OCTOBER 2016 VOL 89 NO 10

SOUTHEAST ASIA For richer, for poorer

INNOVATION Cutting-edge ingredients

APPLICATORSAdminister & enhance

AestheticsWhat can we learn?

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Transparency Market Research (TMR).Facial care is the overwhelming leader inthe skin care segment, followed by bodycare, sun care and hand care. Our insatiable appetite for looking good

and staying youthful is fuelling a growinginterest around the world in cosmeticprocedures, from injections to lasers andcosmetic surgery. According to the Analysis,Outlook And Market Trends In CosmeticMedical & Surgical 2015-2020 Report byIMCAS (International Master Course onAging Science) in January 2016, Europe’smarket is growing at a rate of 6% per year,the US shows 7% per year growth, LatinAmerica is nearly 9% and the Asia Pacificregion has the highest growth of over 13%. The two segments with the highest

market share were shown to be injectables(botulinum toxins, fillers, fat grafts andplatelet rich plasma or PRP) at 39% and energy-based devices (lasers,radiofrequency, ultrasound, cryolipolysis forskin resurfacing, skin tightening and fatreduction) at 29%. Body contouringsystems were noted to have the highestgrowth rate among energy-based devices of13.6% per year.At-home products developed to mimic

the results of clinical treatments are not new,

Today’s anti-ageing market isexpanding to cover a diverse range ofconcerns. Wrinkles are no longerconsidered the only sign of ageing. Agespots, pigmentation, uneven skin tone, dryskin, under eye circles, redness and hairthinning are now an integral part of thegrowing anti-ageing market. While olderconsumers and perimenopausal womenremain the largest target, the market isgetting younger. There is an increaseddemand for anti-ageing products amongwomen in their 30s along with an uptickin millennials interested in preventing ordelaying the ageing process, and youngermen are also more engaged. The constant demand for new and

effective products is leading to excitingnew innovations in natural and organicingredients, anti-ageing hair care products,unique skin care formulations, topicalhealing products and scar remedies. Forexample, the buzzword in sun protection isinfrared rays (IR) that penetrate deep intothe skin, posing a new challenge for suncare formulators. The global cosmetic skin care market

will expand at a CAGR (compound annualgrowth rate) of 5.1% through 2024, toreach more than US$200bn, according to

but the vast spectrum of options continuesto expand. High-performance products catertowards consumer demands and the risingawareness of skin health. According to Kline& Co, the professional skin care market inthe US alone is forecast to grow at a CAGRof nearly 5% through 2020.

ABOUT FACE Facial rejuvenation treatments are by farthe most popular clinical aesthetictreatments. The category includeseverything from microdermabrasion andpeels to deep resurfacing lasers, dermalfillers and Botox, all the way up to facialsurgery and hair transplantation. Over the past decade, skin resurfacing

lasers have gone from ablative (deep) tonon-ablative (less deep) and fractional,reflecting the overriding concerns ofconsumers for minimal to no downtimetreatments so they can get back to theirlives quickly. This global trend hasgenerated a need for post-laser recoveryproducts and treatments, and we are seeinga proliferation of science-based brands thatincorporate the principles of woundhealing and skin restoration.“Basically, skin ageing is the result of

increased breakdown of collagen and

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Thewaywelook nowWendy Lewis investigates the key global trendsshaping the aesthetics segment with an eye to what the future holds and the role topicalproducts can play

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market reportaesthetics

elastin combined with a decrease in theability of the body to repair itself. A goodskin regimen is going to address both ofthese issues,” says San Antonio, Texas-baseddermatologist Vivian Bucay. “Newcomersinclude Alastin Skin Nectar and AlastinRestorative Skin Complex, which containa patent-pending technology called TriHex,shown to enhance extracellular matrixrecycling. Think of it as clearingout damaged collagen andelastin to create an optimalenvironment for natural skinregeneration through theproduction of healthy collagenand elastin. I have patients useSkin Nectar for two to sixweeks prior to laser resurfacingand chemical peels, andcontinue for a few weeks postprocedure before switching toAlastin Restorative SkinComplex for maintenance.Extracellular matrixoptimisation is truly a newparadigm in the approach toprofessional skin care.”Skin needling, also called

microneedling therapy, collageninduction therapy (CIT) and

October 2016 SPC 41

percutaneous collagen induction (PCI), is aminimally-invasive procedure that involvesthe use of a device that contains fineneedles. The needles are used to create acontrolled skin injury that triggers thebody to fill these microscopic wounds byproducing new collagen and elastin. Theclinical results are improvements in skintexture and firmness, as well as reduction inscars, pore size and stretch marks. Similarlythere is a plethora of hand-held pens andstampers sold direct to consumers asstandalone products, and incorporated intoan active skin care regimen for home use.Fractional radiofrequency devices are usedto treat acne scars, pigmentation, fine lines,skin laxity, rosacea and enlarged pores. More recently, radiofrequency energy is

