V Review of Energy-Based Treatments Adapting to Millennial Patients IMCAS 2018 Preview. isionary Company Commits to Global Technology Leadership

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1 V page Review of Energy-Based Treatments Adapting to Millennial Patients IMCAS 2018 Preview 2017 Volume 15 Circulation 25,000 isionary Company Commits to Global Technology Leadership 3

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3 Lutronic Commits to Global Technology Leadership By Jeffrey Frentzen, Executive Editor With 20 years of success as one of the leading laser and energybased device manufacturers, Lutronic Corp. (Boston, Massachusetts, U.S.) is continuing to expand globally into Europe and the U.S., with a clear objective of leaping ahead of competing top tier companies. Lutronic s solid plan to grow its R&D capabilities will ensure the continued delivery of innovative technologies to practices that are eager to adopt its ever-widening range of aesthetic devices. According to Lutronic s CEO, Haelyung Hwang, the company has been reinvesting approximately 20% of its revenues in technology development efforts in order to deliver better products to their customers. Among our peers in the industry we have one of the top in-house technology development teams in the world. And although we have been very conservative about offering our products globally, we now feel that we can make this bold move and increase not only our presence, but also our product offerings. We have a broad range of excellent product lines, as well as highly-qualified managers who can make this growth happen quickly. As a whole, the company s energy-based systems are designed to address practically any indication. Having already cornered the Asia-Pacific markets, Lutronic has the momentum to overcome the competition with next-generation laser, radiofrequency (RF) and other light-based technologies. Lutronic is one of the best hidden secrets in the aesthetic industry, expressed Omar Ibrahimi, M.D., Ph.D., founder and medical director of the Connecticut Skin Institute in Stamford, Connecticut, U.S. Their systems are well built and reliable. I think the company is committed to building faster and more powerful devices across a wide spectrum of technology platforms. They are seeking to advance virtually every product they have and I am impressed with this ambitious desire to continually improve. With the purchase of a Lutronic device comes the real golden egg, which is the company itself and the service support, expressed Gilly S. Munavalli, M.D., M.H.S., F.A.C.M.S., founder and medical director of Dermatology, Laser & Vein Specialists of the Carolinas (Charlotte, North Carolina, U.S.). I ve found in the years I ve been using these devices, I don t really need a lot on the maintenance side, but in terms of setting them up, the training, the updates, the ability to speak to Lutronic s marketing representatives, and even at a technical level, my experience has been unparalleled. Any time my staff or I have questions about using the devices, they are always available. I think that s so important when purchasing a device. Haelyung Hwang CEO Lutronic Boston, MA, USA Gilly S. Munavalli, M.D., M.H.S., F.A.C.M.S. Founder and Medical Director Dermatology, Laser & Vein Specialists of the Carolinas Charlotte, NC, USA Steven Weiner, M.D. Facial Plastic Surgeon Destin, FL, USA Tatjana Pavicic, M.D. Dermatologist Munich, Germany Omar Ibrahimi, M.D., Ph.D. Founder and Medical Director Connecticut Skin Institute Stamford, CT, USA Saleem Loghdey, M.B.Ch.B. (U.C.T.), F.C. Derm (SA), C.C.S.T. (U.K.), F.A.C.D. Dermatologist and Mohs Surgeon Miranda, New South Wales, Australia Bettina Rümmelein, M.D. Dermatologist Owner House of Skin and Laser Medicine Zurich, Switzerland Laurence Imhof, M.D. Head of the Division of Esthetic Dermatology, Laser Medicine and Photodermatology University Hospital Zurich Zurich, Switzerland THE European Aesthetic Guide Volume

4 THE European 2017 Volume 15 Features 54 IMCAS 2018 Preview 76 Energy-Based Treatments for Top Indications 88 Adapting to Millennial Patients 54 Comparison Charts 105 Skin Rejuvenation 109 Hair Removal 112 Vascular Technologies 115 Emerging Technologies Acne Tx Devices 118 Body Shaping Technologies 120 Fractional Technologies 122 Dermal Fillers 88 Directory 100 Aesthetic Company Directory 4 THE European Aesthetic Guide Volume 15

5 Advertisers Index Adoderm 93 Aesthetic Forum THE Aesthetic Industry Awards 98 THE Aesthetic Show , Aesthetic TV BTL Industries 131 Canfield Scientific 17 Classys 27 cocoon medical 79 Croma-Pharma 83 Cutera 35 Cynosure 47 DEKA 63 Ellipse 37 Eunsung Global 85 Fotona 33 Contact Information Hironic The HydraFacial Company 87 IBSA Farmaceutici 69 Ilooda 23 InMode 81 Michael Moretti Editor-in-Chief / Group Publisher mmoretti@miinews.com Leah Morvant Publisher lmorvant@miinews.com Medical Insight 36 Discovery, Suite 170 Irvine, CA USA IMCAS 28 Jeisys Medical 67 Lutronic 11 Merz Aesthetics 2, 13, 132 mesoestetic Pharma Group 73 Novavision Group 45 PerfAction Technologies 49 Quanta System 61 Sciton 53 Sinclair Pharma 95, 97, 99 Jeffrey Frentzen Executive Editor jeff@miinews.com Editorial Staff Erin Velardo Senior Editor erin@miinews.com Telephone: Facsimile: Subscriptions: info@miinews.com Skin Tech Pharma Group 91 STORZ MEDICAL 29 Syneron Candela 15, 59 Ulthera, a Division of Merz, Inc. 25 Laboratoires VIVACY 57 Niamh Cahill Contributing Editor William T. Kelley Senior Editor, International Anthony J. Varro Contributing Editor Kevin A. Wilson Contributing Editor Advertising Inquiries: sales@miinews.com Viveve 39 WONIK 51 ZELTIQ Aesthetics 43 Zimmer MedizinSysteme 65 Correction of errors: Medical Insight assumes no liability for the information contained in this publication. Every effort has been taken to ensure the accuracy of this information by contacting sources believed to be reliable. Errors, when discovered, will be promptly corrected. Copyright: This publication is protected by U.S. Copyright Law; 2017 Medical Insight Unauthorized reproduction is strictly forbidden by law, the penalty for violation is $100,000 per occurance. THE European Aesthetic Guide is a trademark of Medical Insight THE European Aesthetic Guide Volume

