feel the energy and the heat build up. So what the UltraClear does is it really divides that 50 milliseconds into micro pulses. So there's four micro pulses of 12.5 milliseconds. So just when your body's about to feel that, it kind of goes away and goes down and then it comes back and it goes down. So that ability to cause these small micro pulses makes the discomfort much less and allows patients to tolerate these procedures, especially on lower settings like that 3D miracle.

(10:32):
We've also participated in the number of energy-based device studies. So Emsculpt NEO is a technology that came out in 2020 and even despite coming out in the year of the pandemic, it quickly became one of the most popular body treatments and it combines what's called high femme, which is high intensity focus, electrical muscle stimulation, much more so than you can get in any way shape or form by going to the gym. The number of muscle contractions for areas of Emsculpt NEO treatment such as the abdomen would be, it's super physiologic. You could never do that from a workout. It's like 20,000 abdominal crunches in a 30 minute session. So Emsculpt NEO we've been using on the center part of the abdomen, we've been using on the buttock, the inner thigh, the outer thigh, even the calves and the arms. And we just finished the study for the flank applicator. And what Emsculpt NEO allows is combination of that high intensity focused electrical muscle stimulation to tighten musculature and to see more definition for musculature, but at the same time combines a radiofrequency type of parameter to allow decrease in fat in these areas.

(11:56):
So for the center part of the abdomen and the flanks, having that ability to see 25% more muscle definition decrease fat by 30%. And then for people who may have had pregnancies and have some separation of the muscle in the abdomen called diastasis recti, there's a 19% improvement in that as well. So very exciting technology. And the edge applicator, which is the flank applicator, has quickly become the second most common area for NEO to be used, Emsculpt NEO, in our office next to the central abdomen.

Dr. Lawrence Bass (12:34):
And now there's a new system that they've just developed that focuses on facial treatment. So I understand you have some experience with that as well.

Dr. Joel Cohen (12:45):
So at our office, AboutSkin Dermatology and AboutSkin Research in metropolitan Denver, I have enjoyed being a part of clinical trials for a very long time. And in addition to doing the clinical trials for the Emsculpt NEO, I also did the clinical trial for the EMFACE. So we were one of six sites that did the EMFACE clinical trial. So EMFACE uses technology similar to Emsculpt NEO where it uses high intensity focused electrical stimulation of muscle but it's more superficial. And then it also uses radiofrequency and applicator starts placed over very specific areas. So in the cheek, the applicator is going directly from the cheekbone to the corner of the mouth. So in that area is a series of muscles called the Zygomaticus minor and major in the risorius muscle. And these are not muscles that we would typically treat at all with Botox unless somebody had a facial asymmetry or bell's palsy.

(13:51):
So this particular type of approach allows us to focus on muscles, to take muscles that are elongated with aging and understand that these muscles interconnect with ligaments and the ligaments become lax over time. It's similar to the fact that, you know, if you use a hammock over a period of time, the weave on that is going to become much more lax. So being able to tighten the laxity and the weave of these ligamentous structures at the same time being able to tighten some of the elongated muscles leads to a lift in the center part of the face. And that lift actually translates to a much more defined jawline and in many patients dramatic improvement in the jowling that they have as well.

Dr. Lawrence Bass (14:42):
So this is a brand new technology as we record this. And an example of how the ability to do do things that previously we either had no way of addressing or had to be addressed with a significant surgery gives an option, especially when I suspect applied early. This is not going to take the 80 year old and magically make them look like a 40 year old, but in people who are relatively early in the aging game or mid in the aging game, this can really be a big inroad in terms of restoring appearance.

Dr. Joel Cohen (15:25):
So for younger patients and that whole concept that Ken Arndt describes as rejuvenation, you know, sometimes patients feel like they're starting to see changes, whether it's in person or on a video call where EMFACE may come into play because you'll see more jawline definition and reduction in some of the jowling. And really that tightening can help lift up what some people are starting to call tech neck. In addition, having EMFACE as a technology is a complement to other treatments that we certainly do on our office, such as injectables like fillers or neuromodulators like Dysport and Botox. And being able to use these in complement to one another is really key. And you can still do other devices that we've spoken about such as lasers to treat pigment or redness or lines and wrinkles that are etched in the skin.

Doreen Wu (16:22):
Most recently a new laser was just cleared by the FDA for the treatment of acne. Can you tell us how it works and why it's an innovation?

Dr. Joel Cohen (16:30):
So I was part of the clinical trial for the FDA study on what's called the Accure laser, and Rox Anderson who is a dermatologist and a investigator and a really inventor who practices out of Harvard and MIT, it's called the Wellman Institute of Photo Medicine. Rox Anderson invented many of the technologies that we use. He's really done fractional ablative resurfacing fractional technology. He's done pulsed dye laser, laser hair removal, laser tattoo removal, CoolSculpting, and technologies like that. And when he was asked at one point what he wanted to do next in his career, he said he wanted to find a cure for acne. And by coming up with a laser wavelength and really developing this wavelength that's 1726 nanometers, he really, with his team, has been able to focus on destroying or at least minimizing and attenuating the sebaceous gland that causes acne. So now there are two FDA clear devices for 1726. One is the ACCURE laser and the other is the AviClear. And they're two different technologies using the same wavelength and it's exciting to have something to add to the armamentarium for kiddos and even adults that have acne.

