Nov 30 – Dec. 3, 2023: The 26th Annual Mount Sinai Winter Symposium took place at The New York Academy of Medicine (NYC). This nationally recognized, live CME event was attended by over 550 participants. It offered a comprehensive program addressing Medical and Surgical Dermatology, which was delivered by 40 sought-after faculty speakers and world-renowned leaders in the treatment of various skin diseases and conditions. Topics included the most current research on the diagnosis and treatment of medical dermatological conditions, such as psoriasis, eczema, alopecia, hidradenitis supportive, actinic keratosis, rosacea, and skin cancer. In addition, cosmetic procedures were performed in front of the audience allowing them to witness the latest techniques in skin rejuvenation.
Dr. Robert Bard, seasoned diagnostic specialist in NYC and a long-time presenter of the Icahn School of Medicine was personally invited to exhibit at the Mt Sinai Winter Symposium series. The 25th Annual event showcasing Advances in Medical and Surgical Dermatology has been a must-attend event to the medical community nationwide where health professionals and medical students traditionally fill the halls of the NY Academy of Medicine each year. In addition, major vendors from some of the largest pharmaceutical brands and other dermatological health solutionists grace the 15,000 sq. ft grand ballroom. This year, Dr. Bard elected a unique and impressive way of presenting to the institution by introducing his recent collaborative ally, Mr. Charles Vorwaller- CEO of Aspen Laser to present about Photobiomodulation therapy as part of Dr. Bard's reserved space. "We have been performance testing Charles' Aspen Laser Apex Model for the better part of 6 months and found the technology to align with the many skin issues (like inflammatory skin disorders) that I found this event to be the ideal opportunity for me to endorse Aspen laser into the dermatological community."
POWER-PACKED CURRICULUM As educational conferences in medicine goes, this event did not disappoint when it comes to a comprehensive educational resource for Advances in Medical and Surgical Dermatology. "As a recently licensed dermatologist, I was amazed at the variety of CME and NON-CME workshops and presentations", says Abdel Zerzei. "I attended all three days and enjoyed presentations such as: Treatment of Psoriatic Arthritis (Dr. Alice Gottlieb), Tips for Development of a Successful Practice (Dr. Leon H. Kircik) and 'What’s new in Rosacea and Seborrheic Dermatitis' (Dr. Benjamin Ungar)- among others. It was the best educational experience I've had in a very long time!" Surprisingly, Aspen was the only laser company of its class at the event. "I was glad to bring Charles Vorwaller into the society of dermatologists-- he was the perfect educator about near-infrared and so many of the attendees were inspired by his science", continued Dr. Bard.
Among the many honored medical experts and legendary speakers that visited the Aspen Laser booth was Dr. Mark Lebwohl (Image L), top researcher of Itch and Inflammatory Skin Conditions from the Mark Lebwohl Center for Neuroinflammation and Sensation at Mt. Sinai. Dr. Lebwohl is a long-time colleague of Dr. Bard's (R) and recently wrote the foreword to his latest epic textbook project by Springer 'Image Guided Aesthetic Procedures'. "Many of the breakthroughs announced at the symposium were based on work done at Mount Sinai. This annual symposium has been showcasing new developments in dermatology for decades. It is a great source of pride that many of the new treatments are based on our laboratory and clinical research" - stated Dr. Lebwohl.
# # #
DERM-NEWS : TOXINS IN THE SKIN
According to the CDC, DERMAL ABSORPTION happens when a chemical goes through the skin and travels into the body. Many chemicals used in the workplace or even from home (ie. pesticides and organic solvents) can wreak havoc on and under the skin, damage internal organs and also the immune system if they penetrate the skin and enter the bloodstream. Most efforts to address chemical hazards have been focused on breathing, digesting or drinking chemicals rather than what's being absorbed through skin. Because of this, there are far fewer methods and campaigns dedicated to assessing skin exposures to toxins - UNTIL NOW.
With the latest evidence of inflammatory skin disease and foreign bodies under the skin, the medical and aesthetics communities are now facing the many new ways that environmental (toxic) influencers can affect the body through skin contact and absorption. This initiative is achieved thanks to our non-invasive diagnostic imaging advancements including Confocal Microscopy and the 3D Doppler Ultrasound. Dr. Robert Bard, presents this critical health topic as part of his Educational Series on INTRADERMAL IMAGING OF TOXINS in dermatology conferences such as the NIDISKIN Spring Symposium.
(C) 2023 Dr. Robert L. Bard- Inflammatory Skin Disease/NIDI-Weill Cornell event
ELASTOGRAPHY AND QUANTITATIVE IMAGING: CONFIRMING THERAPEUTIC RESPONSE By: Dr. Robert L. Bard
One of the most comprehensive ways to confirm the results of any treatment is by clinically tracking the body's physiological response from underneath the skin. Diagnostic imaging captures measurable data about the injured or inflamed area, allowing both clinicians and patients the ability to identify therapeutic progress in real time. Widely preferred scanning modalities include the Doppler Blood Flow Ultrasound (or sonography) and Elastography, both using high‐frequency sound waves to view inside the body. Like an internal video camera, these high speed scanning innovations capture actual movement of the body's internal organs. This offers a vast amount of biometric information about the patient’s condition, in comparison to still images of conventional x‐rays. The ultrasound's ability to evaluate abnormalities within the soft tissue in research and clinical trials are widely used in recording evidence‐based biomarkers to trace therapeutic efficacy.
ELASTOGRAPHY & DOPPLER ULTRASOUND Elastography and Doppler Ultrasound are both physiologic technologies which show whether the cancer treatment is working or not. They provide effective therapeutic markers over a blood test.