6 For Saleem Loghdey, M.B.Ch.B. (U.C.T), F.C. Derm (SA), C.C.S.T. (U.K.), F.A.C.D., a dermatologist and Mohs surgeon in Miranda, New South Wales, Australia, This is a company I m very happy to deal with, especially in the non-surgical rejuvenation area. A lot of the bases are covered with Lutronic systems. Aesthetics is a growing market and I believe most practices will want to be a part of it. I think Lutronic is the way to go in terms of acquiring these types of systems for your practice. system s Hollywood Peel is a very quick, no downtime procedure to rejuvenate the face using a proprietary carbon-based lotion that is placed on the patient and penetrates the skin to several microns. Then you apply the laser, which pulls off around 7 to 10 microns of skin and makes the skin glow. As well, the Clarity is an exceptional hair removal system, which has an Alexandrite and a 1064 nm wavelength. The Alexandrite wavelength is used to address pigmentary problems, Dr. Weiner continued. Additionally, the company s Healite LED-based system promotes faster healing and decreased inflammation. Popular systems include the INFINI fractional RF-based device, which features a unique method of delivering RF energy. The eco2 laser-based platform incorporates Lutronic s patented Controlled Chaos Technology (CCT), which delivers multiple arrays of randomized microscopic laser beams to the skin for a more natural, uniform treatment that prevents bulk thermal damage caused by conventional linear delivery methods. Clarity is a versatile, dual wavelength Alexandrite and Nd:YAG laser for hair removal, pigmentation, vascular lesions and more. Also, the Spectra provides a dual mode Q-switched Nd:YAG laser that offers customizable parameters, built-in safety and minimized downtime using four distinct Q-switched mode wavelengths (1064 nm, 532 nm, 585 nm and 650 nm). The entire product line is very well priced in comparison to other manufacturers, as well, noted Steven Weiner, M.D., a facial plastic surgeon in Destin, Florida, U.S. It is a little known fact that the Spectra is the biggest selling laser system in the world. It does everything from treating tattoos, pigmentation, all types of congenital nevi and more, he said. Additionally, the Before and six months after one INFINI full face treatment Photos courtesy of Edmond Griffin, M.D. Before and after INFINI full face treatment Photos courtesy of Gilly S. Munavalli, M.D., M.H.S., F.A.C.M.S. Acne scars before and after INFINI treatment Photos courtesy of Swapnil Shah, M.D. 6 THE European Aesthetic Guide Volume 15

7 According to Bettina Rümmelein, M.D., a dermatlogist and owner of House of Skin and Laser Medicine (Zurich, Switzerland), I saw my first Lutronic device, the eco2, at a congress. Each system I ve acquired has had a very positive influence in my clinic Spectra for tattoos; the extremely versatile Clarity; and the INFINI system, which is an outstanding device, and unique in the market. Not only are the Lutronic devices exceptionally versatile, but they are built with care. What I like most about Lutronic systems is their design, they are very easy to move and they always work. I use all my devices every day, and I perform about 40 treatments per day. They are very reliable systems. Before and after one LaseMD treatment Photos courtesy of Gilly S. Munavalli, M.D., M.H.S., F.A.C.M.S. Lutronic s new vaginal rejuvenation application, the Action II is a multipurpose fractional Erbium:YAG laser that received CE mark clearance for treatment of vaginal relaxation syndrome and stress urinary incontinence. The treatment is non-surgical, non-invasive and easy to perform, allowing practitioners to effectively treat a wide-range of vulvovaginal symptoms and conditions, stated Dr. Weiner. I think we are just scratching the surface with this device, because it can also work well for ablative skin resurfacing. On the vaginal rejuvenation side, it offers a quicker process that is very well tolerated by patients and achieves better results than competing systems. There are also potential combination therapies that use the INFINI and the Erbium laser. Other newer systems include the novel LaseMD, a Thulium laser that is changing the way the world thinks about non-ablative technology. This device is an advanced laser system that is designed to Before and after three LaseMD treatments Photos courtesy of Steven Swangel, M.D. work in concert with specially formulated cosmeceutical compounds, which are delivered into the skin via micro-wounds that are created by the LaseMD laser. The LaseMD creates a great niche for Lutronic, said Dr. Weiner. While the Spectra and INFINI have been solid systems for some time, Lutronic has done a great job with technology development efforts, such as laser resurfacing with the introduction of the LaseMD, without using topical anesthesia. Tatjana Pavicic, M.D., a dermatologist in Munich, Germany, utilizes the LaseMD system practically every day, Because it does not need any preparation time and has almost no patient downtime, she said. Due to its non-invasive treatment and the ability to interact with cosmeceuticals, you can use it on any skin type and patients of all ages. It also works well for different indications, from pigmentary problems to anti-aging and even treating superficial wrinkles. I also use the eco2 laser, which is effective for skin resurfacing and tightening, as well as treating acne scars. Adding body sculpting to the company s lineup of products, the new encurve device features an advanced form of RF-based energy that utilizes a specialized frequency (27.12 MHz) to selectively target and heat adipocytes to the optimal temperature to cause denaturation of cells, thus leading to adipocyte death. THE European Aesthetic Guide Volume

8 The encurve is an interesting device that completes Lutronic s portfolio with a body contouring system, said Dr. Weiner. And it is quite powerful, as well. In Dr. Loghdey s experience, the encurve is becoming more popular with people. This will be a system to watch. It is a new technology that patients are just starting to learn about. encurve fills a very real need because a lot of patients are looking for noninvasive treatments to address body shape, size and weight. No other system is as effective when talking about this particular type of RF. The encurve is efficacious, with minimal downtime. Another new product, the Picoplus picosecond laser system, perhaps best epitomizes the company s approach to taking aesthetic technology to the next level. The Picoplus is more powerful than any other picosecond laser on the market, stated Dr. Weiner. It has four wavelengths, a variety of spot sizes and a fractional component for skin rejuvenation. It is good for Asian skin rejuvenation, which is a difficult skin type to treat, but Lutronic perfected treatments on darker skin types. It is clear that this has both pico and nano technologies built into a single platform. For Dr. Loghdey, Picoplus is his favorite device. It is a picosecond laser that really addresses a multitude of problems, he reported. Initially it performs tattoo removal, which is a growing market. We can remove them in one-third to one-half of the time that it took in the past. The cost is much better for our patients, as well as the efficacy. Laurence Imhof, M.D., head of the division of Esthetic Dermatology, Laser Medicine and Photodermatology at University Hospital Zurich, recounted a story about one of her Picoplus patients. I had a young patient who had accidental tattooing on his face due to an explosion in Afghanistan, whom I treated successfully with the Picoplus. Overall my patients are really happy with their results. In addition, the system offers many other benefits, including pigment removal, rejuvenation and laser facial toning, Dr. Loghdey expressed. The user interface Before and after encurve treatment Photos courtesy of Michelle Gueseloff, M.D. Before and after Clarity treatment Photos courtesy of Bettina Rümmelein, M.D. Ephelides before and after one Picoplus treatment Photos courtesy of G.S. Lee, M.D. is very friendly and comes with a toggle function for adjusting fluence energy settings very easily. Settings can be adjusted at any stage of treatment and the warm up time is very quick. For treating pigmentary problems, the Picoplus is safe on all skin types. This is very important, added Dr. Loghdey. I also use it to perform a lunchtime facial where patients get a quick treatment with no downtime, so they can go back to work an hour later. 8 THE European Aesthetic Guide Volume 15

