“HOT TOPICS” at the Aesthetic Meeting 2018

Part of what I love about being a plastic surgeon is that the field is constantly advancing. Furthermore, we as plastic surgeons strive not only to be able to turn back the clock, but also to actually hold back the hands of time. Increasingly, patients expect us to do this with smaller incisions if not none at all, with less and less downtime. Each year there are new devices, and we as plastic surgeons attend annual meetings and do our best to comb through the exhibit halls and listen to data presentations in an effort to offer our patients the newest and most effective devices.

This year, one company stood out for me. InMode brings bipolar radiofrequency to the table. The company’s devices span the spectrum from skin resurfacing to liposuction to vaginal tightening. While the applications are varied, the principles are consistent through the use of A.C.E. technology- acquire, control, and extend heat delivery.

Radiofrequency induces a change in the collagen molecule. The tissue effects include improved skin laxity, improved mechanical strength, neocollagenesis and elastogenesis. To accomplish this, a target temperature must be achieved and maintained for a set period of time. Temperature must be carefully monitored and controlled to avoid overheating and the potential for tissue damage. To avoid this, the devices all come with internal temperature monitors that actually cut off once a target temperature is achieved. Directional delivery allows for the efficient capture of energy and controlled penetration depth without the need for sometimes cumbersome external grounding pads.

Radiofrequency induces a change in the collagen molecule. The tissue effects include improved skin laxity, improved mechanical strength, neocollagenesis and elastogenesis. To accomplish this, a target temperature must be achieved and maintained for a set period of time. Temperature must be carefully monitored and controlled to avoid overheating and the potential for tissue damage. To avoid this, the devices all come with internal temperature monitors that actually cut off once a target temperature is achieved. Directional delivery allows for the efficient capture of energy and controlled penetration depth without the need for sometimes cumbersome external grounding pads.

Optimus, InMode’s beauty suite platform, includes Forma and Fractora. The Forma is completely non ablative and painless. (For the patient, it feels like a warm massage.) It can be used for tightening of the face and neck, and the patients experience no pain or downtime. Fractora is a combination microneedling radiofrequency device that works great on fine lines and can be combined with platelet rich plasma (PRP) for delivery of PRP into the skin. Similar devices on the market are largely monopolar, including Infini, Alma Accent, Vivace, Venus Viva, Endymed, Profound and Skinfinity. The energy produced by these devices is not absorbed by melanin uniquely allowing for safe application on darker Fitzpatrick types. The device also comes with an IPL handpiece that is indicated for brown and red spots.

The holy grail of liposuction has always been the potential to remove fat and tighten skin at the same time. Various devices have promised this, but failed to fully deliver. BodyTite is a device that combines liposuction with radiofrequency. Both internal tissue temperature and external skin temperature are monitored to allow for controlled tissue heating. This can be done safely and comfortably under local anesthesia. While it isn’t a substitute for a tummy tuck or brachioplasty, it is a great alternative for patients who need more tightening than traditional liposuction can offer, but don’t want the scarring, pain, and recovery from an excisional procedure. The FaceTite handpiece also allows for tightening of the face and neck. Having this device in our armamentarium really fills a gap.

One of the most cutting edge devices launched by InMode is Votiva, a bipolar radiofrequency based device for internal and external vaginal rejuvenation. Other RF based devices for this purpose include Protégé Intima, ReVive, ThermiVa, and Viveve. Several fractional ablative and nonablative lasers are also being marketed for vaginal rejuvenation. This class of devices is among the newest additions to the field, and I had the privilege of participating in the ASAPS Hot Topics Panel to discuss their efficacy and indications as well as potential for future research. Votiva is specifically approved for use in the treatment of sexual dysfunction or as an adjunct to Kegel exercises. The Votiva comes with a wand for painless internal tightening and options for external tightening of the labia minora and majora. Votiva is the only bipolar device of its kind approved for use in the United States.

Vaginal rejuvenation techniques have come so far. When I was a resident, labiaplasty was an unusual procedure, and there were so few people doing it. Now, labiaplasty has become one of the core procedures offered by plastic surgeons. The continued expansion of this subset of our field is exciting. Plastic surgery has always been in large part about restoring confidence, comfort, and self-image. The ability to offer less invasive interventions to address both aesthetic and functional problems of the female genitalia and urinary tract is promising. Current measures of efficacy are largely based on validated questionnaires. Research is underway to examine histologic changes, blood flow, and pressure dynamics.

As always, it was exciting to learn about all of these devices, and I do believe that the applications for minimally invasive, energy based interventions will only continue to expand. They are both literally and figuratively “hot.” Furthermore, the introduction of devices to maintain and restore women’s sexual health is empowering and demonstrates a real change. I applaud the great strides we have made to date and look forward to seeing more growth in this arena.

Disclosures: The author is a KOL for InMode.

Dr. Beth Aviva Preminger is a board-certified plastic surgeon specializing in cosmetic and reconstructive surgery of the face, breast and body. Her website is http://www.premingermd.com.

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