being delivered with a needle into thedeeper layers of the skin for more profoundbenefits. This new crop of devices, includingInfini from Lutronic and Fractora fromInMode, for example, use needles toimprove the skin by adding trauma andenergy that stimulate new collagen. There isa trend towards applying topical medicationsand solutions post microneedling treatmentswhen the microscopic channels in the skinare open, so that the topical agents canpenetrate well. Skinceuticals is one suchglobal skin care brand that has conductedjoint studies with dermatologists thatdemonstrated the efficacy of its antioxidantserums post laser procedures.Many practitioners are now combining

topical growth factors with energy-basedtreatments to enhance the rejuvenatingresults of both therapies. According to Lincolnshire, Illinois-based

dermatologist at Advanced DermatologyAmy Taub, one of the newcomers to watchamong professional skin care technologiesis DefenAge. “DefenAge stands out in the

Use of Alastin SkinNectar is recommendedprior to procedures,while DefenAge bridgesthe gap between topicaland non-invasivetreatments

saturated growth of the anti-ageingindustry due to its focus on molecularspecificity, as the science behind the skincare is to stimulate stem cells that live inthe hair follicles. DefenAge products turnon the stem cell (your body’s own woundhealing process) resulting in the creation ofproteins from a young cell.” Another category that bridges the gap

between non-invasive injections andinvasive surgery is suture suspension lifts.Silhouette Instalift from Sinclair Pharmawas recently introduced as a non-surgicalprocedure that lifts sagging tissue of themid-face without surgical intervention.According to Chicago-based PlasticSurgeon Julius Few of The Few Institute:“Silhouette Instalift fills an important void.We are seeing that when we stackSilhouette Instalift with other non-surgicalsolutions, we can accomplish a surgery-likeresult in well-selected patients. It delivers animmediate result with outcomes gettingbetter over a three-month time span withresults lasting 18 months.”The Silhouette Instalift appeal is that it

can be used safely in patients of all skintones and of all ages, and takes about 30minutes to perform. Combination procedures using minimally

invasive techniques are the new norm. The ‘liquid facelift’ is a trend that hascertainly gained traction. “By filling the areas around the temples

and the tear trough [the sunken area underthe eyes], and replacing lost volume in thecheeks, nasolabial folds [nose-mouth lines]and lips we can get close to therejuvenating effects of a surgical facelift insome cases,” says New York City-basedplastic surgeon Bryan Forley. If there issagging around the jawline and neck, hewill add a skin tightening treatment withradiofrequency or ultrasound energy-baseddevices. “Ultherapy, which uses ultrasoundwaves, is my go-to choice for skin firmingon the upper face, mid-face and neck downto the décolleté,” he says. Fillers are not just for the face any more.

Radiesse (Merz Aesthetics) has thedistinction of being the first injectable fillerthat gained FDA approval in the US toplump ageing, volume-depleted hands. Thisdermal filler improves the appearance ofhands while stimulating the skin’s ownnatural collagen to deliver long-lastingresults. Ellanse (Sinclair Pharma) is anotherlong-lasting tissue-stimulating option forhand rejuvenation that is used extensivelyin Europe and the Middle East, and whichis eyeing the US market next. Due to the rise of tattoo artists and the

acceptance of tattoos of all kinds across anexpanded range of age groups, the market

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helmet that the consumer wears. CapillusLaser Cap for Hair Regrowth now offersthree versions, priced from $799-$3,000based on the amount of scalp coverageprovided. Hair restoration therapies are going more

mainstream with streamlined alternatives totraditional methods including scalpreduction and FUE (follicular unitextraction). The expansion of modified andautomated systems, such as NeoGraft andSmartGraft, can be found in clinicspredominantly catering to men. The holygrail of hair restoration lies in precision andreproducible results, as can be achievedthrough the first and only ARTAS RoboticSystem from Restoration Robotics. Another emerging category includes

novel hair implantation systems that useboth human and synthetic strands. Forexample, Biofibre Hair Implant from Italyuses Biocompatible Artificial Hair to add

volume and conceal thinning areas for maleand female alopecia. This concept opens upa novel solution for people who do nothave enough of their own natural hair toundergo more conventional hair restorationprocedures. It should be noted that theimplantation of synthetic hair to date hasnot been accepted by the US FDA. The final frontier in hair growth may

ultimately lie in harnessing the power ofstem cells. One of the most interesting newdevelopments in this area is Kerastem HairTherapy, which is CE-marked andcurrently undergoing a multi-centreclinical trial in the US. The system uses thepatient’s own naturally-derived stem andregenerative cells (from their fat) to treatfemale and male early stage hair loss.

