Lifting Without Cutting #5: Sofwave w/ Dr. Jason Pozner

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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. This is episode five in our series, Lifting Without Cutting, where we explore non-surgical options for skin laxity. In today's episode, we are discussing Sofwave. I didn't realize how many options there are for this indication. Dr. Bass, what are we talking about in this episode?

Dr. Lawrence Bass (00:36):
Well, you're right, Doreen. There are many, many devices that doctors are using or trying to use to reduce skin laxity without surgery. I focus the attention in this series on the most widely used devices and treatments, mostly those with specific FDA clearances for lifting. In this episode, I've invited my friend and colleague, Dr. Jason Pozner, to talk about Sofwave, a treatment for nonsurgical lifting of face and neck skin, which is one of the most recent additions to this category. Dr. Pozner's a board certified plastic surgeon in Boca Raton, Florida with extensive experience with a range of lasers and other energy-based devices and an extensive practice in facial rejuvenation, both surgical and non-surgical. He's been a guest on the podcast on multiple occasions. Dr. Pozner, thank you for joining us again and welcome.

(01:36):
Thank you, Larry. Thank you Doreen for having me.

Doreen Wu (01:39):
Okay, Dr. Bass. So before we get into the details of Sofwave, give me a history lesson.

Dr. Lawrence Bass (01:45):
Well, the first device that really focused in on using energy to lift skin that was marketed that way, that had clearances from FDA for that was Thermage. This was a radiofrequency device that came on the market in 2004. It treated one depth right at the skin underneath the skin interface, and it was a full field treatment. It exposed the entire area being treated. The next big device in this regard was something called Ultherapy, which is still on the market today and still used. This is micro-focused ultrasound. These are little dots of sound energy that go in the skin as a broad exposure and focus down to a tiny.at a predetermined depth underneath. So this allowed you to do fractionated treatments at multiple depths just at the base of the skin and underneath. And it also had visualization like the ultrasounds we use to look at people's babies and joints and things like that.

(03:03):
And that came on the market in 2009. And in fact, Dr. Pozner and I were both involved in some of the development efforts for that. And more recently we have Sofwave, which it also uses ultrasound, but in parallel beams. This exposes a single depth in cylindrical patterns coming on the market in 2019. The idea is that each of these exposures creates heat, that the heat, that little minimal controlled injury that that produces, stimulates the body to add collagen and creates densification of the tissues and some tighten up or pulling in all directions of the tissues between the skin and the underneath.

Doreen Wu (03:54):
That gives me a pretty good sense of what the device does. So Dr. Pozner, can you tell me about what the treatment process is like and how long does it take? What type of anesthesia is used?

Dr. Jason Pozner (04:05):
Sure. So let's talk a little bit more about the history before I get into that. So when the patients ask us about this technology, so I simply asked them some questions in return. So I go, have you heard of Ultherapy? Absolutely. So they said, what's the difference between Sofwave and Ultherapy? And I always have my handy iPhone ready and I say, Ultherapy is iPhone one. Sofwave is iPhone 14. New technology with a lot of advances over the ensuing many years. And in fact, I had the first Ultherapy unit, clinical unit in the world in 2009, and we all did all of the studies as Dr. Bass said. So with this process, I think this is on the easier side of treatment for patients, and I've had this done too. I did one a couple of weeks ago on myself. So typically with this treatment, I try everything.

(04:59):
So typically with this treatment, the patient comes in, clean your face, take your makeup off, photograph them like we do for every procedure, and then put a numbing cream on their face that sits for anywhere from 15 to 45 minutes depending on the numbing cream. Then we wash off the numbing cream and we put some ultrasound gel on the patient and the ultrasound gel helps the ultrasound energy transmit into the skin. And then what we do is this transducer, the head of the transducer is one by four centimeters. So like that, and then you just put it along with your face, neck, brow, under eyes, and you leave it on there and each pulse is five seconds. So it'll go 1, 2, 3, 4, 5, and then there's cooling at the same time. So Ultherapy didn't have cooling. This chills the skin and then the pulse is for five seconds and sometimes you can feel little the fifth second, and then there's a one second post, cool down, and then you move it and then you do a second pass. So a typical face to neck takes between 30 and 40 minutes to do a full face. With this, you can count the number of pulses.

Doreen Wu (06:09):
Is there any recovery time after a Sofwave treatment? Is it a single treatment or a series?

Dr. Jason Pozner (06:16):
So good question. The answer is, I don't know. We sell it both ways as a series and a single treatment. I don't like selling too many things in series. I like to tell patients, do one, see what you like. If you want to do it again, we'll do it again in a month or so. And many people do return for a couple of these in a row, but I'm not a big series fan. And the answer to your previous question is there is zero recovery from this. You actually leave the office feeling and looking a little tighter so you get some instant gratification and you can go into our bathroom, put some makeup on and go out for that three martini lunch, no problem.