Elastography measures hardness of tissue and tissue healing through elasticity. Hard scar formation or fatty changes is measured on the scale at the top right. FAT, which is soft, appears as blue (at 120) whereas the 480 level the scar tissue is harder. We know that scar tissue impedes muscle contractility greater than fatty changes, thus treatment can be appropriately applied to the type of tissue that needs regeneration.
SCANNING INFLAMMATORY SKIN DISORDERS AND TUMORS WITH ELASTOGRAPHY Elastic ultrasound technology is an advancement where we can get real‐time images, this scan shows the tumor from beginning to end as we scan through it. Notice that the blue area is the softer tissue and the hard tissue (with more aggressive) cancer is the red. In this screen, we are able to have a comparative study of the regular ultrasound (below) and the elastogram on top. After the use of real‐time elastogram, we can freeze frame a significant image showing the red area of active tumor on the bottom. Fluid does not have elasticity, it does is not hard and it appears as black. Therefore the two top areas which we saw had low blood flow or no blood flow in the previous image have zero elastic qualities‐ meaning these areas that are dead and inactive. This also means that elastography is a usable treatment marker to show treatment effect. In other words, when you go from red to black, it means that the black area is a degenerated or dead inactive part of the cancer.
CASE STUDY #7: PSORIASIS / FOOT & ELBOW
FOOT: laser compare 3-11-23. Hx: Right foot pain Sonofluoroscopy of the plantar and hallux tissues was performed in multiple scan planes with 18 and 20 MHz transducer frequencies. Power and spectral Doppler was performed. Mild tendinitis unchanged.
3D DOPPLER: Normal posterior tibial and pedal arterial Doppler flows. No regional hyperemia. Triphasic waveforms. Peak vel 11cm/s. Hyperemia decreased to the dip joint. 3D shows abnormal dermis decreased from 2.1mm to 15mm.
ELASTOGRAM: Decreased edema psoriatic plaque (light blue) with early fibrosis of talar ligament (yellow).
PATIENT NARRATIVE“I have been suffering from PSORIASIS since I was 25. Periodically my psoriasis gets inflamed and gets very scaly and very itchy. (When I scratch, which is often it gets worse). I received my first treatment with the (Aspen) Laser back in March, 2023 and I received various treatments afterward. I continue to have this laser treatment on my right foot, which is the worst and on my right elbow. Lately, the scaling seems much flatter. I don't know whether it's the laser or some of the other home treatments I'm doing for myself… but it seems to be quite a bit improved”.
2024 MagLaunch: HEALTHTECH REPORTER For this SKIN HEALTH issue, we caught up with Aspen Laser (photobiomodulation) who exhibited at the 2023 Mt Sinai Symposium. CEO Charles Vorwaller showcased the many advantages of near-infrared laser in cell regeneration and addressing inflammatory skin disorders. Low-level laser therapy (LLLT) or photobiomodulation (PBM) is a form of medicine that applies low-power lasers or light-emitting diodes (LEDs) to the surface of the body. It is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function. It addresses the underlying cause of all dysfunction in the body (inflammation & disease) and that is cellular health and wellness. Red light is known for its ability to penetrate deeper into the skin- and can be absorbed by cells deep in the body. Today's technology offers Red Light therapy in a variety of devices with different capacities, including the red light bed panels and targeted deep tissue laser therapy systems. Aspen Laser is recently featured in HealthTechReporter.com.
Another recent SKIN feature on HealthTech Reporter is the COMPREHENSIVE PERFORMANCE REPORT OF A TOPICAL SKIN CONDITIONING PRODUCT- Review this anecdotal test drive of the Canon Aplio e550 under a pilot study of an exosome‐based topical product called ELEVAI. Global interest in the advancement of Exosomes continues to raise significant interest in the research community to explore and confirm findings about this technology as has been raised since the advent of stem cell research (early 1980’s). Dr. Robert Bard initiated this “test drive” employing an IMAGE-GUIDED approach to monitor, track and report his findings through the use of advanced ultrasound scanning modalities.
A MAJOR CAST OF CLINICAL AESTHETICS LEADERS IN ONE COLLABORATIVE TEXT!
Meet BETH HANEY, DNP- one of the recognized industry achievers assembled in this aesthetics collaborative and an honored literary contributor of the recently published IMAGE GUIDED AESTHETICS PROCEDURES textbook by Springer Medical Publishing. Dr. Haney authored a comprehensive study on (Ch4) "FACIAL REJUVENATION AND NON-SURGICAL PROCEDURES" and also co-wrote a remarkable analysis (Ch6) called "FACIAL DANGER ZONES IN AESETHETICS" with Dr. Michelle Zappas. Dr. Haney is currently faculty at USC teaching health policy, a former Assistant Clinical Professor at UCI, is a member of the American Association for Nurse Practitioners Health Policy Committee, the Southern California AANP state liaison, and served as Chair of the 2022 and 2023 AANP Health Policy Conference. She founded the Luxe Aesthetic Center in Yorba Linda, CA- a high-profile medspa offering professional aesthetic products and treatments catering to private individuals & celebrity clients. Dr. Haney is currently Mayor Pro-Tem and former Mayor (2020) of Yorba Linda, doctor of nursing practice & a nationally certified family nurse practitioner specializing in cosmetic dermatology treatments, business and leadership, & policy.
10/21/2023 - After two years in the making, we congratulate Dr. Robert Bard and his alliance of clinical experts for the launch of "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS". Springer Medical Publishing proudly presents the first installment in clinical aesthetic procedures. This detailed and up-to-date overview of image-guided procedures focuses on the many aesthetic and reconstructive strategies delivered by some of today's renowned leaders in the clinical aesthetics community. They share their valuable expertise and field-based findings throughout this feature-rich textbook. The wide list of audiences for this text (ie. dermatologists, plastic surgeons, aestheticians, general surgeons) will enjoy an insider's look at each treatment program while providing remarkable field-based knowledge for the general non-medical audience seeking the latest information in non-invasive and minimally invasive aesthetic procedures.
