Designer fillers, vaginal rejuvenation, the finer points on microneedling, and lightweight breast implants were among the hot topics featured at the 2015 American Society for Aesthetic Plastic Surgery (ASAPS) meeting in La Ville de Montreal in Quebec in May.

Toxins are considered to be a gateway procedure, and fillers are the fastest-growing segment, with cheeks emerging as the top area treated with fillers, says David Moatazedi, vice president of facial aesthetics at Allergan, who presented the results of consumer research. Dual users were shown to be the most loyal and profitable of injectable patients. In addition, perhaps not surprisingly, the gender breakdown of patients getting injections is 90% women versus 10% men, which presents a huge opportunity for expanding the male segment. The mean age of women having neurotoxin treatments is 47, and for fillers, it’s 50. The majority are married, working, and have a college degree. For men, the mean age comes in at slightly older—age 50—and crow’s feet and the undereye area are the most important areas to get treated.

In addition, Allergan’s research showed that 71% of the market is current patients, with new patients representing only 19% and 10% being lapsed patients who have left the market. The average number of treatments is 1.79 per year, but that has been shown to be higher due to the implementation of a customer loyalty program.

The trend toward targeted filler products was widely emphasized during the meeting. The expanding filler options available allow advanced injectors to treat previously neglected areas of the face. “Adding volume to the midface region, for example, will require fillers to be injected into the temple and forehead to balance out a patient’s facial features,” explains Miami-based plastic surgeon Jackie Yee, MD.

More designer products continue to evolve. Juvéderm® Voluma (Allergan) was the first US Food and Drug Administration (FDA)-approved filler designed specifically for midface rejuvenation. Restylane® Silk (Galderma) was recently approved by the FDA specifically for lip definition and augmentation, and Radiesse® just scored FDA approval for adding volume to the hands.

Radiesse is a great option for the hands. It is opaque, unlike other fillers, and can therefore conceal an aging appearance of the hand, according to Yee. The big news at ASAPS was the FDA clearance of Kybella™ (Kythera Biopharmaceuticals), which had plastic surgeons buzzing about finally having the injectable fat dissolver in their armamentarium by Q3 2015.

The Rise of the Designer Vagina

Labiaplasty, as well as other designer vagina procedures, got a good deal of airtime. By all accounts, labia reduction appears to be the most popular form of vaginal cosmetic surgery, although that is just where the list of options starts. Vaginal rejuvenation, vaginoplasty, hymenoplasty (also called revirgination), clitoral hood reduction (or clitoral unhooding), labial fat injections, and G-spot enhancement are becoming more mainstream.

The exhibit floor echoed this theme with new launches from major players, like Cynosure, and emerging technologies, including Thermiva. The new entries include devices using radiofrequency or CO2 fractional energy to promote the recovery of genital mucosa by stimulating the production of collagen and restoring blood flow. Energy may be delivered externally to address tissue laxity, and internally to improve the functional aspects of the vagina.

Lightweight breast implants were introduced by Tel Aviv plastic surgeon Michael Scheflan, MD. “We know from clinical experience that the heavier breast always sags more in the asymmetric patient. If weight was not the cause, the breast would be larger in all directions.”

Scheflan presented his experience with microsphere-enhanced silicone used in the Bi-Lite Lightweight Breast Implant (G&G Biotechnology). “These new implants are up to 30% lighter than traditional silicone gel implants. The microspheres reduce the density, the relative quantity of silicone gel and gel bleed, and improve radiological definition,” he says.

The Finer Points of Microneedling

From the myriad of handheld pen units to high-priced systems powered by radiofrequency energy for skin tightening on the face and body, cellulite, and wrinkle reduction, microneedling is another hot topic in aesthetics. Panelists agree that there is definitely a place for these devices in aesthetics, but there is a ton of consumer confusion as to what they are, what they can and cannot do, and who should be using them.

The uses for microneedling range from delivering actives into the skin as well as botulinum toxins, fine fillers, and serums, as well as lifting, contouring, and adding volume to the lower face. The holy grail may turn out to be microneedling-based drug-delivery systems that are under development.

News You Can Use

Three new web-based platforms were rolled out to ASAPS members. is a free online consultation process for cosmetic patients and doctors. Prospective patients can sign up and complete a series of forms about their goals and pertinent personal details, and receive e-responses. was created by industry insiders, dermatologists, and plastic surgeons. It provides real-time, unbiased content from professional organizations, vetted news, and information sources, and delivers it to the user an ongoing basis. A proprietary content-matching search engine has been developed that remembers each user’s interests to deliver fast and personalized articles, news, social feeds, and photos, and helps them locate a physician in their community.

Another new site,, has positioned its platform as an open marketplace for aesthetics. Members can access a daily stream of curated news content, plus a nationwide network of board-certified physicians and brands. Currently, HintMD physicians, including plastic surgeons, facial plastic surgeons, dermatologists, oculoplastic surgeons, hair restoration specialists, and cosmetic dentists, are board-certified by the American Board of Medical Specialties or the Royal College of Physicians and Surgeons of Canada.

Lewis_WendyWendy Lewis is president of Wendy Lewis & Co Ltd, Global Aesthetics Consultancy,, founder/editor in chief of, and a contributing editor to Plastic Surgery Practice. She can be reached at [email protected].