30 Innovations in 30 Minutes: Aesthetics and Regenerative

Rounding out our first day in Miami was a favorite multispeaker session on the newest technologies in aesthetics and regenerative dermatology. Mark Nestor, MD, PhD, started this session with an overview of how he runs a successful dermatology practice by bridging clinical patients into aesthetic referrals and retaining patients. 

Dr Glaser also encouraged us to use complications from outside providers as opportunities to retain new patients and demonstrate a collaborative clinical manner. She later covered a trending area for cosmetic products and procedures, the neck, which can have a higher risk of complications with energy-based devices. She recommended hyaluronic acid diluted with 0.4 cc of 1% lidocaine for horizontal lines, though bruising can occur, and high-intensity focused ultrasound, which has no downtime. Dr Weinkle demonstrated an injection technique using a cannula for this area as well as the central face. 

Dr Goldenberg encouraged us to use devices to their fullest potential in our clinical practice, including for diverse indications like acne. Dr Katz also emphasized the importance of reviewing data on devices before incorporating them into clinical practice. His go-to devices are fractional CO2 and erbium lasers, pulsed dye lasers, radiofrequency microneedling, and picosecond lasers. Dr Goldenberg underscored the importance of anxiolytics and cooling devices or NSAIDs in a device-heavy practice to help retain patients. New aesthetic treatments reviewed included a new injectable polypeptide nanoparticle that delivers siRNA to target TGF-B1 and COX-2, leading to apoptosis of adipocytes in novel fat remodeling technology which is now in Phase 1 trials. Dr Katz also showed the mechanism of the new microcoring energy-based device for skin laxity. Another novel device is a bilayer patch with alkali metals to reduce sweat and inhibitor bacteria in the axilla by generating heat when in contact with sweat, thereby inactivating the sweat gland. Dr Glaser showed us how this novel process of alkali thermolysis works with application of under 3 minutes and a peak temperature equivalent to that of a hot tub. 

Diosmin, a medical food, is a flavonoid covered by Dr Nestor that may be able to improve progressive pigmentary dermatosis, or Schamberg disease, senile purpura, and rosacea by impacting capillaries and vascular wall permeability. Curcumin, a derivative of turmeric that requires specific complexes and processing to become bioavailable, may also help with pigmentation, premature aging, and dark circles by suppressing melanogenesis and tyrosinase activity. Another medical food covered was genistein, which works at the estrogen-beta receptor and is cancer protective, unlike its alpha-type counterpart. It may play a role in improving skin hydration, increasing collagen synthesis, and decreasing bruising and has a small (n=26) RCT that indicated significant improvement in fine wrinkles and elasticity. 

Lastly, Dr Weinkle covered some practical injection tips like dropping injections of the procerus to be in line with the medial canthus and similarly lowering corrugator injections to avoid frontalis fibers. She cautioned us to avoid zygomaticus major, levator labii alaeque nasi, and the depressor labii inferioris when injecting the masseter, platysma, or orbicularis oris to avoid impacting facial expression.