Produced and edited by Dr. Robert L. Bard, (NYC based cancer diagnostic imaging specialist) this collective project showcases the most highly sought-after cosmetic treatments in each priceless chapter- through detailed breakdowns, experiential insights and a generous graphic tour of before and after progress visuals. Thanks to the additional safety benefits of clinical imaging, our treatment professionals express added confidence in the pre-operative and post-op areas. In addition, many aesthetics procedures noted also brings significant advantages (of accuracy and efficiency) to the actual treatment process from real-time image guidance.
AUTHOR LIST (alphabetical)
• Arun K. Garg, DMD • Beth Haney, DNP • Cameron Christiansen, BS • Cameron Rokhsar, MD • Cari Green, MD • Elie M. Ferneini, MD • Gabriel Borden • January Howard
• John Catanzaro, MD • Lennard Gettz, EdD • Lio Yu, MD • Lucian Fodor MD • Mairead Moloney • Marc J.Saltzman, MD • Mary Nielsen • Michelle Zappas, DNP
• Noelle Cutter, PhD • Paul Dreschnack, MD • Peter A. Everts PhD • Randall L. Weisel DDS • Richard Kushner, DPM • Robert L. Bard, MD • Samuila Sergiu, MD • Stephen Chagares, MD
Excerpt from CHAPTER 1: INDUSTRY REVIEW OF THE AESTHETIC INDUSTRY By: January Howard & Lennard M. Gettz, Ed.D
Abstract The history of cosmetics is reviewed with technologies unfolding less invasive options and more functional solutions involving nutraceutical supplementation with natural resources. Minimally invasive options are documented as is the adaptation of therapy to the Covid-19 pandemic. This chapter dives into the positive and negative implications of aesthetic procedures and how minimally invasive tactics could help advance all procedures focusing on the sake of performance, safety, and longevity
Introduction Conducting an industry review on the current state of the aesthetic industry would be incomplete without shedding a spotlight on social outlook and how it drives consumer activity trends. All aesthetic procedures are promoted to enhance one's overall look and public appeal and are often theorized to elevate one’s self-appreciation. The public desire to achieve this is what supports this multi-million dollar industry to self-generate constant energy to acquire new market support each year. Fig 1.
Figure 1: Facial injections may avoid nerve and vascular structures under ultrasound image guidance.
Historically, the study of human nature has shown consistent evidence of aesthetic personalization throughout every social class as part of natural human desire and need for visually expressing personal pride and individualism. To date, there is an ever-growing list of solutions to enhance and improve a person's image, from PRP injections, microneedling,
chemical peels, Botox, and fillers. These procedures have widely grown in popularity throughout the global community because of their affordable cost to the client/patient, their easy access and their immediate performance and effectiveness.
The future of minimally invasive modalities has projected a major market growth without any signs of slow-down. Introducing aesthetic procedures to just about ANY practitioner, let it be a dentist, an OB/GYN, a plastic surgeon or a urologist offers a natural add-on, exponentially widening the access of these treatments to the community at large. Where dentists and plastic surgeons clearly have their specialized work intact, aesthetic procedures offer a supplemental income and a lucrative addition to their existing service set. For the practitioner, these procedures are a sensible upgrade by adding fairly recognizable protocols and equipment from prior training.
Practitioners find the integration and learning curve of adapting aesthetic modalities into their existing practice to be quite comfortable and cost-effective. For example, one can be trained to produce their own dermal filler or bio filler by extracting PRP (which is the client's own biologic) by "cooking" the platelet poor plasma. This is instead of purchasing bio filler from any of the existing manufacturers, offering a savings of anywhere from $300 to $800 per box.
As the industry concepts of beautification evolved and expanded toward clinical procedures, a sensible upgrade is the implementation of IMAGE GUIDANCE- a valuable tool forged by medical diagnostics. For over 30 years, ultrasound imaging has offered great value in clinical applications and is now adding great directive support to injection situations whereby knowing where the veins and bones truly are could be very helpful as a matter of safety. Whether someone is new to conducting injectable treatments or is a seasoned professional, having the reassurance of visual confirmation lowers the likelihood of hitting a vein or creating an occlusion. Reducing or eliminating risk to the client from pain or the stress of a “land mine” event is a major selling point for imaging devices in pre and post procedures.
The Modern Age of Clinical Aesthetics Throughout the 20th century, economic and medical industry reports have traced major activity in cosmetic procedures as part of a global consumer trend of personal enhancement investments. Where elective surgical procedures like breast augmentation, liposuction and rhinoplasty once dominated the aesthetic media, the early 1980's brought forth a new wave of Minimally Invasive procedures which forged an entire industry of cosmetic self-rejuvenation. In 1981, bovine collagen was the first agent approved by the FDA for cosmetic injection. It was developed to induce a youthful appearance (as well as address facial deformities) to target smile lines and improve the presence of facial acne scars. The first regulatory approval gave way for dozens of injectable cosmetic filling agents as well as technologies in pursuit of "anti-aging" or facial enhancement. This minimally invasive treatment trend includes chemical peel, dermal fillers, laser skin resurfacing, hair removal techniques, microdermabrasion and others. [1][2] Fig2.