9 In particular, the Picoplus has been very helpful in treating melasma, Dr. Loghdey continued. This is an extremely difficult condition to treat that often comes back, he said. With other laser systems I would find that there would be an initial improvement, but then at some point the condition would rebound. With the Picoplus system, we are able to stay on top of this condition, so it has been a bonus having it in our practice. Tattoo previously treated with nano and pico lasers before and after three Picoplus treatments Photos courtesy of G.S. Lee, M.D. Overall, Lutronic systems have had a very positive impact on Dr. Pavicic s clinic. I recently opened another clinic and added new Lutronic devices, she said. They always work well and are ready to use almost immediately. I don t have to wait five minutes for them to start like some other systems I ve used. But most importantly, they are safe and I can manage any risks very efficiently. As a result, patients proactively ask for these procedures and we see increased patient satisfaction, as well as better turnover and conversion rates. Satisfaction has been very high and we ve not had any serious adverse events. That makes me confident. In order to meet what is seen as a growing demand for its systems, Lutronic has boosted its technical support capabilities. As stated by Dr. Weiner, With picosecond lasers you have to make sure that the company is reliable and they have good service because picosecond lasers can be finicky. I have no problem working with Lutronic s technical support, though there really are very few problems that I have encountered with their devices. The highly trained technicians respond quickly and fix any issues in a single visit. That has to be factored into the cost equation when you purchase a laser-based device. Before and after Picoplus treatment Photos courtesy of G.S. Lee, M.D. According to Dr. Ibrahimi, Having more options available to individual practices is a winning scenario. Lutronic s wonderful portfolio of products will also raise the bar and force other companies to improve their product offerings, which will ultimately increase the quality available to individual practices. I ve been working with Lutronic for over five years and have been impressed with their growth trajectory. I attribute this to their wonderful products and great customer service. As Mr. Hwang asserted, prospects for Lutronic s global push are extremely bright. We have more than 10,000 customers worldwide who have found a home with us. In addition, we have the stable financial structure and funding that will make this continued expansion a success. This very strong financial ability and dedication to technology advancements will bring us closer to our customers, he said. Dr. Weiner concluded, This is a solid manufacturer and they are financially very sound, and that is something you need to evaluate when you buy aesthetic devices. In an environment where larger players are acquiring so many energybased device suppliers, a big concern for practitioners is; what does the future hold for these companies? Is the research going to continue? Will the product lines be upgraded and will there be new products created that offer the latest technology advancements? In the case of Lutronic, the answer is a definite yes. THE European Aesthetic Guide Volume

10 SCIENTIFIC ADVISORY BOARD Maurice Adatto, M.D. Medical Director Skinpulse Dermatology & Laser Center Geneva, Switzerland Daniel Cassuto, M.D. Professor of Plastic Surgery University of Catania Catania, Italy Doris J. Day, M.D. Clinical Assistant Professor of Dermatology NYU Langone Medical Center Director Day Dermatology and Aesthetics New York, NY, USA Macrene Alexiades-Armenakas, M.D., Ph.D., F.A.A.D. Assistant Clinical Professor Yale University School of Medicine New Haven, CT, USA Director Dermatology and Laser Surgery New York, NY, USA Henry Chan, M.D., Ph.D., M.B.B.S., F.R.C.P., F.H.K.C.P., F.H.K.A.M. Dermatologist Honorary Professor Li Ka Shing Faculty of Medicine University of Hong Kong Hong Kong, China Koenraad De Boulle, M.D. Director Aalst Dermatology Group Aalst, Belgium Red M. Alinsod, M.D., F.A.C.O.G., A.C.G.E. Urogynecologist and Pelvic Reconstructive Surgeon Laguna Beach, CA, USA Gregory W. Chernoff, M.D., F.R.C.S. Plastic Surgeon Medical Director Chernoff Cosmetic Surgery Indianapolis, IN and Santa Rosa, CA, USA Jason B. Diamond, M.D., F.A.C.S. Diplomate American Board of Facial Plastic and Reconstructive Surgery Los Angeles, CA, USA Tina Alster, M.D. Washington Institute of Dermatologic Laser Surgery Washington, D.C., USA Suneel Chilukuri, M.D., F.A.A.D., F.A.C.M.S. Cosmetic and Dermatologic Surgeon Houston, TX, USA Barry DiBernardo, M.D., F.A.C.S. New Jersey Plastic Surgery Montclair, NJ, USA Benjamin Ascher, M.D. Plastic Surgeon Clinique IENA Lecturer and Clinical Assistant Paris Academy Paris, France Hong-Kyu Cho, M.D. Plastic Surgeon NB Plastic Surgery Clinic Seoul, Korea Christine Dierickx, M.D. Medical Director Skinperium Boom, Belgium Peter Bjerring, M.D., Ph.D. Professor of Dermatology Aarhus University Hospital Vejle, Denmark Joon-Yong Choi, M.D. Chief Plastic Surgeon Dream Plastic Surgery Group Seoul, Korea Jason Emer, M.D., F.A.A.D. Board Certified Dermatologist Beverly Hills, CA, USA Kevin Brenner, M.D., F.A.C.S. Board Certified Plastic and Reconstructive Surgeon ROX Center Beverly Hills, CA, USA Steven R. Cohen, M.D., F.A.C.S. Medical Director FACES+ Plastic Surgery Skin and Laser Center Clinical Professor of Plastic Surgery University of California, San Diego La Jolla, CA, USA Sabrina Fabi, M.D. Board Certified Dermatologist Goldman, Butterwick, Fitzpatrick, Groff & Fabi Cosmetic Laser Dermatology San Diego, CA, USA Gregory Buford, M.D., F.A.C.S. Board Certified Plastic Surgeon Beauty by Buford Englewood, CO, USA Angelo Cuzalina, M.D., D.D.S. Past President American Academy of Cosmetic Surgery, 2011 Diplomate American Board of Cosmetic Surgery Tulsa, OK, USA Klaus Fritz, M.D. Director, Dermatology and Laser Centers Landau, Germany Associate Professor Carol Davila University of Medicine and Pharmacy Bucharest, Romania President, European Society of Laser Dermatology 10 THE European Aesthetic Guide Volume 15

