Editor’s Message

A Possible Cosmetic Surgery Future

Jeffrey Frentzen

People used to laugh at science fiction B-movies for presenting futures in which everyone looked like soap opera actors. But maybe they were right.

All indications are that personal aesthetics in even the near future will advance quickly—technologically and in social terms—to the point where the so-called fantastical visions of science fiction authors of decades ago will have been realized.

Laser- and other energy-based technologies are at the forefront of these types of advancements. Look at how laser-based devices have revolutionized the aesthetic medicine field in a short period. Also, take a look at how the technologies behind some of the most popular cosmetic treatments came to be developed. As with so many technology leaps in the 20th century, the development of lasers came via research at Columbia University and Harvard; the military side was developed via Bell Labs and Hughes Research. In the mid-60s, the government’s excitement over laser-based weapons subsided. Industry was left to develop the technology further.

One can follow the precedent of technologies that are initially explored and developed by weapons contractors attached to the US military and its vast taxpayer-generated subsidies. It is possible, then, to try to extrapolate the future of plastic surgery procedures—for example, biotechnology breakthroughs that could revolutionize the way we deal with replacing hair lost by male pattern baldness. Instead of using plugs of real hair moved to the front surgically, gene therapy “cocktails” could be injected or delivered via a surface cream or paste.

In another example, face transplantation may someday be more commonplace. On another front, sexual cosmetic surgery is already more or less accepted in most cultures, so the popularity of female genital reconstructive procedures may someday intersect with the inclusion of energy-based devices for some aspects of these procedures. Present and future technologies would be melded together to create a response to what the public perceives it needs, aesthetically.

Facial transplants could improve the quality of life of the severely disfigured, but raise questions of identity—to self and to others, especially people who knew the deceased donor. Patient and donor consent issues would be raised. Legalities and procedures associated with other organ donations would likely not be acceptable for face donation. Back to the sci-fi analogy, the procedure may be exploited by surgeons willing to service criminals or those who have succumbed to the notion that they are hopelessly “ugly.”

Some of the more fantastic aesthetic procedures and treatments could be advanced with new, biotech-based science. Regrowth of damaged skin and other organs is often cited as a logical example of where to take our technology-driven experiments.

On the other hand, odd variations on cosmetic and reconstructive surgery are at hand. For example, lovers of anthropomorphized animals may want to adopt some animal look via body modification—as in the tiger lover who covered her body with striped tattoos and got dental implants with canines.

Along those same lines, cosmetic surgery for pets is already popular in some countries, and as a procedure would eventually be taken down to the level of a marketed commodity or service that anyone could purchase for their pet.

Energy-based devices will no doubt be brought to bear in the current development of therapies using stem cells and other biotechnology. Cosmetic procedures using stem cells has a strong buy-in from the public, and any company that develops products and services in this area will see tremendous market growth and increased controversy in the public arena.

Candela Corp

530 Boston Post Rd, Wayland, MA 01778 (508) 358-7400 www.candelalaser.com

Before and after hair removal of the face

Candela Corp, (a wholly owned subsidiary of Syneron Medical) has released its new generation of GentleLASE lasers: the GentleLASE PRO High Speed Hair Removal System, a cutting-edge Alexandrite-based laser that builds on the company’s existing, well-regarded hair-removal product line. The next-generation GentleLASE PRO has been improved to satisfy patients and better equip physicians by giving them faster treatment times, greater treatment versatility, and enhanced ease of use.

For the practitioner, the upgraded system is convenient, versatile, and offers greater treatment flexibility. For patients, the GentleLASE Pro has been designed for maximum comfort during treatments. For example, it lets physicians provide either DCD or air-cooling depending on patient preferences. It also offers physicians a new benchmark in terms of speed and convenience, featuring unprecedented improvements in uninterrupted treatment delivery.

In addition to representing a total rethinking of the aesthetic industry’s premier laser for removing hair, epidermal pigmented lesions, and wrinkle reduction, the GentleLASE Pro is faster and loaded with advanced features that continue to deliver superior results.

New features include:

  • An enhanced 2-Hz repetition rate without degradation, enabling you to treat more patients in a shorter amount of time.
  • A selection of multiple, lightweight delivery systems and ergonomically enhanced handpieces to minimize operator fatigue and improve treatment convenience.
  • Multiple spot sizes—6-, 8-, 10-, 12-, 15-, and 18-mm spot sizes give the GentleLASE PRO anatomically appropriate spot sizes and greater fluence delivery capabilities.
  • An intuitive touch screen-based user interface that has been redesigned to help you more easily select and save treatment parameters.
  • Variable pulse duration for even greater treatment flexibility.
  • An elegant, smart design with an improved user interface and large touch-screen display.
  • Candela’s patented Dynamic Cooling Device (DCD™), which helps provide practitioners consistent, reproducible epidermal cooling and more consistent treatment results. DCD operates by selectively spraying the upper layers of tissue with a cooling burst of cryogen in adjustable spray/delay durations, milliseconds before and after the laser pulse. DCD’s unique design provides excellent visibility throughout the entire process and avoids the use of messy gels required with some other laser systems and cooling methodologies.

GentleLASE PRO technology allows you to successful treat a variety of conditions, including the following:

  • Hair removal (all skin types)
  • Epidermal pigmented lesions, including sun-damaged skin, age spots, and freckles; and
  • Wrinkle reduction.