Doreen Wu (18:05):
It's definitely exciting to hear about all the new innovations that are currently on the market. So earlier you promised a glimpse into the future, Dr. Cohen, what's coming down the pipeline that you were excited about?

Dr. Joel Cohen (18:18):
I think in the world of energy-based devices, we're seeing a lot of new treatments such as combination treatments. So I mentioned Emsculpt NEO and using the high intensity focused electrical stimulation of muscle plus radiofrequency. And I think being able to treat different body areas and now the flank with that type of technology is really leading to great results for our patients. Being able to use similar technology for the face combination technology like EMFACE similarly is giving our patients really nice results where we can stimulate the muscle and the elongated muscle and the lax ligaments. But we can also use this in complement with other types of treatments such as injectables, such as neuromodulators like Botox and Dysport as well as fillers. And now we have new neuromodulators and new fillers that offer us different things that we didn't necessarily have before.

(19:20):
 and some of those things in the pipeline are the ability to really tailor the injection to what the patient's looking for. So the company that makes Botox called Allergan has been developing a short-acting neuromodulator called Bonti, which is a botulinum type E. So it's very short acting. And the thought process behind this is that if patients aren't sure they're going to like the way that they look, they can essentially try it on. So many of us wouldn't buy a car unless we took it for a test drive. So this is kind of like a test drive where it's like going to a Nordstrom dressing room and and trying it on. And then similarly, there are companies that are developing neuromodulators that the goal is to actually have a longer overall efficacy. It won't have a longer efficacy for everybody, but for some people it may actually last longer.

(20:17):
And that's little tweaks in the technologies. So the one that got FDA approved recently is called DAXXIFY by Revance Aesthetics. And similar to Botox and Dysport, it is a botulinum agent type A. So the mechanism of action isn't any different, but it has a special peptide where it may potentially lead to longer efficacy in some patients because of the charge on that peptide, as well as the fact that the peptide prevents the neuromodulator molecules from aggregating to each other. So it's exciting to have new agents that for some people may be able to alter their dosing regimens so that it fits in their schedule more conveniently. And I think we all have patients that may come from far to join us and see us at the office and being able to cut down from perhaps three treatments a year to two treatments a year may actually work better for them.

(21:17):
And then there are new studies looking at products that we've had for a long time, such as Dysport, I was in the DREAM study, which is the Dysport Real World Experience trial that showed that some people are happy with their treatment of Dysport in the glabella at a six month interval. Anyway. So for those patients, you know, I think that having that new data to show them that they may actually have satisfaction in that particular study, it was 95% satisfaction with 60% satisfied and 35% very satisfied. And then Galderma, the company that makes Dysport and the Restylane family products has been innovating their own neuromodulator called QM. And I presented the phase two FDA data at the World Congress of Dermatology in Milan. And the phase three data is being looked at right now and has been made public for some parameters of it. And what they're seeing is that this is a neuromodulator that also probably has a longer amount of duration. So I think there's a lot of exciting things going on in the world of aesthetics from the devices and energy-based devices we have in our offices to some of the injectables that are going to be coming out or are out now.

Doreen Wu (22:39):
Finally, before we conclude Dr. Bass, what should our listeners take away from today's episode?

Dr. Lawrence Bass (22:45):
Well, Dr. Cohen was talking about participating in clinical trials, and I also participate in clinical trials. And I love doing that for exactly the reasons he was describing. You are working with new technologies, you're seeing the latest and greatest, and you also get an in-depth understanding of the performance of those technologies because you're not just treating people who leave, but you're treating people studying the effects in depth in conjunction with multiple collaborators around the country. And that gives you a level of insight that it's hard to get any other way. I think listening to this fabulous update from Dr. Cohen about some of the newest and most interesting additions in aesthetic medicine teaches us a couple of things. We can see that there are a range of options for early and late changes. There's a degree of predictability to those options and gradability from light to heavy, even within a given option. The parameter range allows a lot of adjustment for individual needs. And finally, I think we see that these new technologies are much more data driven than a lot of what happened in past decades. So there's a lot of study and identification of the performance characteristics of these new technologies that gives us the assurance as they hit the market of what they're going to do for us and how they're going to perform.

Doreen Wu (24:39):
Dr. Cohen, would you like to add any takeaways?

Dr. Joel Cohen (24:42):
I think it's really important for people to think about the fact that many different treatments have been really commoditized, and it's not the paint, it's the painter. And when you're having a treatment done such as resurfacing, you really want to see somebody who has a lot of experience and you want to see their results because it really varies. And again, you know, you could give me some paint and I'm not going to be able to make a beautiful painting. Whereas some world class artist will, there is artistry in medicine and it's important to really realize that.

Doreen Wu (25:20):
Thank you, Dr. Cohen and Dr. Bass for sharing your insight and expertise on the status of innovation and various cutting edge developments in the world of aesthetics.

Dr. Lawrence Bass (25:29):
And I'd like to add my thank you to Dr. Cohen for again, sharing a fabulous perspective and I think very well said point of view about how to approach your aesthetic care.

Dr. Joel Cohen (25:42):
Thank you very much, Dr. Bass. I appreciate it.

Doreen Wu (25:46):
Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with commons or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.