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12 SCIENTIFIC ADVISORY BOARD Takahiro Fujimoto, M.D., Ph.D. Medical Director Clinic F Laser and Skin Centre Tokyo, Japan Pearl E. Grimes, M.D. Director Vitiligo and Pigmentation Institute VPI Cosmetic Center Los Angeles, CA, USA Chang-Hun Huh, M.D., Ph.D. Clinical Assistant Professor Department of Dermatology Seoul National University Budang Hospital Gyeonggi, Korea Ma. Teresita G. Gabriel, M.D., F.P.D.S. Chair Department of Dermatology Research Institute for Tropical Medicine Alabang, Muntinlupa City, Philippines Sanjay Grover, M.D., F.A.C.S. Diplomate American Board of Plastic Surgery Newport Beach, CA, USA Christopher Inglefield, B.Sc., M.B.B.S., F.R.C.S.(Plast) Medical Director London Bridge Plastic Surgery & Aesthetic Clinic London, UK Dore J. Gilbert, M.D. Dermatologist Newport Dermatology & Laser Associates Newport Beach, CA, USA Ka-lam Hau, M.B.Ch.B., M.R.C.P., F.H.K.A.M., F.H.K.C.P., D.C.H. Dermatology Specialist Hong Kong SAR, China Garo Kassabian, M.D., F.A.C.S. Dual Board Certified Plastic and General Surgeon Founder and Medical Director Lift MD Aesthetics Beverly Hills, CA, USA Chee-Leok Goh, M.D., M.B.B.S., M.Med., M.R.C.P., F.R.C.P.E., F.A.M.S. Clinical Professor National University of Singapore Adj. Professor Duke-NUS Graduate School Sr. Consultant Dermatologist National Skin Centre, Singapore Per Hedén, M.D., Ph.D. Associate Professor of Plastic Surgery Karolinska Institutet Founder and Chairman Akademikliniken Private Hospital Group Stockholm, Sweden Bruce Katz, M.D. Clinical Professor of Dermatology Mount Sinai School of Medicine New York, NY, USA Michael H. Gold, M.D. Gold Skin Care Ctr. Tennessee Clinical Research Ctr. Clinical Assistant Professor Vanderbilt University School of Medicine Nashville, TN, USA Gangaram Hemandas, M.B.B.S., M.R.C.P., F.R.C.P., M.Med., F.A.A.M. Head and Consultant Dermatologist Department of Dermatology Prince Court Medical Center Consultant Dermatologist Tropicana Medical Center Petaling Jaya and Kuala Lampur, Malaysia Arielle Kauvar, M.D. Clinical Associate Professor of Dermatology New York University School of Medicine New York, NY, USA David J. Goldberg, M.D. Clinical Professor of Dermatology Mount Sinai School of Medicine New York, NY, USA Alberto Goldman, M.D. Board Certified Plastic Surgeon Clinica Goldman Porto Alegre, Brazil Chanyeong Heo, M.D., Ph.D. Assistant Professor Department of Plastic Surgery School of Medicine Seoul National University Chairman and Chief of the Department of Plastic Surgery Seoul National University Budang Hospital Seoul and Gyeonggi-do, Korea Sindy Hu, M.D. Department of Dermatology Chang Gung Memorial Hospital Taipei, Taiwan Suzanne Kilmer, M.D. The Skin Surgery Center of Northern California Sacramento, CA, USA Beom-Joon Kim, M.D., Ph.D. Dermatologist Head Professor and Chairman Department of Dermatology College of Medicine, Chung-Ang University Seoul, Korea Miles Graivier, M.D., F.A.C.S. Plastic and Reconstructive Surgeon North Atlanta Plastic and Reconstructive Surgery Roswell, GA, USA Peter Huang, M.D. Plastic and Cosmetic Surgeon Director Rebecca Cosmetic Institute Taipei, Taiwan Lorrie Klein, M.D. President Lorrie Klein, M.D. - Dermatology & Laser Center Euro Day Spa, Inc. Laguna Niguel, CA, USA 12 THE European Aesthetic Guide Volume 15

