The Future Looks Beautiful: A Discussion of What Lies Ahead in Plastic Surgery & Aesthetic Medicine

Doreen Wu (00:00):
Welcome to another episode of Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu. And 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 "The Future Looks Beautiful: A Discussion of What Lies Ahead in Plastic Surgery and Aesthetic Medicine." Dr. Bass, we want all our beauty dreams to come true. We're always hoping for a new treatment that will work miracles.

Dr. Lawrence Bass (00:35):
That's what I call the magic wand treatment, Doreen. No risk, no recovery, perfect result. That being said, aesthetic physicians, people in the core four, like plastic surgeons, facial plastic surgeons, dermatologists, and oculoplastic surgeons. These are the doctors who as part of their training learn aesthetic treatments, work extensively with the aesthetic industry, the pharmaceutical and medical device companies to create advancement by imagining new options, doing research and teaching the science to others in the medical profession. And these aesthetic physicians have had an immense amount of success along with the aesthetic industry in bringing the field of aesthetic medicine forward over the last two or three decades. And this is what I've spent a lot of my time doing both during my clinical training and ever since. And it's really been an incredible experience to see the immense changes taking place in the field of plastic surgery and aesthetic medicine over the past few decades.

Doreen Wu (01:49):
On this podcast, we always like to talk about history a little bit. Dr. Bass, can you give us a recap of where cosmetic medicine has come since the 1980s and when the big explosion in aesthetic innovation really began?

Dr. Lawrence Bass (02:02):
So there have been a number of things taking place, but particularly with devices, injectable fillers, and neuromodulators, and all of this really started to gain momentum in 1990 and the rate of innovation, the rate of introduction of new technologies and the volume of care using these technologies has just been expanding ever since. And there were a couple of reasons for this. There were a few technological breakthroughs in our understanding of laser tissue interaction that let us design and engineer devices to have certain particular parameters, amounts of energy, amount of time that a laser pulse came out. But in addition to that we have backtracked and gone to bulk heating or long pulse exposures after exploring a number of options with short pulse exposures. We've technologically created the ability to have extremely short pulse exposures with not just thousandth or millionth of a second pulses, but trillionth of a second pulse technologies.

Dr. Lawrence Bass (03:33):
So we've really explored both sides of really short energy exposure and really long energy exposure. And a number of other things have happened to address other things besides the skin to get heat under the skin. With that, longer heating allows us to treat fat, to treat connective tissue elements that support the skin and work on body skin smoothing in ways we weren't able to before. So that's really a big thing about how we've expanded along with the ability to create fractionated treatments, where an injury or an energy exposure or a mechanical exposure is performed in a tiny pin prick sized area of skin and all of those dots of exposure accumulate to 10 or 20 or 30% of the total skin area that's being treated. But that allows you to do things to the skin that were you to do it over the entire area, might create too much damage or not heal in a favorable way, but the body accepts that kind of exposure in the very small pinpoint. And that allows us in a very tricky way, with much less risk and much less recovery to rejuvenate photo damaged skin, or create other effects even extending under the skin.

Doreen Wu (05:12):
It sounds like in such a short amount of time, we've really come a long way. And now we have this vast array of treatments that are available today. My grandmother's cold cream is pretty much nothing compared to the technology available to keep me looking young and otherwise enhance my appearance, but I feel like it could always be better. What is on the horizon, Dr. Bass? Is it possible for you to put on your reading glasses and tell me what the shadows in the crystal ball are suggesting? What aesthetic medicine will look like in, let's say 10 and 20 years from now?

Dr. Lawrence Bass (05:45):
Well, it's always hazardous to try to predict the future. And of course, if anyone thinks they know what the future will bring, they're probably not as smart as they think they are. That being said, though, there are clearly certain trends. A number of things are are happening that take advances we've already developed in this historical period that I just discussed and extend them, or bring them into a new arena. So some of the fractionated treatments being extended into what are called micro-coring technologies, where instead of using a laser and vaporizing tissue, which always leaves a zone of thermally damaged tissue in each of the little pinpoint areas, there are technologies that are under development to create micro-coring, mechanically taking out a tiny pinpoint of tissue that then cumulates to a certain amount of tissue reduction, heals in a few days without a scar, and takes advantage of this altered mode of healing when you do something fractionally. And that's despite fractional treatments being nearly 20 years old, that's something that really has not been exploited up until this point in time.

Dr. Lawrence Bass (07:14):
And so those technologies are on the way. There are very short pulse technologies, even shorter than the trillions of a second pulses that are in development. And it's not clear where that's going to bring us, but they're reconstructive applications. And we'll see if that also brings us aesthetic applications there have been use of multiple modalities to treat body skin in ways that we haven't been able to previously and body skin smoothing for a long time has been an unsolved problem in plastic surgery. And there are reasons it's very difficult. I mean, you're talking about very large skin areas compared to something like the face and neck. You're talking about a lot more weight on the skin. So the mechanical forces work against you much harder than on the face and neck. And the metabolism of body skin is not as good as face skin.