Figure 2: Optical and thermal energy devices build collagen and firm tissue characteristics
We can track the history of cosmetic enhancement and aesthetic rejuvenation through the timeline of cosmetic body art as the earliest tribal rituals, to the old testament (840 BC) from the book of Esther to ancient Egypt (1,320 BC)[3]. Since ancient times, the concept of cosmetics, and facial enhancement have been part of personal essence- especially for the elite. Often they were used in religious ceremonies - as seen in ancient Egypt - or as cultural identification. [4] Cosmetic products such as creams, lotions, and talcum powders became more globally accessible to the human zeitgeist, supporting pursuits of cultural acceptance, personal enhancement and beauty. Tracking the aesthetic market in the west, skin care products including skin lotions, powders, creams, bleaches, ointments, and cleansers have historically accounted for a large percentage of the American cosmetics and hygiene industry. The claims and perceived notion of smoother, whiter skin is aligned with better health and beauty has become the impression of beauty since the 1800s. Concealing and removing imperfections like freckles, rashes and pimples are also part of the aesthetic objectives. [5]
References
1) Breaking down the most popular noninvasive cosmetic treatments, American Society of Plastic Surgeons , Rod Rohrich, MD, FACS | Dallas, TX Friday, June 16, 2017 - https://www.plasticsurgery.org/news/blog/breaking-down-the-most-popular noninvasive-cosmetic-treatments 2) The history of injectable facial fillers, Theda C Kontis 1, Alexander Rivkin. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/19415573/ 3) History of cosmetics: https://en.wikipedia.org/wiki/History_of_cosmetics 4) Library of Congress, History of the Beauty Business: https://guides.loc.gov/business-of-beauty/history 5) Cosmetics and Personal Care Products in the Medicine and Science Collections https://americanhistory.si.edu/collections/object-groups/health-hygiene-and-beauty/skin-care
ISBN 978-3-031-36264-4 ISBN 978-3-031-36266-8 (eBook)
10/21/2023 - After two years in the making, we congratulate Dr. Robert Bard and his alliance of clinical experts for the launch of "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS". Springer Medical Publishing proudly presents the first installment in clinical aesthetic procedures. This detailed and up-to-date overview of image-guided procedures focuses on the many aesthetic and reconstructive strategies delivered by some of today's renowned leaders in the clinical aesthetics community. They share their valuable expertise and field-based findings throughout this feature-rich textbook. The wide list of audiences for this text (ie. dermatologists, plastic surgeons, aestheticians, general surgeons) will enjoy an insider's look at each treatment program while providing remarkable field-based knowledge for the general non-medical audience seeking the latest information in non-invasive and minimally invasive aesthetic procedures.
AN ALL-STAR CAST OF INDUSTRY LEADERS IN ONE COLLABORATIVE TEXT!
Produced and edited by Dr. Robert L. Bard, (NYC based cancer diagnostic imaging specialist) this collective project showcases the most highly sought-after cosmetic treatments in each priceless chapter- through detailed breakdowns, experiential insights and a generous graphic tour of before and after progress visuals. Thanks to the additional safety benefits of clinical imaging, our treatment professionals express added confidence in the pre-operative and post-op areas. In addition, many aesthetics procedures noted also brings significant advantages (of accuracy and efficiency) to the actual treatment process from real-time image guidance.
AUTHOR LIST (alphabetical)
• Arun K. Garg, DMD
• Beth Haney, DNP
• Cameron Christiansen, BS
• Cameron Rokhsar, MD
• Cari Green
• Elie M. Ferneini, MD
• Gabriel Borden
• January Howard
• John Catanzaro, MD
• Lennard Gettz, EdD
• Lio Yu, MD
• Lucian Fodor MD
• Mairead Moloney
• Marc J.Saltzman, MD
• Mary Nielsen • Michelle Zappas, DNP
• Noelle Cutter, PhD
• Paul Dreschnack, MD
• Peter A. Everts PhD
• Randall L. Weisel DDS
• Richard Kushner, DPM
• Robert L. Bard, MD
• Samuila Sergiu, MD
• Stephen Chagares, MD
CHAPTER 1: INDUSTRY REVIEW OF THE AESTHETIC INDUSTRY By: January Howard & Lennard M. Gettz, Ed.D
Abstract The history of cosmetics is reviewed with technologies unfolding less invasive options and more functional solutions involving neutraceutical supplementation with natural resources. Minimally invasive options are documented as is the adaptation of therapy to the Covid-19 pandemic. This chapter dives into the positive and negative implications of aesthetic procedures and how minimally invasive tactics could help advance all procedures focusing on the sake of performance, safety, and longevity
Introduction Conducting an industry review on the current state of the aesthetic industry would be incomplete without shedding a spotlight on social outlook and how it drives consumer activity trends. All aesthetic procedures are promoted to enhance one's overall look and public appeal and are often theorized to elevate one’s self-appreciation. The public desire to achieve this is what supports this multi-million dollar industry to self-generate constant energy to acquire new market support each year. Fig 1.
Figure 1: Facial injections may avoid nerve and vascular structures under ultrasound image guidance.
Historically, the study of human nature has shown consistent evidence of aesthetic personalization throughout every social class as part of natural human desire and need for visually expressing personal pride and individualism. To date, there is an ever-growing list of solutions to enhance and improve a person's image, from PRP injections, microneedling,
chemical peels, Botox, and fillers. These procedures have widely grown in popularity throughout the global community because of their affordable cost to the client/patient, their easy access and their immediate performance and effectiveness.
The future of minimally invasive modalities has projected a major market growth without any signs of slow-down. Introducing aesthetic procedures to just about ANY practitioner, let it be a dentist, an OB/GYN, a plastic surgeon or a urologist offers a natural add-on, exponentially widening the access of these treatments to the community at large. Where dentists and plastic surgeons clearly have their specialized work intact, aesthetic procedures offer a supplemental income and a lucrative addition to their existing service set. For the practitioner, these procedures are a sensible upgrade by adding fairly recognizable protocols and equipment from prior training.