Dr. Lawrence Bass (06:49):
And I think that's an important point though, that this is something where you can see improvement in a single treatment because there are radio frequency wanding devices that for sure you would have to do five or six times also comfortable. Also easy to do also no recovery, but you're not going to do a treatment and see what happens because you're not going to see anything happen, that you're going to have to do a minimum of five or six treatments to try to get some kind of a modest tighten up going on the face. So even though you may choose to do more than one because you want a little more of a good thing, the notion is that one treatment is enough to get you some visible change.

Dr. Jason Pozner (07:45):
What I like about this is the patients are happy. So we've had probably three years into this device by now, we had among the first commercial units out there, maybe not the first, but I was within the first week or two of commercial release. And when we bought this, we didn't know what was going on. We didn't know whether patients were happy. And on Ultherapy, I was on the Ultherapy advisory board and all the clinical studies with Ultherapy showed 20% of the patients had no response, not a bad response, not a limited response, no response. And Ultherapy hurt. So many of the patients had this done, didn't get a result, told their friends, it hurt, it didn't get a result, and that's not a good way to sell a procedure to your patients with Sofwave. We've treated a few hundred patients and I can count on two fingers the patients that got limited results, two out of a few hundred. And interestingly, I just re-treated one of those patients and she got a good result. So I think maybe didn't get enough pulses in that patient, but patients are happy. Not one patient has asked for their money back and almost no complaints. If anything, they sign up for another one because they had an easy procedure that had a good result and they wanted another one with no downtime.

Doreen Wu (08:59):
Speaking of results, how much improvement can I expect? Exactly what features are being targeted?

Dr. Jason Pozner (09:05):
So this device is different than the Ultherapy device. And I think the problem with Ultherapy is in retrospect, we were targeting too deep. We were targeting through the skin. Matter of fact, some of the patients worldwide that got the best results out of Ultherapy were patients probably with fuller faces with thicker skin. Some of the Asian patients did really well. I think they burned some fat and just slimmed out their face. But the thin skin Caucasian patients, I don't think it had much result on at all. Sofwaves focus down to a much more superficial level that's right in the middle of the dermis. So I don't care what your ethnicity is, you're going to get targeted in the middle of your skin. Doesn't matter if you're a millimeter or thicker or not by different ethnic groups, so you and you're going to get tightened. So I think overall they were getting more efficacy and what we've learned about the Sofwaves is the same lesson we learned with Ultherapy. The more passes you do, the more energy you put in, the better results you get. So we've kind of gone for a little longer treatment now recently, and we seem to be getting even some better results.

Dr. Lawrence Bass (10:10):
And I think treating close to the skin is important. The concept of treating deep and taking ligaments that we know surgically have to be released in order to be repositioned is not likely to be worthwhile. I had always focused my lines with Ultherapy on the more superficial transducers and really scale back the number of any deeper lines.

Dr. Jason Pozner (10:45):
Smart.

Dr. Lawrence Bass (10:46):
But the ability to treat with minimal discomfort, the ability to treat a large area quickly has kind of led to some application of this technology in body treatments because body skin tightening and smoothing is important and sort of an unmet need. And also more recently has resulted in a specific FDA clearance for cellulite. Isn't that right?

Dr. Jason Pozner (11:18):
Absolutely. Absolutely. They just got clearance for cellulite. We're just starting to introduce that into our practice. This is a nice machine for your office. Again, the one thing is it's delegatable. I do a couple of these here and there, but we delegate this and it's so safe that you really cannot get into trouble with this device. We had a couple of nerve injuries with Ultherapy that were luckily temporary, but you cannot get any injury with this. It just doesn't go deep enough.

Dr. Lawrence Bass (11:46):
And overall, because when I look at all of these devices, I always like to ask this question, is this a wrinkle treatment in any way or it's really a loose skin treatment or is it a little bit of both?

Dr. Jason Pozner (12:00):
I think this is a lifting treatment, and I think when I look at lifting technology, I look at three different technologies for 2023 that we have available. One is Sofwaves, and I consider that to the left. That is the easiest treatment we do with no downtime and good reproducible results. I look at Ellacor on the right as the most aggressive treatment, probably the best results, but really aggressive with some downtime. And I put in the middle the microneedling radio frequency devices because you can target multiple levels and you can make that more aggressive than Sofwave and you have a little more downtime than Sofwave. But I'm not convinced that the microneedling radio frequency devices are any better than Sofwave. Not yet. We need to have some head-to-head studies between them, but that's how I kind of explain it to the patient. So no downtime, extreme downtime, a little bit of downtime.

