Dr. Joel L. Cohen discusses technologic advances in medical and aesthetic dermatology for the treatment of warts, acne, visceral fat, and face and neck contouring.
LISTEN to Dr. Cohen detail several recent cosmetic dermatology devices, including one, he said, that is resurrecting interest in laser hair removal, another for nonsurgical eyelid ptosis, and more.
“A lot of really great things are going on in the world of aesthetics. In the world of dermatology, in some cases, it’s merging both aesthetics and dermatology,” said Joel L. Cohen, MD, who lectured in and moderated the panel “What’s New, What’s Coming, and What Are We Doing That’s New in 2022” at Maui Derm 2022.
Nano Pulse Stimulation
Nano pulse stimulation (NPS) is a therapy that applies electrical pulses to cells and tissues, said Dr. Cohen.
“Those electrical pulses cause the membrane of a cell to open up and then allow calcium channels to flood the cell…. It overwhelms the cell’s ability to produce ATP in the endoplasmic reticulum, and then the cells die.”
The CellFX System (Pulse Biosciences; Hayward, California), which uses NPS technology, is currently cleared in the U.S. for dermatologic procedures requiring ablation and resurfacing of the skin and intended use of treating benign lesions. Currently, it is being used as treatment for sebaceous hyperplasia and seborrheic keratosis after several recent clinical trials and publications. Studies are underway for non-genital warts.
“Warts are so common—warts on the hands or on the feet, or different areas—can be very difficult to treat,” said Dr. Cohen, who believes that NPS technology holds particular promise for this indication.
“I’ve done one of the clinical trials… We’ve seen some really very, very good efficacy, and …it doesn’t tend to leave hypopigmented changes to the skin or the mild scarring sometimes you can see with liquid nitrogen.”
Dr. Cohen also cited an article1 published by E. Victor Ross, MD, published this year that establishes nano technology is nonthermal and has no airborne particulate concentration after treatment. Therefore, plume is not a concern – unlike many other destructive modalities, like laser.
“The area in addition to warts where I think that this technology may be really interesting and useful in everyday practice is nodular basal cell carcinoma – as the cellular density of nodular subtype BCC’s can serve as a focal target,” said Dr. Cohen.
Pilot studies have shown that NPS technology also shows some potential promise in the treatment of syringomas and benign nevi (eg, junctional, intradermal and compound).
Bipolar RF for Facial Contouring
According to Dr. Cohen, another energy-based treatment that warrants a look is Evoke, the non-invasive, “hands-free” device from InMode that uses bipolar radio frequency energy for face and submental contouring.
“This facial device delivers radio frequency while a patient is sitting with a helmet-like device at either (or both) the lower face (secondary smile-line/jowl area) or submental area. There’s no pain. There’s no downtime. Patients literally can watch an iPad positioned on a table in front of them during the 30- to 40-minute treatment session.”
While dermal fillers are often used to address the marionette lines, the Evoke device delivers heat which causes tissue contraction and may even support the ligamentous structures that hold up the fat pads, said Dr. Cohen.
“In the lower face area of fullness from medial fat pad laxity, Evoke and other energy-based devices that offer contouring can be particularly of interest – as fillers can be rather challenging there because we don’t want to add to the volume. The device can help to visibly improve the secondary smile lines and lower facial areas, including the jowls,” said Dr. Cohen.
1726 nm for Acne
Keep your eyes on the 1726 nm laser for acne by treating sebaceous glands, said Dr. Cohen who has been working with Accure as an investigator along with Dr. Emil Tanghetti and
Dr. Roy Geronemus over the past few years. The laser is yet another innovation by Dr. Rox Anderson.
“Rox really thought about the wavelength that the sebaceous gland is most susceptible to, and he invented this technology to really minimize and miniaturize and change the density of sebaceous glands in the acne prone areas of the face.”
“We have seen some really nice efficacy in patients who have inflammatory acne lesions on the face. It’s being done on the cheeks and on the chin with monthly treatments over four sessions in the trial. Dr. Tanghetti has presented some of this data at ASLMS, and we are seeing significant improvement in all skin types—including darker skin types. The sebaceous gland is really the target, so we have patients that are type 5 or type 6 skin that have done very well with this.”
Dr. Cohen believes this will probably one day compete with isotretinoin. “It’s pretty exciting to see the improvement in [patients] and to think about the niche for the Accure 1726 nm laser.”
HIFEM + RF
According to Dr. Cohen, energy-based devices designed for aesthetic use are finding applicability in the medical world, including the EmSculpt NEO (BTL Technologies; Marlborough, Mass.).
“The NEO actually has not only high intensity focused electrical muscle stimulation, but it also has radio frequency…. By adding the radio frequency to the HIFEM, we’re able to actually see improvement in both muscle gain and fat loss with the RF affecting the fat. And I think that’s really interesting from a perspective of what we can do with it.”
Studies show abdominal muscle stimulation improves muscle tone by about 25% and core strength after three to four treatments, said Dr. Cohen.
“With the addition of the radio frequency, not only do you have the muscle gain tone in the abdomen area, but studies show that there’s a 30% loss of subcutaneous fat and then there is a 14% loss of visceral fat – and this is the aspect that is so interesting medically.”
Visceral fat is notoriously difficult to lose or treat, said Dr. Cohen.
“So, the fact that Emsculpt is also affecting visceral fat is pretty exciting, as shown in a study by Dr. David Kent.2”
The NEO has also been shown to improve diastasis recti by about 19%, said Dr. Cohen.
References
- Ross EV, Newman J, Ravichandran J, Nuccitelli R. Airborne particulate concentration during non-thermal nano-pulse stimulation wart clearance is negligible compared to thermal modalities. Lasers Surg Med. 2022 Jan;54(1):189-192. doi: 10.1002/lsm.23468. Epub 2021 Aug 25. PMID: 34431551.
- Kent DE, Kinney BM. The effect of high-intensity focused electromagnetic procedure on visceral adipose tissue: Retrospective assessment of computed tomography scans. J Cosmet Dermatol. 2021 Mar;20(3):757-762. doi: 10.1111/jocd.13952. Epub 2021 Feb 5. PMID: 33543566; PMCID: PMC7986109.