Practitioners find the integration and learning curve of adapting aesthetic modalities into their existing practice to be quite comfortable and cost-effective. For example, one can be trained to produce their own dermal filler or bio filler by extracting PRP (which is the client's own biologic) by "cooking" the platelet poor plasma. This is instead of purchasing bio filler from any of the existing manufacturers, offering a savings of anywhere from $300 to $800 per box.
As the industry concepts of beautification evolved and expanded toward clinical procedures, a sensible upgrade is the implementation of IMAGE GUIDANCE- a valuable tool forged by medical diagnostics. For over 30 years, ultrasound imaging has offered great value in clinical applications and is now adding great directive support to injection situations whereby knowing where the veins and bones truly are could be very helpful as a matter of safety. Whether someone is new to conducting injectable treatments or is a seasoned professional, having the reassurance of visual confirmation lowers the likelihood of hitting a vein or creating an occlusion. Reducing or eliminating risk to the client from pain or the stress of a “land mine” event is a major selling point for imaging devices in pre and post procedures.
The Modern Age of Clinical Aesthetics Throughout the 20th century, economic and medical industry reports have traced major activity in cosmetic procedures as part of a global consumer trend of personal enhancement investments. Where elective surgical procedures like breast augmentation, liposuction and rhinoplasty once dominated the aesthetic media, the early 1980's brought forth a new wave of Minimally Invasive procedures which forged an entire industry of cosmetic self-rejuvenation. In 1981, bovine collagen was the first agent approved by the FDA for cosmetic injection. It was developed to induce a youthful appearance (as well as address facial deformities) to target smile lines and improve the presence of facial acne scars. The first regulatory approval gave way for dozens of injectable cosmetic filling agents as well as technologies in pursuit of "anti-aging" or facial enhancement. This minimally invasive treatment trend includes chemical peel, dermal fillers, laser skin resurfacing, hair removal techniques, microdermabrasion and others. [1][2] Fig2.
Figure 2: Optical and thermal energy devices build collagen and firm tissue characteristics
We can track the history of cosmetic enhancement and aesthetic rejuvenation through the timeline of cosmetic body art as the earliest tribal rituals, to the old testament (840 BC) from the book of Esther to ancient Egypt (1,320 BC)[3]. Since ancient times, the concept of cosmetics, and facial enhancement have been part of personal essence- especially for the elite. Often they were used in religious ceremonies - as seen in ancient Egypt - or as cultural identification. [4] Cosmetic products such as creams, lotions, and talcum powders became more globally accessible to the human zeitgeist, supporting pursuits of cultural acceptance, personal enhancement and beauty. Tracking the aesthetic market in the west, skin care products including skin lotions, powders, creams, bleaches, ointments, and cleansers have historically accounted for a large percentage of the American cosmetics and hygiene industry. The claims and perceived notion of smoother, whiter skin is aligned with better health and beauty has become the impression of beauty since the 1800s. Concealing and removing imperfections like freckles, rashes and pimples are also part of the aesthetic objectives. [5]
The Demand for Aesthetic Surgeries The history of plastic surgery goes back as far as between 1000 and 800 BC with Sushruta - considered the "Father of Plastic Surgery" from ancient India. He was responsible for the advancement of medicine and his early teachings of anatomy, pathophysiology, and therapeutic strategies were achievements linked to nasal reconstruction. Sushruta's surgical studies led to his development of the cheek flap for nasal reconstruction. His surgical concepts and his creative approaches still apply today. [6]
The term PLASTIC surgery is traditionally a clinical term often used for reconstructive treatment of parts of the body affected by disease, injury, infection, birth defects or trauma. COSMETIC or aesthetic surgery is an elective procedure that enhances or reshapes parts of the body to support the patient’s pursuit for self- esteem. Analysts identified the many influences of opting for cosmetic surgery- covering perceived advantages of the likelihood of a more fulfilled life. Where one’s self-confidence is linked by societal behavior with an attractive appearance through surgical enhancement, studies emphasized exposure to the media may have significant influence in pursuing cosmetic surgery.[19]
One of the oldest cosmetic procedures has been Rhinoplasty (nose job) dating back to the 6th century. Within the recent decade, surgeons have perfected this process such that in 2014, Rhinoplasty has been recognized as the second most popular procedure in the US with over 215,000 cases within a total estimate of 15M cosmetic procedures. This procedure is second in popularity only to breast enhancement. Other aesthetic procedures that fill this public demand is for gluteal implants, liposuction and eyelid uplift. [7]
The demand for enhancement procedures directly aligns with the worldwide human ambition to fight the many foibles of natural affliction of the aging process. To pursue the ability to improve one's personal health and appearance is heavily driven by the desire to look and feel young again- such that "the battle to reverse time" has expanded this multi-million dollar market. This trend includes the increase in demand for facial aesthetics products such as anti-aging, anti-wrinkle, oxygenation, rejuvenation neurotoxin free botulinum as well as the growing industry of minimally invasive procedures.
Additionally, dental implants have been added to the list of cosmetic procedures, addressing the treatment of dental imperfections and congenital defects. More recent dermal solutions cover technology-driven laser treatments of lesions, skin toning and the removal of tattoos, hair and scars. [7]
Risks and Complications By now, we all understand the set of risks that exist within any surgical procedure. Not only are all patients prone to different healing rates and capacities, but there may be a wide array of possible complications associated with cosmetic / plastic surgeries- including: Infection, post-op internal bleeding, reactions to foreign materials or anesthesia and complex issues during the healing process such as nerve damage, fluid buildup and blood clotting. [8]
2020 news headlines published a major health alert with women who invested in textured breast implants to potentially cause Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) - an uncommon and treatable type of large cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself. In a 2020 FDA study, there have now been 733 unique confirmed cases worldwide which included 36 known deaths. [9][10]
Minimally Invasive/ Injectable Treatments According to international studies, the market of non-invasive aesthetic treatment has been a steady boom at an estimated USD 53B since the early 2020’s with a projected growth of
15%+ for the next 10 years. This continued consumer demand for improving physical appearance in adults gained an uptick in the induction of the more affordable and more accessible non-invasive and minimally invasive aesthetic procedures within this period.