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14 SCIENTIFIC ADVISORY BOARD Malavika Kohli, M.D., D.V.D., D.N.B. Consultant Dermatologist Aesthetic Dermatologist Jaslok Hospital and Research Centre Director Skin Secrets Mumbai, India Joyce Teng Ee Lim, M.B.B.S., F.R.C.P.I., F.A.M.S. Dermatologist Joyce Lim Skin and Laser Clinic Singapore Visiting Consultant National Skin Centre Singapore Rhoda S. Narins, M.D. Clinical Professor of Dermatology NYU Medical Center Medical Director Dermatology Surgery and Laser Center Manhattan and White Plains, NY, USA Taro Kono, M.D. Department of Plastic and Reconstructive Surgery Tokyo Women s Medical University Tokyo, Japan Corey S. Maas, M.D., F.A.C.S. The Maas Clinic for Aesthetic and Facial Plastic Surgery Associate Clinical Professor University of California, San Francisco San Francisco and Lake Tahoe, CA, USA Kei Negishi, M.D., Ph.D. Associate Professor and Chief of Aesthetic Dermatology Division Aoyama Institute of Women s Medicine Tokyo Women s Medical University Tokyo, Japan Marina Landau, M.D. Dermatology Wolfson Medical Center Holon, Israel Daniel Man, M.D. Plastic Surgeon Boca Raton, FL, USA Joseph Niamtu, III, D.M.D. Cosmetic Facial Surgeon Richmond, VA, USA Moshe Lapidoth, M.D., M.P.H. Head of the Laser Unit Rabin Medical Center Tel Aviv, Israel Woraphong Manuskiatti, M.D. Professor Department of Dermatology Siriraj Hospital, Mahidol University Siriraj Skin Laser Center Bangkok, Thailand Andrew P. Ordon, M.D., F.A.C.S. Plastic Surgeon Host CBS talk show The Doctors Beverly Hills and Rancho Mirage, CA, USA Geun-Soo Lee, M.D., Ph.D. Dermatologist Drs. Woo and Hann s Skin and Laser Center Seoul, Korea David Matlock, M.D., M.B.A., F.A.C.O.G. The Laser Vaginal Rejuvenation Institute of Los Angeles Los Angeles, CA, USA Hsien-Li Peter Peng, M.D. Director Dr. Peng s Dermatological Clinic & Cosmetic Laser Center (P-Skin Clinic) Taiwan, Republic of China Wendy W. Lee, M.D. Assistant Professor of Clinical Ophthalmology, Oculofacial Plastic and Reconstructive Surgery Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Co-Director UM Cosmetic Medicine Miami, FL, USA Tess Mauricio, M.D., F.A.A.D. Founder Scripps Ranch Dermatology and Cosmetic Center San Diego, CA, USA Jorge A. Perez, M.D., F.A.C.S. Plastic and Reconstructive Surgeon Perez Plastic Surgery Ft. Lauderdale, FL, USA Hang Li, M.D. Associate Professor Chief of the Dermatologic Surgery Division Department of Dermatology Peking University First Hospital Beijing, China David McDaniel, M.D. Laser Center of Virginia Virginia Beach, VA, USA Miriam Emily Piansay-Soriano, M.D., F.P.D.S. Davao Doctors Hospital Davao City, Philippines Yuanhong Li, M.D., Ph.D. Associate Professor of Dermatology Vice Chairman No. 1 Hospital of China Medical University Shenyang, China Ronald L. Moy, M.D. Dermatologist and Facial Cosmetic Surgeon Moy, Fincher and Chipps Facial Plastic & Dermatology UCLA Medical School Beverly Hills, CA, USA Jason Pozner, M.D., F.A.C.S. Medical Director Sanctuary Medical Aesthetic Center and Sanctuary Plastic Surgery Boca Raton, FL, USA 14 THE European Aesthetic Guide Volume 15

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16 SCIENTIFIC ADVISORY BOARD Nark-Kyoung Rho, M.D. Clinical Assistant Professor Department of Dermatology Samsung Medical Center Director Leaders Aesthetic Laser & Cosmetic Surgery Center Seoul, Korea Gordon H. Sasaki, M.D., F.A.C.S. Clinical Professor Department of Plastic Surgery Loma Linda Medical University Center Private Practice Pasadena, CA, USA Siak-Khim Tan, M.D., B.S. Medical Director The DRx Clinic Singapore Alexander Z. Rivkin, M.D. Facial Cosmetic Surgeon Founder Westside Aesthetics Los Angeles, CA, USA Gerhard Sattler, M.D. Founder and Medical Director Rosenpark Klinik Darmstadt, Germany Mark B. Taylor, M.D., F.A.A.D. Director Gateway Aesthetic Institute and Laser Center Salt Lake City, UT, USA Leif Rogers, M.D., F.A.C.S. Plastic and Reconstructive Surgeon Leif Rogers, M.D. Reconstructive and Cosmetic Plastic Surgery Beverly Hills, CA, USA Kyle Koo-Il Seo, M.D., Ph.D. Clinical Associate Professor BOTOX Clinic Department of Dermatology Seoul National University Hospital Director Modelo Clinic Seoul, Korea William Philip Werschler, M.D., F.A.A.D., F.A.A.C.S. Assistant Clinical Professor of Medicine/Dermatology University of Washington School of Medicine Seattle, WA, USA E. Victor Ross, M.D. Director Cosmetic and Laser Dermatology Unit Scripps Clinic San Diego, CA, USA Ava Shamban, M.D. Laser Institute for Dermatology Santa Monica, CA, USA Assistant Clinical Professor of Dermatology University of California, Los Angeles Los Angeles, CA, USA ChongHyun Won, M.D. Assistant Professor Department of Dermatology Ulsan University School of Medicine Seoul, Korea Mark G. Rubin, M.D. Assistant Clinical Professor of Dermatology University of California, San Diego Private Practice Beverly Hills, CA, USA W. Grant Stevens, M.D., F.A.C.S. Plastic Surgeon Marina Plastic Surgery Clinical Professor of Surgery University of Southern California Marina Del Rey, CA, USA Woffles Wu, M.B.B.S., F.R.C.S., F.A.M.S. Plastic Surgeon Woffles Wu Aesthetic Surgery & Laser Centre Singapore Neil Sadick, M.D. Clinical Professor of Dermatology Weill Cornell Medical College New York, NY, USA Insuck Suh, M.D., Ph.D. Professor Department of Plastic and Reconstructive Surgery College of Medicine, Hallym University Kangnam Sacred Heart Hospital Seoul, Korea Sabine Zenker, M.D. Dermatologist Dermatology Surgery Clinic Munich, Germany Claudine Santos-Roura, M.D., F.P.D.S. Dermatologist and Cosmetic Surgeon Contours Advanced Face and Body Sculpting Institute Manila, Philippines Nantapat Supapannachart, M.D. Dermatologist Clinical Professor Ramathibodi Hospital, Mahidol University Medical School Clinical Staff Bumrungrad Hospital Bangkok, Thailand Guoyu Zhou, M.D. Oral and Maxillofacial Surgeon Deputy Director Medical Laser Centre of Shanghai Jiaotong University Medical College, Ninth People s Hospital Shanghai, China Deborah S. Sarnoff, M.D., F.A.A.D., F.A.C.P. Clinical Professor of Dermatology NYU Langone Medical Center New York, NY, USA Atchima Suwanchinda, M.D., M.S. Consultant Laser and Dermatologic Surgery Unit Ramathibodi Hospital, Mahidol University Director Medisci Biointegrative and Anti-Aging Center Bangkok, Thailand Craig L. Ziering, D.O., F.A.O.C.D. CEO and Medical Director Ziering Medical Worldwide West Hollywood, CA, USA 16 THE European Aesthetic Guide Volume 15