Dr. Lawrence Bass (08:28):
It doesn't remodel as well. It doesn't heal as quickly, and this has made this a tough problem, but there are newer technologies using microwaves that may bring more more outcome, more results than what we've achieved up till now using radio frequency technologies. There are technologies that use shock and various other short pulse technologies that create a neovascularization creation of new blood supply and a neogenesis development of new collagen in the skin to create more youthful looking and behaving skin and using a lot of these things in combination often will let us amplify the result rather than just trying to hit harder in a small number of treatments with one modality. Using biological and pharmacologic options in conjunction with technologies is another thing we're going to see a big expansion of, I believe in the future. So many technologies, particularly the fractional lasers and other fractional devices, fractional microneedling, open channels into the skin. And that allows you to put a medicine into the skin in high doses in a way that you could not take systemically because it wouldn't be safe or wouldn't be well tolerated. And in a way that you can't get into the skin just by applying a skin cream, because the skin is our natural barrier against the outside world. So these are a few of the ways I think we'll be moving forward into new horizons in the future.

Doreen Wu (10:33):
Speaking of modalities, you mentioned devices, pharmaceutical medicines, biologicals, treatments, and even surgery. Dr. Bass, were we likely to see some revolutionary change in the coming years?

Dr. Lawrence Bass (10:46):
First, let's talk about the issue of evolutionary change versus revolutionary change. So of course, evolutionary change is something we've already got that we make a little bit better, kind of the new and improved version of what we already have. Revolutionary change is something that takes us to a whole different place that we really haven't worked in before. Evolution change is a lot easier to predict than revolutionary change because we know ways we might explore improving what we've got, but when we're going to make a holy novel discovery, something new that nobody thought of or did before, is much harder to predict. You know, you can't schedule innovation. You know, the breakthrough is scheduled for Tuesday at 10:00 AM. That's not how science works. Of course we'd like it if it worked that way, but we have to wait until lightning strikes.

Dr. Lawrence Bass (11:47):
Certainly we're going to see a whole host of improved devices, evolutionary change but there are some novel devices and modalities that are poised to launch that again, pivot in a significant way from previously, things like micro-coring, things like the muscle stimulation technologies using electro mechanical stimulation and so forth. And those are really changes. We're going to see revolutionary change in biologics. We really don't have a lot of biologics and aesthetic medicine that we're using to reprogram the biology of skin. We are using biologics like injectable fillers and neuromodulators, but we're going to see more biologics that reprogram the behavior of skin. More like the program skin was following when we were younger. When that's going to come is not clear. And it's not around the corner in the next year or so, but there's going to be a point in the next 10 or 15 years where there's likely quite a bit more of that. I think the other change is going to be the approach that we take to treatments and to aesthetic surgery. And that is going to evolve to a different place. So not revolutionary, but evolutionary.

Doreen Wu (13:31):
Based on our discussion today, it's safe to say there are exciting times ahead for cosmetic medicine. Before we conclude Dr. Bass, I would like to ask you to share some important takeaways for our listeners.

Dr. Lawrence Bass (13:43):
Sure. And you know, this is something I think about a lot, every time we run into some problem we can't treat well or every time patients find it frustrating to have to keep coming back for something or not quite get where they hope to get. We put our thinking caps on and ask how we might get to a better place with this. And I think the approach and management style is going to change. I've said several times on the podcast, that beauty is a process, not an event and so easy, quick, no recovery ways of maintaining skin is going to overtake what previously was the almost exclusive restoration of skin that was failing to take care of itself due to aging changes. As I said, we're going to see more emphasis on biologicals and possibly stem cells or other kinds of cell-based therapies. There are things that are not stem cells that are mature cells that may increasingly be incorporated in aesthetic therapies. And big restorative surgery will become less common, small surgical procedures done earlier in the game before the need for a major restorative surgery will become increasingly common.

Dr. Lawrence Bass (15:18):
And we are going to use more tracking and planning tools, tools that show us what aging changes are taking place and how things are changing over time and how successful we're being with a given treatment or a given program of treatments in restoring the appearance. We're going to have much more sophisticated tools utilizing artificial intelligence and improved imaging and other objective assessments to tailor our treatment for patients in the future. And I'm fairly certain we're going to see that and see that soon. Of course, disruptive breakthroughs are hard to predict when they're going to happen, but I'm sure there'll be a few pleasant surprises in that regard, in terms of new things that really change the whole game.

Doreen Wu (16:18):
Thank you, Dr. Bass for sharing your insight and expertise with us, and thank you to our listeners for joining us today, to hear about the future of aesthetic medicine and plastic surgery, the field is constantly evolving and we will bring you new updates as they come. I hope you found this episode as fascinating and informative as I did. If you think of other exciting developments or trends in plastic surgery that you would like us to discuss in upcoming episodes, please reach out by email or Instagram. We'll see you next time. This is Doreen Wu, thanking you for joining Dr. Bass and me for this discussion of the future of aesthetic medicine and plastic surgery. Be sure to tune in next time. And don't forget to subscribe to our podcast, to stay up to date with all of the exciting content that is coming your way.

Speaker 3 (17:01):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor-patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.