INJECTABLE procedures also gained significant popularity especially in the 50+ year old age group. A high population of women are recorded to request aesthetic fillers including Botox. In 2018, an est. $2.8 Billion minimally invasive cosmetic procedures were conducted domestically, (according to the Grand View Research) showing a consistent rise each year of 9%- identifying its major growth in demand and popularity. These procedures rose sharply by an est 228% within 2000–2018 in the US, and they now account for 95% of all cosmetic treatments undertaken were for NSFA treatments with a 5% decrease in surgical procedures. Minimal invasiveness results in faster recovery, lesser scarring, limited stress, and better patient satisfaction. [5][7][12][13] Fig 3
Figure 3: Variations on injections include microneedling procedures are useful in scar and keloid treatments
Within the last two decades, the widening term “Medical Aesthetics” has become a trend representing physical corrections and restoration beyond cosmetic applications. Injectable techniques have expanded to clinically support the aesthetic dermatologist to repair facial texture structurally through contouring, lifting, volumizing, improving muscle and tissue tone or implement focal fat reduction. The professional may apply a host of materials into the skin including inert fillers, platelet-rich plasma (PRP), stem cells and lipolytic agents. As the expansion of agents and injecting materials continue to grow with its demand, the inducing clinician must undergo comprehensive safety and procedural training alongside a solid understanding of the elements used in these injectable treatments in order to achieve proper outcomes. [14]
The Covid-19 Pandemic & Self-Enhancement Global analytics of the aesthetics community during the coronavirus outbreak (COVID-19) in 2019 resulted in the freeze of all non-emergency/elective hospital procedures. It is this suspension alongside the societal distress caused by the lockdown that created a backlog
of procedures and an increased demand for self enhancement. Also, other influential factors driving the rise in cosmetic surgery during the pandemic were attributed to the vast exposure to video conferencing, where more individuals are forced to view themselves (and grow critical of their appearance) during video meetings. Fig 4.
Figure 4: Real time imaging may better demonstrate blood flow and thin facial nerves and provides a preop map of danger sites
Global studies have been implemented on adults observing behaviors and concerns while undergoing multiple video conferencing usage, including the use of video-enhancement tools to improve picture quality and focus of visual attention while on video calls. A significant percentage of participants identified appearance concerns while on video- associated with self-focused attention and increasing appearance concerns due to their time on video calls. The report concluded a large number of interest in acquiring future beauty treatments and nonsurgical aesthetic procedures such as anti wrinkle injections. A recent colloquialism for this is the “Zoom Face Phenomenon” driven by the covid-driven boom of video conferencing (tying this issue with the Zoom video brand). [15][16][17][18]
Phasing out the “Anti-Aging” Terminology More than a definition, applying the term "REJUVENATION" is truly the goal vs. ANTI-AGING. For decades, the term “anti-aging” has been a phrase that represented the entire marketing lexicon describing products, services and procedures to promote aesthetic enhancement. Further review of this Ageism is seen as more about stereotyping and/or discrimination against individuals or groups on the basis of their age.
The science is not about recapturing the fountain of youth, alluding to a criticism of one’s natural aging process - but about firming, tightening, polishing or skin conditioning. A commentary on social appeal dictates that beauty and attraction is defined not necessarily on looking younger but having a radiant appearance. The recent trending term identifies today’s aesthetic procedures as REGENERATIVE or AESTHETIC ENHANCEMENT; implying a more objective-based category. Where wrinkles, shadows and loose skin render a fatigued and worn
impression, it is the million dollar industry of ENHANCEMENT that has taken on what tolls of time has done to the physical self- both the face and body. [19][20]
Overview on Minimally Invasive Procedures The value of aesthetics in our community exists throughout all social groups. The market recognizes one popular focus group in particular to include the parent community - whose exhaustive commitments to countless physical demands may oftentimes appear in their features. Investing in facial enhancements offer a sense of personal satisfaction about their renewed public appearance. In addition, such procedures have been studied to bring personal empowerment from experiencing that natural facial glow from having improved skin texture. Psychologists and counselors identify the means of having a rested appearance as looking and feeling optimized could actually support an emotional uplift by motivating the self to manifest a healthier lifestyle.
Face Lifts A facelift, technically known as a rhytidectomy (rooted from the word rhytis or "wrinkle", and ektome "excision"- or the surgical removal of wrinkles), is a cosmetic process dedicated to providing a more youthful facial appearance. To achieve this, there are various surgical and minimally invasive techniques available. Surgery could mean the extraction of loose, sagging skin (often from age) and the skin tightening on the patient's face, neck, cheeks or eyelids. Non-surgical enhancement strategies that address these and issues like frown lines and other facial wrinkles can also be achieved with other modern techniques such as the injection of bio fillers and the performance of laser skin resurfacing- or photodynamic therapy for the removal of wrinkles, spots, and textures.
Microneedling Microneedling is a procedure using small needles to prick the skin in order to generate new collagen and healthier tissue for more toned skin. The concept of Microneedling was widely used on a commercial level since the 1900’s in Europe to address acne and skin scars. The technology continues in popularity throughout the aesthetics community and has evolved from manual applications to electric Microneedling may help with a wide set of issues such as: fine lines and wrinkles, oversized pores, acne, dark spots, hair loss and stretch marks. [21]
As a working arsenal to dermatologists, aestheticians and other trained clinical subscribers, microneedling is recognized to be far less costly than other skin therapeutic technologies including laser treatments, which by comparison can cost about 3-4 times. The entire process is usually around 15-20 minutes and may commonly require 4-6 treatments depending on need.