Doreen Wu (12:55):
And what type of patient would you recommend Sofwave to? Who is the ideal candidate?

Dr. Jason Pozner (13:00):
I think this is a younger patient that's not yet ready for a facelift or someone who had a facelift looking for a little bit of improvement. I think if they're heavy jowled and have a lot of laxity of them face and neck, they're looking for an improvement that this device is not going to give them, and I think they're going to be underwhelmed by the treatment and unhappy with their result. But if you take someone with a little bit of laxity and understands what they're getting into, I think they'll be very satisfied. And I think we've been very successful in choosing the correct patients. That's why we don't have a lot of complaints. There's lots of people out there who are new to this industry who they'll take every 85-year-old with wrinkles and you're going to get her a face lift result. And Dr. Bass and I are kind of old dogs in this. We know that money upfront is going to lead to a dissatisfied patient and grief on the long end.

Dr. Lawrence Bass (13:50):
Yeah, I mean, you said something very telling that we do these treatments and we work in aesthetic medicine and surgery because we'd like to make people happy. And so I always want to do treatments that make people happy, that are satisfying and fun for them because that's why I went into this. And if that's not where I'm going to end up, it's not what I want to be doing because it's just unhappiness for me and for the patients. But basically I think there are two things about these technologies that are kind of important. One is, even though you might respond if you have a lot of laxity, you don't get to the meaningful results stage. If you have a turkey waddle under your chin and I take 20% of that away with a nonsurgical treatment, 80% of it is still there. You still have a turkey wattle, you still definitively look like you're in a later stage of aging, a certain decade of life.

(15:01):
And if you only have a little bit there, that can probably be well treated with one of these technologies. And so the result is much more meaningful. It's taken what's starting to look like it's aging and put it back into a quiet place. I think the other thing that's interesting is that a lot of other countries around the world use these kind of technologies very differently than we do. They start doing them very early in the aging process before there's much visible aging change. They're not looking for a visible change, they're looking for prevention and they do the treatments once a year, twice a year, very lightly not to look different, but to stay looking the same. And they go forward five years, seven years more looking the same as they did way back when they started. But Americans are in a rush. We want a big change. We want it quick in one treatment, and companies want to sell a single very expensive treatment. That's a better business model for them. And so it's left us with a little bit of a disconnect that we're starting to work around with some of these newer devices,

Dr. Jason Pozner (16:22):
Especially you're correct the Asian countries are really good with prejuvenation. They've sold a lot of Sofwaves in, believe or not in Taiwan lately, but Taiwan has taken off like crazy and I suspect the Asia Pacific, other countries are going to hit. This is going to take off very soon, and Korea is a hotbed. Once it hits in Korea, that's going to be it. And then I'm not sure about its China approval yet. China approval will be also good.

Doreen Wu (16:48):
Lastly, Dr. Pozner, what takeaways would you leave our listeners with when it comes to Sofwave?

Dr. Jason Pozner (16:53):
This is an exciting technology that is cutting edge, and if you're looking for some prejuvenation or a little bit of tightening in your face and you meet the right criteria, which is not needing a facelift, this is a great technology for you. If you go like this and that's your result you want, this is not for you.

Doreen Wu (17:11):
Dr. Bass, would you like to add any takeaways?

Dr. Lawrence Bass (17:14):
So this is a transcutaneous energy treatment. In other words, the energy has to go across the skin to get to the deep surface of the skin and just below, which is the target area. So in order to do that safely, that means it's on the lighter side of treatments. But the Sofwave technology treats a much bigger volume of tissue than preceding, more fractionated technologies at that single depth. That's probably most important, as I said, because it's lighter than other treatments that are in micro invasively or minimally invasively, putting energy into or under the skin. It's for earlier stages of aging. And the best use may well be that prevention and maintenance more than restoration, but that requires us as Americans to rethink our game plan a little bit. And finally, I agree a hundred percent with Dr. Pozner, in the presence of obvious hanging skin, it's simply not a good option. That's the place where something surgical is going to be much more effective and much more meaningful. So I'd like to thank Dr. Pozner for joining us yet again on the podcast. He just has a wealth of expertise in all things device and all kinds of non-surgical options, so I greatly appreciate him joining us and sharing it with us in such a forthright fashion.

(18:56):
Thank you for having me. Hopefully I'll be on again.

Doreen Wu (18:59):
Thank you Dr. Pozner, for coming on yet again and sharing your extensive device experience with all of us. 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 comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.