BODY SHAPING Most image-conscious women are, withthe myriad options on offer, nowabsolutely glowing, well-treated andpreserved, so now they have moved on tothe body. No matter how good your facelooks, if your arms and décolletage showage spots, sun damage and wrinkles, itpresents an obvious disconnect. Fat reduction remains the holy grail of

medical aesthetics and casts the widest netamong both female and male consumers.According to a report from Research andMarkets, Global Non-Invasive Fat ReductionMarket 2016-2020, the category is expectedto grow at a CAGR of 26.6%. Advances innon-invasive fat reduction technologiesinclude transdermal-focused ultrasound,low-level lasers, high-intensity focusedultrasound, monopolar radiofrequency andcryolipolysis. These technologies have ledthe way from traditional liposuction tonon-invasive options to meet consumerdemands. In particular, cryolipolysis offersthe benefits of freezing fat from trouble

for tattoo removal treatments is showingsteady growth. The new picosecondtechnology currently available in clinicsworldwide has changed the way tattoos canbe removed by offering a faster treatmenttime and fewer sessions.

MAKING STRIDES IN HAIR HEALTHTherapeutic hair treatments areexperiencing a tremendous growth spurtwith more specialist products that formerlyrequired a prescription being marketedthrough physicians’ clinics, direct toconsumers online and through retailers.The women’s hair loss sector offersopportunities for marketers to capitalise onconsumer awareness of age-related diffusehair thinning, as well as hair health. For example, the hair health supplement

category is experiencing new entries fromNutrafol and Qilib Hair Regrowth (bothfrom Galderma), as well as major direct-to-consumer campaigns promoting Viviscaland Keranique. More aesthetic clinics arenow incorporating hair supplements andproducts to stimulate regrowth, as well as tocontrol dandruff, itching, flaking anddamage into their retail vertical due topatient demand. According to Kline Group,the most thriving professional hair caretrends include scalp care for hair loss andthinning, and bond multipliers forthickening, such as the Olaplex system. Low level laser therapy has been shown

to stimulate and energise the cells withinthe hair follicle to produce thicker,healthier hair. LED-enabled products withprice points between $30 and $3,000 haveexpanded this category among the massesby offering clinical treatments with theconvenience of at-home use. Most recently,iRESTORE Hair Growth System receivedFDA approval for a home version of itslight-based technology in the form of a

market reportaesthetics

As an adjunct to the skin care category,the medical aesthetics industry isincorporating more ingestible productsinto a skin health regimen, oftenincorporating food-based ingredients.This trend dovetails with the greening ofskin care and beauty, and an overallconsumer interest in wellness. The globalnutraceuticals market is growing fasterthan the overall skin care market. Some of the leading causes of disease

and the ageing process are inflammationand nutritional deficiencies. We areseeing buy-in from clinics offering IVdrips infused with vitamins and minerals

delivered directly to the cells as acomplement to oral supplements and ahealthy diet. Each IV treatment can becustomised with select ingredients thattarget the individual’s needs. This model oftransporting nutrients is gaining tractionamong ‘young Hollywood’ and in upscaleclinics for millennialsthrough tomenopause.Newcomer Aethern

Advanced NutritionSkin Beauty Programfrom Barcelona’sBiorganic Pharma

BEAUTY FROM WITHINentered the market with an innovativenutritional collagen-based formulacreated with 14 special ingredients in onedrinkable 25ml dose that is equivalent totaking 25 vitamin tablets. The system isbeing sold exclusively to clinics andmedical spas.

Cryolipolysis, suchas that offered byCoolFit, is one ofseveral availablenon-invasive fatreductiontechnologies

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spots women and men are seeking,including chest, waist, abdomen in men,plus upper arms, bra fat and thighs forwomen. Non-invasive fat reductiontreatments may involve a series ofprocedures and often a combination oftechnologies, which adds to the overall cost for the consumer and the profit for the clinic. The injectable drug Kybella (Allergan)

has received a ton of attention for reducingsubmental fullness, better known as chinfat. Until recently, liposuction was the onlyoption available to reduce a double chin,and it required an incision and somerecovery. Kybella is a synthetic form ofdeoxycholic acid, a naturally occurringmolecule that breaks down fat. After aseries of injections – as little as two and asmany as six – fat is dissolved. Topokine Therapeutics, a clinical-stage