The PRP Process In recent years, the success of Platelet-rich plasma (PRP) treatment protocols are growing in popularity, capturing an expanding share of the aesthetics market. To date, the history of the PRP therapeutic process has been recorded from Equine (Horses) Medicine since the early 1990’s. Veterinary medicine applied the use of PRP to treat ligament damage such as tears or inflammation in the tendons. This process has also been applied in horses with osteoarthritis both showing significant success for continued research both in animals and early human studies. The evolution and success of the PRP relied on the preparation of the plasma, including volume and percentages applied and the quality and consistency of the extracted matter. [22][23][24].
Clinical professionals find its benefits to be easily integrated within their practices to expand their services. From dentists, dermatologists and cosmetic surgeons to most non-medical cosmetic practices, training and adopting PRP systems into a practice or aesthetic related business has been found to require a low level of commitment and investment.
The vast appeal of offering a minimally invasive (non-surgical) regenerative enhancement solution provides a great alternative to the consumer while adding a much lower cost alternative to acquiring PRP is now being used to treat chronic osteoarthritis and other orthopedic injuries and is also more widely marketed in the aesthetics channels. PRP is widely applied in various areas of the medical field for its proven properties of regenerative therapy as well as in many areas of clinical aesthetics. In dermatology, there has been significant success in PRP’s expanded use from wound healing, scar reduction, skin and tissue regeneration and skin enhancement.
The science of PRP originated in hematology IN THE 1970’S as part of plasma transfusion for thrombocytopenia patients or those with low platelet count in their blood. The biological concept of plasma extraction by centrifugation of autologous blood (sourced from oneself) offers 1-to-1 cellular compatibility by accessing one’s own healing properties. [25]
In aesthetics, the PRP extraction and application process forges the healing properties of the plasma- extracting the usable ‘platelet rich plasma’ from the ‘platelet poor plasma’ to be used TOPICALLY in applications similar to microneedling. It is also widely applied as SUBCUTANEOUS injections such as breast lifts or to increase collagen on the facial skin’s surface. PRP also offers restorative and tissue healing value for follicles in hair restoration procedures. Fig 5
Figure 5: PRP and other injectable biologics are improving blood perfusion to treated areas
Under clinical supervision, PRP treatment of facial enhancement and wrinkle removal involves drawing approximately 20-60 ml of blood. The practitioner would centrifuge this to separate plasma from blood cells, capturing the injectable YELLOW matter known to be ‘rich in platelets’. But in larger aesthetic services, like a vampire breast lift, or a P-shot (Priapus Shot), you actually need to draw an estimated minimum of 60 ml of blood to a rough minimum of six to 10 tubes. Upon the centrifuging process, once the PRP is harvested, in most cases, platelet poor plasma is discarded. [26][27][28]
Historical Context of Natural Aesthetics Four thousand years ago the Egyptians used plants especially rose petal extracts for aesthetic enhancement. The treatment of the flower of Rosa Gallica, organically grown in France, pesticide free and chemically balanced with antioxidants, is currently used in clinical practice as an extract of whole fresh or cut and dried rose petals; rose petal tinctures: organically distilled.
Traditional usage has been as:
- Anti-inflammatory
- Anti-mutagenic
- Anti-oxidant
- Cellular Regeneration
- Collagen Accelerator
- Internal Detoxification
- Dermal Rehydration
Chinese medicine recommends rose petal extract for regulating vital energy or "qi", for strengthening blood circulation, purifying the liver and for alleviating joint pains. The high concentration of anthocyanins in the petals are known for their ability to strengthen the vascular system, prevent blood platelet stickiness (blood clots) and also have powerful antioxidant, antibacterial and anti-inflammatory activity.
Rose petal essential oils were used as a dermal rehydrator to beautify the skin by the ancient Egyptians. In Roman times people treated breast diseases, skin conditions and even wound infections with orally ingested preparations. Research has shown that an extract from Rosa Gallica strikingly increases the effectiveness of several antibiotics against methicillin-resistant Staphylococcus aureus. Two active compounds from the extract have been identified as tellimagrandin I and rugosin B. Other studies have demonstrated strong activity of Rosa Gallica extract against strains of Candida albicans isolated from overtreatment with antibiotics. Additionally, the effect of an anthocyanin preparation isolated from the flower petals of Rosa Gallica demonstrated strong effects of Rosa extracts against abnormal cells. A three year research study by the Biofoundation for Angiogenesis Research preceded the development of the chemical constituents of the ProRose+ formulation. Scientific evaluation has shown the antioxidant effect to be 10x (ten times) more powerful than green tea preparations and resveratrol formulations. Collagen regeneration has been observed clinically and documented with high resolution sonograms. Improved blood flow to hair follicles has been demonstrated with vascular imaging technologies. The 2011 World Anti Aging Conference showed poor dermal penetration of creams and good tissue regeneration with internal antioxidants. A 20 year study by the AngioFoundation revealed that the curative effects appeared in other glandular sites, such as the breast, prostate and thyroid which was presented at the international 2021 Inflammatory Skin Disease Symposium as it showed improvement in cutaneous inflammatory processes such as psoriasis, rosacea, lupus, hidradenitis and related collagen type diseases.