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19 Aesthetic Insights THE Aesthetic Forum Showcases Top Players in $9.5 Billion Industry After 25 years of continuous unbridled growth, the global medical aesthetic industry shows no signs of slowing down. Medical Insight ( research shows that in 2017 the B2B side of this lucrative sector will exceed $9.5 billion in revenues with a projected 10.5% CAGR. On the procedure fee side, healthcare providers are generating over $25 billion per year with an estimated CAGR of 5.7%. This consistent expansion in a private pay arena is incredibly exciting to major global healthcare companies that want to hedge against government price controls on reimbursed drugs and devices. As a result, we are seeing an increase of high-level investor and corporate business development activity, combined with major investments in pipeline R&D projects focused on producing the next generation of aesthetic treatments and products. Private equity buy-outs of market leaders such as Syneron Candela are now competing with major manufacturers such as Allergan, Almirall, Hologic and Merz to grab the best assets in the industry. This bidding war environment explains the record-breaking valuations that ZELTIQ Aesthetics, Cynosure and Kythera recently obtained. Meanwhile, smaller competitors like Alma Lasers, The HyrdaFacial Company, Sienna Pharmaceuticals, Thermi, Valeant / Solta Medical, Revance Therapeutics and Viveve are taking advantage of this rising tide of investment frenzy to either execute on public offerings to raise large amounts of capital or to cash out via private equity players such as APAX. These tactical moves then lead to investors using the platform or the capital to make more acquisitions and build out their respective portfolios. In this extremely rich environment, innovative start-ups are claiming their niche position and building strategic value at an amazing rate. Some new ventures enter the market with a concept and then receive incredibly lucrative investment offers within a short period of time before they have even commercially launched or sold a single product. Michael Moretti Editor-In-Chief / Group Publisher In this extremely rich environment, innovative start-ups are claiming their niche position and building strategic value at an amazing rate. Based on the substantial business development demand to learn more about new opportunities and market potential faster, Medical Insight has created a very focused and exclusive event on February 18, 2018 in San Diego, California, U.S. during the American Academy of Dermatology (AAD) annual meeting. While this private invitation-only conference has no connection to the AAD, it will draw upon the top 25 medical aesthetic and pharmaceutical company executives in our industry to lead a progressive discussion and strategic analysis. Joining these seasoned business leaders will be several Wall Street analysts and major investors. If you wish to participate in this exclusive and highly immersive business development forum, please contact me directly for further details. THE European Aesthetic Guide Volume

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22 Fractional CO 2 GynoLaser Addresses Genitourinary Syndrome of Menopause By Anthony J. Varro, Contributing Editor Gayle Fischer, M.D., M.B.B.S. Associate Professor of Dermatology The University of Sydney Medical School Sydney, Australia With its patented GynoLaser applicator, the Fraxis fractional CO 2 laser by Ilooda (Suwon, South Korea) may help women with genitourinary syndrome of menopause (GSM). Low levels of circulating estrogen, the cause of GSM, can cause vaginal and/or vulvar dryness, burning, dyspareunia and urinary problems. While topical estrogen therapy is an effective treatment option even after breast cancer many women are understandably reluctant to undergo hormonal therapy, said Gayle Fischer, M.D., M.B.B.S., an associate professor of dermatology at the University of Sydney Medical School (Sydney, Australia). Estrogen is the physiological answer for post-menopausal vaginal problems, but there are a number of women who, for whatever reason, are unable to use it. Most of it centers around fear of breast cancer risk, Dr. Fischer explained. Allergy to or intolerance of the topical estrogen preparations, and side effects (such as increased risk of candidiasis), also make it difficult to use estrogen supplements, she noted. Despite a lack of robust evidence, ever since the microablative vaginal laser has become available, it has been enthusiastically used for many women, particularly in Australia, Dr. Fischer stated. Dr. Fischer likes that the GynoLaser was designed specifically for vaginal use. I do not have any concerns about safety. In the patients I have treated there have been no adverse effects, she shared. Nevertheless, the real questions are, how well does it work? Is it really a substitute for estrogen; and is it cost-effective? Currently, patients pay up to $3,000 (Australian dollars) per treatment cycle. This expense likely introduces a significant placebo effect, she indicated. In a small prospective study, Dr. Fischer and colleagues used the GynoLaser to treat six patients (median age 52 years) with GSM for free. Investigators applied topical anesthesia 20 minutes prior to treatment. Then, the treating physician inserted the cylindrical handpiece tip (covered with a disposable sleeve and operating at a fluence of 120 mj with 0.8 mm dot spacing) approximately 11 cm into the vagina and progressively withdrew it to treat the entire vaginal wall. Then we changed the handpiece to a conventional fractional tip for treating the vaginal vestibule (at 12 mj, 8 mm square spot). The whole procedure takes approximately five minutes, Dr. Fischer noted. Patients typically rate discomfort felt mostly during external treatment as three on a ten-point scale, and they usually experience slight soreness in treated tissues for a few days post treatment. Five patients completed the cycle of three sessions spaced one month apart; a sixth patient underwent two treatments. After treatment, four patients reported improvement in Dermal Life Quality Index (DLQI), Vulvar Disease Life Quality Index (VLQI) and Female Sexual Dysfunction Scale (FSDS) scores. Median VLQI dropped from 16/45 before treatment to 6/45 after (p= 0.043). Also, median FSDS decreased from 29 to 18 (p = 0.043). The GynoLaser s exact mechanism of action remains unknown, Dr. Fischer reported. As with facial treatments, we re creating microscars in the dermis that result in collagen regeneration, which contracts the dermis. What I find fascinating is that the treatment returns lubrication to the vagina. It must somehow be stimulating the glands in the vaginal wall to secrete again. So far, patients who responded well have maintained results up to six months post treatment, she said. Dr. Fischer and colleagues are already looking ahead to 2018 and have planned a double-blind, randomized, controlled trial in patients with GSM who have had breast cancer. What I find fascinating is that the treatment returns lubrication to the vagina. It must somehow be stimulating the glands in the vaginal wall to secrete again. So far, patients who responded well have maintained results up to six months post treatment. Illustration depicts vaginal tightening treatment with Ilooda s GynoLaser handpiece. Photo courtesy of Ilooda 22 THE European Aesthetic Guide Volume 15