biotechnology company that was acquiredby Allergan, has a first-in-class topical agentin late-stage development for the treatmentof steatoblepharon, also known as undereyebags. Applied to the lower eyelids oncenightly, XAF5 penetrates the skin and actson fat cells to shrink undereyebags. According to dermatologist andclinical researcher Jeffrey Dover of SkincarePhysicians in Chestnut Hill, Massachusetts:“Topokine is developing an exciting newtopical agent for the non-surgical treatmentof eye bags. This novel approach mayrevolutionise the non-surgical treatment ofeye ageing.” Neothetics LIPO-202 is currently being

investigated for the reduction of localisedfat deposits under the chin (submental fat).So far, LIPO-202 has been used in theabdominal area and may offer anon-invasive approach to localised fatreduction. It is interesting to note that the next

target for market leader ZeltiqCoolsculpting technology is going fromfreezing fat to targeting cellulite andpotentially to a solution for acne bydestroying oil glands.

BEYOND KEGELSVaginal health is another hot topic in therealm of medical aesthetics, with a widerange of energy-based systems focused onwomen’s key concerns, including vaginaldryness, pain during intercourse, laxity andstress urinary incontinence, most oftenbrought on by childbirth and menopause.There is an unmet need for topical agentsto complement these treatments, the mostcommon being performed with CO2,radiofrequency and Erbium:Yagwavelengths. Treatments for external, aswell as internal improvements are now

The female personal care device forat-home vaginal rejuvenation calledvSculpt uses light therapy with gentle heatto rev-up vaginal tissue into increasing thenatural production of collagen and elastin.It also improves sensation and hydration.

BEAUTY TECH The market for at-home beauty devicescontinues to deliver with sales increasing by11.5% in 2015 to reach nearly $2bn at themanufacturers’ level, according to KlineGroup’s Beauty Devices: Global MarketAnalysis and Opportunities report. Homedevices continually offer higher levels ofefficacy, with technology such as DNAtesting and wearable skin monitorspotentially adding new levels of technicalcertainty and self-assessment. LEDtechnology, including wearable maskdevices, has become a mainstay in thisgrowing category. Beauty apps have been a hot trend in the

market for the past few years. These tend totarget millennial consumers who live ontheir mobile devices, but that reach hasbeen greatly expanding with moresophisticated offerings that appeal to awider range of consumers. One to watch isa new launch from ModiFace of a livevideo simulation technology that showshow skin care products will look on aconsumer’s own skin. Created bydermatologists, this unique face and skinmapping technology facilitates details ofthe skin to be analysed and shown aslife-like visualisations. Scientific innovations and technological

advancements are generating excitement inthe aesthetic beauty segment. It appearsthat the future potential of regenerativemedicine is looming large, and it is only inits infancy.

growing in popularity around the world,with the US leading the way. “It’s the inevitable confluence of

advances in laser technology and an ever-expanding market. Women are living longerand want to enjoy this time, and now wehave treatments that are minimally invasive,with no downtime, that actually work,” saysDr Jessie Cheung, a dermatologist inIllinois. “It probably started with Viagra andthe gradual diminution in the stigmaassociated with sexual dysfunction. Thesocial taboo has been shattered and we aremore open about discussing theseinevitable events in women’s lives.” Dr Cheung offers the Sciton diVa hybrid-resurfacing laser for vaginal rejuvenation. “I use the diVa system in conjunction withplatelet-rich plasma therapy in the vaginalcanal and injected as the ‘O-Shot’, andoffer bio-identical hormone replacement.These complementary treatments are ahome-run,” she says. Plumping deflated labia with fat, fillers

and platelet rich plasma (PRP) has givenway to the ‘O-Shot’ procedure that hasbeen picking up steam in clinics aroundthe world. Vaginal rejuvenation is going

mainstream. Apex from InControl Medicalis a medical device that inflates inside thevagina to strengthen the pelvic floormuscles to stop stress urinary incontinence.

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THE BOYS’ CLUBMen have come full circle from cringingat the idea of anything more thanwashing their face and shaving to‘bro-tox’ and fillers, freezing their chinand belly fat with Coolsculpting, hairrestoration and scar-reducing lasers.

According to Washington DCdermatologist Terrence Keaney: “Themale population has been largely ignoreduntil recently. Physicians and theaesthetics industry have focused on thelow hanging fruit, the female face. Thattrend is shifting, with men representingabout 10% of the aesthetics market andthat number is growing. Botox (Allergan)has been a gateway to attracting male

patients and Kybella [results picturedbelow] will only add to that growth.

“The male jawline is an importantmasculine facial feature. I often equate themale jawline to the female lips in terms oftheir importance to the respective gender,”he says.

Before After

Women’s sexual health is no longer taboo anddevices like the diVa laseroffer vaginal rejuvenation,an increasingly sought-after procedure

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