To get an idea of what has been shaking up the cosmetic surgery market recently, look no further than the image of reality TV star Kim Kardashian that was plastered on the cover of an art and fashion magazine late last year.

“Between her and Jennifer Lopez, that’s who people are mimicking,” says Dr. Scot Glasberg, current president of the American Society of Plastic Surgeons and a private practice physician based in New York City.

While there’s no shortage of people seeking to recapture their youth through facetightening treatments using ultrasound and radiofrequency, buttock augmentation using fat transfer or fat grafting has been one of the fastest growing cosmetic procedures, with nearly 10,000 done in 2013, up 16 percent from 2012, according to statistics from the American Society of Plastic Surgeons.

Fat grafting, which consists of taking fat from one part of the body and adding it to other areas, most often the buttocks and breasts, has been enhanced, so to speak, by a new technology that cleans the fat so that it is more likely to be retained in the body, and not reabsorbed.

“The technology revolves around the processing of the fat, which used to be a clumsy and messy technique,” Glasberg says.

Glasberg uses a system called Revolve, manufactured by LifeCell, which cleans and processes the fat, usually taken from the patient’s abdomen, and then transfers it to the other area in a single, closed device. He says it allows the surgery to be done in one session, instead of two or three separate sittings.

A similar product is Puregraft from Puregraft LLC. In the past, technologies to remove free lipids and debris consisted of gravity separation or centrifugation. A study published in April 2013 in the journal Plastic and Reconstructive Surgery comparing three different fat graft preparation methods found that washing with filtration within a closed system using Puregraft, as opposed to using gravity separation or centrifugation, produces a fat graft with higher tissue viability and a lower level of contaminants.

“When you transfer it, the goal is to get a blood supply,” Glasberg says. “There’s a process and science behind it.”

Marie-Francoise Harris, group marketing manager for adipose cellular transplantation at LifeCell Corp., says one advantage of Revolve, which has a list price of $495 for each single-use device, is that the surgeon can harvest the fat and send it directly into the system, quickly processing a large volume of fat within the canister.

“We have data showing that we produce high-quality fat,” Harris says. “Based on the feedback we receive from surgeons, they save more time.”

With Puregraft, the fat is cleaned in a separate machine. Bradford Conlan, chief executive officer of Puregraft says that Puregraft’s filtration technology was “designed to purify tissue in a gentle and consistent manner.

“It’s the only product to have independent clinical studies that validate a higher tissue quality and in turn, improved retention rates,” Conlan says.

Glasberg says there’s hope that in the future, surgeons will be able to use stem cells to recreate the fatty tissue found in a particular part of the body, such as the breasts.

“If we could harvest down to stem cells, we might be able to put it where we want and mimic the tissues there,” Glasberg says.

Non-lipo
Ultrasound is also becoming a popular technology for use in minimally invasive cosmetic treatments. For patients who aren’t ready for an invasive surgery, such as liposuction, doctors have been promoting a new fat-reducing technology using pulsed focused ultrasound. In April 2014, Syneron and Candela received clearance from the U.S. Food and Drug Administration to market UltraShape for reducing fat in the abdomen.

Dr. Bruce Katz, director of Juva Skin and Laser Center in New York City, is one of the first doctors to use UltraShape, and he usually tells patients that it takes 2 to 4 inches of fat away over two or three treatments spaced two weeks apart. It replaces older technology that used heat to melt fat, which is much more painful. The non-thermal, focused ultrasound destroys fat cells while leaving the surrounding tissue undamaged.

The main drawback of UltraShape is that the results are not quite as dramatic as more invasive surgical procedures. In the randomized, controlled clinical study of UltraShape, there was an average reduction of 2.5 cm in the treatment phase and 0.5 cm reduction in the control phase.

“There’s no substitute for the original liposuction,” Glasberg says.

The ultrasound fountain of youth
Ultrasound also continues to be popular for patients who want to look youthful without undergoing expensive and invasive facelifts. Ultherapy, which received FDA clearance for eyebrow lifts in 2009, and two years later for facial lifting and tightening, recently received FDA approval to market the system for lifting of the chest, or décolletage. The ultrasound stimulates collagen at a depth of 1.5 mm for fine lines and wrinkles down to the connective tissue at 4.5 mm.

“Micro-focused ultrasound creates more of a lift than we have been able to achieve with the Thermage and radiofrequency devices,” says Dr. Tina Alster, director of the Washington Institute of Dermatologic Laser Surgery and a clinical professor of dermatology at Georgetown University Hospital. “We’ve been very impressed with this particular technology.”

Matthew Likens, the president and chief executive officer of Ulthera Inc., says the company’s product uses two ultrasound technologies — the strong thermal effects of focused ultrasound and also the ability to image the area.

“The imaging happens simultaneously with the treatment itself,” Likens says. “With pinpoint precision, you can get to any depth. It only affects tissue at the depths that you’re trying to affect tissue.”

While dermatologists and plastic surgeons are the primary market for Ulthera, the company has recently been selling the Ultherapy systems to obstetrics and gynecology, as well as ear, nose and throat practices looking for alternative revenue streams.

Alster uses Ultherapy in “mega combinations,” tightening or lifting the lower segment and then doing laser resurfacing on top of that.

“In the past, when we were limited to radiofrequency, people didn’t see as much tightening or lifting as anticipated,” Alster says. “I think this is the best noninvasive lift we can provide.”

Katz, of the Juva Skin and Laser Center, says he prefers radiofrequency for skin tightening, and uses vShape, a focused radiofrequency workstation by Alma Lasers, which stimulates collagen. Katz said he tried Ultherapy a few years ago.

“We decided to wait until something better came along, which it did,” Katz says. “The results, I think, are better.”

Likens counters that radiofrequency is not as focused as ultrasound.

“It’s in there, but it’s heating everything to a much lower temperature that we’re able to get,” Likens says. “We get to 65 degrees centigrade, the optimal temperature for building new collagen. Radiofrequency can’t get to those temperatures.”

DOTmed Registered Aesthetic Treatment Options Companies

Names in boldface are Premium Listings.
Domestic
Christopher Ostler, Wholesale Aesthetics, LLC, CA
DOTmed Certified
Thomas Merolla, Eastern Surgical Company, CO
DOTmed Certified
DOTmed 100
Scott Ehrlich, EZ Brokerage, KS
Jay Jordan, State of the Art Medical, KY
DOTmed 100
Alison Bouck, Medical Laser Resources LLC, MI
DOTmed Certified
DOTmed 100
Alison Fortin, Global Inventory Management, NH
DOTmed Certified
DOTmed 100
Eric Graham, Sentient Medical Technologies, UT
DOTmed Certified

International
Navneet Kumar, Emerging India Healthcare , India