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24 Ultrasound Visualization Creates Unrivaled Precision for Ultherapy By Kevin A. Wilson, Contributing Editor user learns using DeepSEE imaging plays a major role in how transducer depth is modulated. For example, since the introduction of Ultherapy Amplify software-optimization of treatment parameters, Ultherapy is more efficient and tolerable, but you want to avoid the bone. Treating on or below the bone surface is painful, and DeepSEE helps us avoid that as we choose which transducer to use, Dr. Bucay explained. There are other nearby tissue structures where the application of energy may cause unnecessary damage or at least provide no therapeutic benefit. The goal of any therapy is to target tissue or tissue structures that will lead to a therapeutic benefit, and avoid anything else. The better one can do that, the better any therapy will be. Vivian Bucay, M.D. Medical Director Bucay Center for Dermatology and Aesthetics San Antonio, TX, USA The use of ultrasound to visualize organs and tissue structures non-invasively has been a boon to medicine for decades. The Ulthera System from Merz Aesthetics (Frankfurt, Germany) utilizes that same energy as a therapeutic modality for noninvasive facial tightening, but still incorporates a real-time ultrasound visualization component known as DeepSEE imaging into the platform to provide unparalleled precision in treatment, a feature that sets Ultherapy apart. Ultherapy targets as deep as the superficial muscular aponeurotic system (SMAS layer), the same facial anatomy tightened during surgical face-lifting to combat tissue redundancy due to aging, in a single 30 to 90 minute treatment with no downtime. The capability to visualize subsurface tissue stratification is what makes truly effective non-invasive tightening of the SMAS possible. There is no substitute for having real-time visualization when performing a treatment of this type, said Vivian Bucay, M.D., medical director of the Bucay Center for Dermatology and Aesthetics (San Antonio, Texas, U.S.). We know exactly where we re supposed to be treating. We know where our target should be and can see where it is, exactly. You can know facial anatomy in and out and have years of experience, but until you see it you don t know where that individual patient needs to be treated. Everyone is different, so it s a great advantage that we re not treating blindly. We can see where we re supposed to treat, as well as structures we want to avoid. Ultherapy transducer depth can be set at 1.5 mm (superficial dermis), 3.0 mm (deep dermis) and 4.5 mm (SMAS/platysma), depending on the needs of the patient, and what the Before treatment 90 days after one Ultherapy treatment using DeepSEE technology Photos courtesy of Merz Aesthetics Using intensive, up-to-date training programs and regular forums promoting the free exchange of information, Merz keeps its physician partner base informed and performing so that the patient gets the best outcomes Ultherapy has to offer. I don t know of any company that spends as much time and money on their presence at conferences around the world, regularly bringing in expert physicians to share with users at all levels of experience, said Dr. Bucay, who herself has often been called upon in that capacity. Add to that the safety and efficacy, realtime imaging, and what I believe to be the best ROI of any treatment I offer, and you have a proven winner in Ultherapy. 24 THE European Aesthetic Guide Volume 15

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26 Non-Invasive Scizer Comfortably Melts Subcutaneous Fat By Kevin A. Wilson, Contributing Editor minimal discomfort for patients of any skin type. A typical course of Scizer treatment is three sessions at monthly intervals, Dr. Lim noted. Some patients may require additional sessions for a greater result, or will wish to treat other body areas, he said. Maintenance is not usually needed because this type of fat reduction is likely to be permanent, as long as patients adhere to a healthy lifestyle. Fat cells are destroyed by necrosis, which is irreversible cell death, and generally do not repopulate in number, although remaining adipocytes can still enlarge with excessive caloric intake. Adrian Lim, M.D. Dermatologist Royal North Shore Hospital Sydney, Australia Scizer from Classys, Inc. (Seoul, South Korea) combines the power of 2 MHz macrofocused scanning ultrasound (MSFU), with state-of-the-art intelligent cooling to melt subcutaneous adipocytes without damaging the epidermal barrier, for maximum safety and efficacy. Its linear scanning technology, harnessed for use with ultrasound, delivers the necessary energy in a remarkably consistent and reproducible manner for recontouring areas such as the abdomen, flanks or thighs with Before and after Scizer treatment Photos courtesy of Adrian Lim, M.D. According to Adrian Lim, M.D., a dermatologist at Royal North Shore Hospital in Sydney, Australia, it takes a lot of energy to permanently disrupt fat cells. Scizer s uniform linear scanning technology not only delivers ultrasound energy at precise depths, it allows for the accumulation of therapeutically adequate levels of energy, which carefully elevates subcutaneous tissue temperature to between 65 C and 70 C, to destroy fat cells, without sedation or analgesia. But the key to patient comfort is the built-in intelligent cooling system, he added. Contact Cooling Control is coordinated with energy delivery to protect skin and surface tissue structures, focus thermal effect at the target depth, and minimize the perception of pain. Detailed demonstration of Scizer outcomes and its mechanism of action have been reported in scientific literature. 1 Outcomes begin to manifest soon after the first session. There may be some initial mild swelling and bruising, which resolves predictably, Dr. Lim continued. Real improvement in contour will be noticeable by the third or fourth week, with subsequent applications leading to progressive improvement in contour and reduction in circumference. One of the best aspects of Scizer treatment is the natural look of the result, created by the diffusion of energy and the way the body responds as it removes fat and cellular debris. We see noticeable fat reduction without evidence of imprints, divots or uneven contours. The 9 mm and 13 mm spot size cartridges improve coverage and treatment speed, but there are other advantages as well. Scizer is not only effective and well tolerated, enabling flexible and personalized targeting of different body areas, it is fast, with procedure times of about two minutes per area, Dr. Lim reported. Scizer is safe and predictable enough for use by ancillary staff rather than the physician, and patients enjoy the hands-on attention of staff during therapy. In addition to being tolerable, the procedure itself is clean and efficient because no topical anesthesia or sticky contact facilitating gels are required. Furthermore, since Scizer does not employ a laser, no special laser certification/ licensing or goggles are required. Reference: 1. Kwon TR, Im S, Jang YJ, et al. Improved methods for evaluating pre-clinical and histological effects of subcutaneous fat reduction using high-intensity focused ultrasound in a porcine model. Skin Res Technol 2016;0: THE European Aesthetic Guide Volume 15