Active Ingredients Rose Petals contain: Anthocyanins and proanthocyanidins; tellimagrandin I and rugosin B; carotenoids; plant acids including gallic acid and essential oils. The liquid portion of oil of rose contains as its chief constituent the alcohol geraniol. Geraniol, with a rose-like odor, is a primary alcohol, and yields, upon oxidation, the aldehyde citral, also present in rose petals. Rose oil furthermore contains about 20 percent of l-citronellol. A proprietary blend of balancing antioxidants has been added to the extract. Rose petals as concentrated extract/elixir with the recommended dosage of ten to twenty drops twice per day. Drug Interactions: None known Contraindications: None known except alcohol dependence.
Side Effects: Allergic reactions are possible in susceptible persons.
Synergism: when combined with Coenzyme Q10 and resveratrol the treatment benefit is enhanced. [29-39]
Epilogue The modern age of aesthetic procedures has much to thank the medical scientific community when it comes to their approach and strategies behind clinical treatments. Recent visionary concepts such as injectable bio-fillers are clearly rooted from the same delivery of
therapeutic material, showing similar logic, tools and applications. Also, medical innovations such as laser, ultrasound, radiotherapies and other non-invasive electronic devices have also added a major foothold to the aesthetics movement.
The evolution in clinical aesthetics continues to advance all procedures especially for the sake of performance, safety and longevity. Over time, this level of evolution also reflects on the economics and access of these procedures- where the major BOOM in aesthetic modalities have clearly engaged the global market. And as the global market maintains a major uptick in demand for aesthetic procedures, so continues the introduction of new protocols, strategies and improvements in treatment options and opportunities.
References
1) Breaking down the most popular noninvasive cosmetic treatments, American Society of Plastic Surgeons , Rod Rohrich, MD, FACS | Dallas, TX Friday, June 16, 2017 - https://www.plasticsurgery.org/news/blog/breaking-down-the-most-popular noninvasive-cosmetic-treatments
2) The history of injectable facial fillers, Theda C Kontis 1, Alexander Rivkin. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/19415573/
3) History of cosmetics: https://en.wikipedia.org/wiki/History_of_cosmetics
4) Library of Congress, History of the Beauty Business:
https://guides.loc.gov/business-of-beauty/history
5) Cosmetics and Personal Care Products in the Medicine and Science Collections https://americanhistory.si.edu/collections/object-groups/health-hygiene-and-beauty/skin-care
6) Sushruta: father of plastic surgery https://pubmed.ncbi.nlm.nih.gov/23788147/
7) Worldwide Medical Aesthetics Industry - Market is Expected to Grow at a CAGR of 9.9% Between 2021 to 2029:
9) BIA-ALCL Physician Resources, American Society of Plastic Surgeons: https://www.plasticsurgery.org/for-medical- professionals/health-policy/bia-alcl-physician resources#:~:text=The%20August%2020%2C%202020%2C%20FDA,which%20included%203 6%20known%20deaths.
10) Bia-ALCL: Americal Society of Plastic Surgeons,
13) Characteristics of Patients Seeking and Proceeding with Non-Surgical Facial Aesthetic Procedures, NIH- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935348/
14) Trends for Facial Injectable Therapies in Medical Aesthetics
15) Medical Aesthetics Market to Reach USD 16,034.87 million, Globally, by 2028 at 12.5% CAGR- - COVID-19 Impact and Global Analysis by The Insight Partners / https://www.prnewswire.com/news-releases/medical-aesthetics-market-to-reach-usd-16- 034-87-million-globally-by-2028-at-12-5-cagr----covid-19-impact-and-global-analysis-by-the-in sight-partners-301387695.html
16) The Zoom Effect: Exploring the Impact of Video Calling on Appearance Dissatisfaction and Interest in Aesthetic Treatment During the COVID-19 Pandemic, NIH
https://pubmed.ncbi.nlm.nih.gov/34146086/
17) ‘Zoom face’ phenomenon has people eyeing plastic surgery- By Sandy Cohen • February 3, 2022, UCLA
18) Commentary on: The Zoom Boom: How Video Calling Impacts Attitudes Towards Aesthetic Surgery in the COVID-19 Era- https://pubmed.ncbi.nlm.nih.gov/34232299/
22) A Critical Overview of the Use of Platelet-Rich Plasma in Equine Medicine Over the Last Decade, https://www.frontiersin.org/articles/10.3389/fvets.2021.641818/full
23) What is the potential use of platelet-rich-plasma (PRP) in cancer treatment? A mini review: NIH/PUBMED: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113436/
25) “Platelet-Rich Plasma: Where Are We Now and Where Are We Going?”- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445108/
26) Availability of platelet-rich plasma for treatment of erectile dysfunction and associated costs and efficacy: A review of current publications and Canadian data
27) Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338460/
28) Healthline: "What to Expect from a Vampire Breast Lift (VBL)" -
Dr. Robert Bard, seasoned diagnostic specialist in NYC and a long-time presenter of the Icahn School of Medicine was personally invited to exhibit at the Mt Sinai Winter Symposium series. The 25th Annual event showcasing Advances in Medical and Surgical Dermatology has been a must-attend event to the medical community nationwide where health professionals and medical students traditionally fill the halls of the NY Academy of Medicine each year. In addition, major vendors from some of the largest pharmaceutical brands and other dermatological health solutionists grace the 15,000 sq. ft grand ballroom. This year, Dr. Bard elected a unique and impressive way of presenting to the institution by introducing his recent collaborative ally, Mr. Charles Vorwaller- CEO of Aspen Laser to present about Photobiomodulation therapy as part of Dr. Bard's reserved space. "We have been performance testing Charles' Aspen Laser Apex Model for the better part of 6 months and found the technology to align with the many skin issues (like inflammatory skin disorders) that I found this event to be the ideal opportunity for me to endorse Aspen laser into the dermatological community."