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32 Fotona 4D Provides Fast Non-Invasive Face-Lift By Anthony J. Varro, Contributing Editor Annamaria Pfau, M.D. Policlinic Novakov i Sar. Novi Sad, Serbia Marijana Krsticevic, M.D. Policlinic Novakov i Sar. Novi Sad, Serbia Fotona s (Ljubljana, Slovenia and Dallas, Texas, U.S.) 4D procedure, performed via the SP Dynamis, treats all the required levels of tissue to provide a quick, comfortable and effective non-invasive face-lift. According to Annamaria Pfau, M.D., of the Policlinic Novakov i Sar. in Novi Sad, Serbia, the complementary combination of Er:YAG and Nd:YAG wavelengths is at its best in 4D Fotona treatment. It provides deep thermal firming effects with superficial peeling and buccal firming, she explained. Together, the superficial ablative effect of the Er:YAG laser (2940 nm) and the deep tissue stimulation of the Nd:YAG laser (1064 nm), give the effect of glowing, firmer, more toned skin. The 4D procedure works especially well when combined with platelet-rich plasma (PRP), said Marijana Krsticevic, M.D., who also practices at Policlinic Novakov i Sar. Dr. Krsticevic shared a recent case, which involved a 43-year-old female with no previous history of aesthetic treatments who presented with relaxation of the lower face and cheeks, skin tone and discoloration concerns and fine lines. After thoroughly cleaning the patient s face, Dr. Pfau and Dr. Krsticevic performed the four steps of 4D treatment. Step one involves intraoral treatment with the Er:YAG laser in SMOOTH mode (2 J/cm 2, 1.6 Hz, 7 mm spot size, three to four passes on each side of the mouth). This helps firm and lift the nasolabial region, Dr. Krsticevic noted. Step two consists of a full-face treatment with the Nd:YAG laser in FRAC3 mode (35 J/cm 2, 1.6 ms, 1.5 Hz, 6 mm spot) to correct skin imperfections and light to moderate lines. Step three is a full-face treatment with the Nd:YAG laser in PIANO mode (110 J/cm 2, 5 second pulses, 1.5 Hz, 9 mm spot). Dr. Krsticevic pointed out that with a few passes on each region effective heating is reached and the emission of long pulses rapidly and safely warms the deep skin structures, leading to overall firming of tissue. Step four includes fractional superficial peeling with the Er:YAG laser (50% coverage at 4 J/cm 2, 6 Hz, 1 ms pulse, 7 mm spot). Partially ablating the superficial epidermis leads to healthier, firmer skin and a more even complexion, Dr. Pfau reported. Typically Dr. Krsticevic and Dr. Pfau also target the neck during treatment, avoiding the area above the thyroid gland with the deeply penetrating Nd:YAG modalities. Before treatment After treatment a cream containing glycerin, cyclopentasiloxane, cyclohexasiloxane, panthenol, zinc gluconate and dimethicone was applied, Dr. Krsticevic shared. The patient was instructed to apply it several times daily for the next week. We also recommended a high SPF sunscreen. Post-treatment, the patient experienced slight erythema that resolved within one day, followed by mild flaking a couple of days later. The 4D laser treatment took around 45 minutes, Dr. Pfau stated. We use chilled-air cooling, which in the vast majority of cases is more than enough anesthesia to perform this efficient yet safe, comfortable therapy. Two weeks after 4D treatment, the patient also received PRP therapy. 45 days after SP Dynamis 4D treatment followed by PRP treatment Courtesy of Annamaria Pfau, M.D. and Marijana Krsticevic, M.D. To maximize results, both Dr. Pfau and Dr. Krsticevic recommend repeating the 4D procedure two to three months after the initial application. 32 THE European Aesthetic Guide Volume 15

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34 Cutera s enlighten Platform Delivers Powerful Photodamage Treatment By Kevin A. Wilson, Contributing Editor Sach Mohan, M.D. Revere Clinics London, UK Powering away the pigmentary signs of photo-aging and photodamage, the PICO Genesis and PICO Genesis FX protocols for the versatile enlighten laser system from Cutera, Inc. (Brisbane, California, U.S.), utilize picosecond pulse capabilities for maximum clinical impact and outstanding results for overall skin tone and appearance. By creating zones of laser-induced optical breakdown (LIOB) in the dermis, skin quality is improved, pigment is resolved and a lighter, more even skin tone is achieved. Primarily a pigment and tattoo laser system, the high-performance enlighten platform features a full range of spot sizes and variable pulse durations in the nano and picosecond domains, using non-ablative 532 nm, 670 nm and 1064 nm wavelengths through a single handpiece, without consumables or contact with the skin. Its new micro lens array (MLA) attaches to the Sabika Karim, M.D. Revere Clinics London, UK handpiece to create a fractional effect. Users transcend the limits of basic pigment lasers by harnessing the platform s unrivaled power and adjustable pulse delivery to target pigment with photomechanical, rather than photothermal treatment vectors, with little or no downtime. What I appreciate the most in the dayto-day use of enlighten is that it has a userfriendly interface, making it easy to move between wavelengths and pulse durations at the touch of a button on the screen, said Sach Mohan, M.D., who practices at the Revere Clinics in London, U.K. Variation in spot size is just as easy with no need to change lenses or handpieces. But best of all, there are no consumables. PICO Genesis and its sister, PICO Genesis FX (using the MLA attachment), combine high power and picosecond pulse duration (with the 1064 nm or 523 nm wavelengths) to initiate a cavitation effect (via LIOB) that shatters pigment and improves overall tone without the usual heat injury and related side effects. Treatment is safe enough even for typically challenging skin types, such as Asian skin. In addition to pigment, collagen remodeling and revitalization of overall skin quality, the PICO Genesis FX treatment utilizing the MLA provides a three-in-one treatment for textural irregularities and more challenging pigmentation, as well as minor scarring and blemishes. Since water is not the target chromophore, the laser doesn t behave like your traditional CO 2 or erbium in that there are no ablation or coagulation zones, and the parameters allow for a no downtime, minimal, or moderate downtime protocol, where pinpoint petechia is visualized followed by a mild plasma ooze similar to that seen after microneedling, explained Sabika Karim, M.D., who practices with Dr. Mohan at the Revere Clinics. Downtime is dependent on how aggressive the treatment is, with postprocedure erythema and edema that can last between one day to a few days based on treatment density, number of passes and fluence. Two sessions are recommended at minimum, spaced four weeks apart, using either protocol seperately or both in combination. Furthermore, additional applications using enlighten s nanosecond pulse duration can further enhance outcomes. The capabilities of these protocols go beyond skin rejuvenation and these are being explored, Dr. Mohan noted. With our initial evaluation, the response for atrophic acne scarring has so far been on par with any traditional resurfacing laser, in a one-to-three session, six-week protocol, and we have been treating every Fitzpatrick skin type. Before and eight weeks after second PICO Genesis treatment and one PICO Genesis FX treatment Photos courtesy of Cutera Before and four weeks after PICO Genesis and PICO Genesis FX treatments Photos courtesy of Cutera 34 THE European Aesthetic Guide Volume 15

V Review of Energy-Based Treatments Adapting to Millennial Patients IMCAS 2018 Preview. isionary Company Commits to Global Technology Leadership

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