The advanced technology and improved capabilities of GentleLASE PRO make it the laser of choice for precise, noninvasive treatments.


Using the advanced features of the GentleLASE Pro, practitioners will be able to provide their patient population with fast, effective, and comfortable treatments in virtually any environment. Reports from the early adopters confirm that the GentleLASE Pro exceeds patient expectations in terms of speed, comfort, and convenience.

With its sleek, lightweight design and small footprint that is ideal for small treatment areas, the GentleLASE Pro system demonstrates Candela’s commitment to earning the trust of physicians and their patients worldwide. Practices and patients alike will benefit from the technological advances that have been built into the new GentleLASE PRO.

Ultimately, it’s all about speed, efficacy, and ease of use. Your patients demand the very best, and the GentleLASE PRO will meet their expectations by providing fast, effective, comfortable, and superior hair-removal results.

Iridex Corp

2323 Terra Bella Ave, Mountain View, CA 94043 (800) 388-4747 www.iridex.com

The Gemini® is IRIDEX’s top-of-the-line laser used to treat 93% of the most common cosmetic indications. Proven technology, product longevity, and clinical effectiveness have made the Gemini the go-to device for many leading physicians.


With two distinct wavelengths to choose from—long-pulse 1,064-nm Nd:YAG and 532-nm KTP—the Gemini offers ultimate versatility for treating a vast array of indications.

The most powerful 532-nm wavelength is ideal for the precision treatment of vascular lesions, pigmentation, cutaneous lesions, and acne.

While using the 1,064-nm Nd:YAG wavelength, the Gemini provides deep penetration and optimizes treatment of leg veins and hair removal. The Gemini’s 532-nm KTP wavelength can be used on skin types I to IV while the 1,064-nm Nd:YAG can be safely used on all skin types.



  • Telangiectasia
  • Rosacea
  • Cherry angiomas
  • Spider angiomas
  • Venous lakes
  • Hemangiomas
  • Port wine stains
  • Neovascularization
  • Leg veins


  • Lentigines
  • Dermatosis papulosis nigra
  • Freckles
  • Poikiloderma of Civatte
  • Melasma
  • Cutaneous lesions
  • Verruca
  • Keratoses
  • Skin tags
  • Acne vulgaris
  • Rejuvenation
  • Dyschromia
  • Skin texture
  • Wrinkles
  • Hair removal
  • Pseudofolliculitis barbae

The system offers 42 available spot sizes in a single integrated system, allowing you to treat more precisely without collateral damage to surrounding tissue. Using computer-assisted settings, an intuitive touch screen interface, and either of two handpieces, practitioners can set the Gemini for the treatment of either large areas or small spots, dialing settings appropriate to each problem and each patient.

For example, you can choose a 10-mm spot size using the system’s VersaStat™ handpiece to effectively treat larger, deeper targets and achieve faster treatment times.

To precisely treat smaller targets, the system can adjust to spot sizes from 1 mm to 5 mm using a VersaStat adjustable handpiece.


Handpieces come with unique parallel cooling, which protects skin continuously by cooling before, during, and after each pulse for optimal epidermal protection. This not only provides comfort for the patient during treatment, but also decreases the risk of redness and swelling post-treatment.


In a split-face, single-blind, controlled, comparison study, Uebelhoer et al compared the pulsed-dye laser to the use of the Gemini for the treatment of facial telangiectasia.1


  1. Uebelhoer N, Bogle M, Stewart B, Arndt K, Dover J. A split-face comparison study of pulsed 532-nm KTP laser and 595-nm pulsed dye laser in the treatment of facial telangiectasias and diffuse telangiectatic facial erythema. Dermatol Surg. 2007;33:441-448.
532-nm KTP Advantages
  • Optimal pigment absorption enables exceptional pigment and vascular results
  • Industry’s largest 532-nm KTP spot size promotes superior speed and penetration
  • Purpura-free treatments
1,064-nm Nd:YAG Advantages
  • When combined with epidermal cooling, precise spot size selectivity enables superb leg vein results
  • Deep, safe heating for well-controlled dermal injury encourages skin tightening and wrinkle reduction
  • Superior skin-rejuvenation results
  • Target hard-to-treat lesions with a precision spot, before treatment of the greater area
Photon Recycling
  • Unique photon recycling process redirects scattered energy back into the tissue
  • Increases energy efficiency for improved photorejuvenation

Sciton Inc

925 Commercial St, Palo Alto, CA 94303 (888) 646-6999 www.sciton.com

A female patient before (top) and 4 months after (bottom) Contour TRL treatments.

Sciton Inc’s Contour TRL (Tunable Resurfacing Laser) is a significant breakthrough in the development of the dual-pulse-mode Erbium laser, providing physicians with a sophisticated full-field skin-resurfacing solution.

Contour TRL decouples ablation and coagulation, and allows for precise application of each. Practitioners can dial in the exact tissue effect needed for each patient’s pathology, desired outcome, and tolerance for downtime.

From a shallow MicroLaserPeel® (up to 50 µm of ablation) to deep resurfacing (up to 200 µm of ablation per pass, with or without variable depth coagulation), the Contour TRL gives the physician exquisite control over surgical outcomes.

It achieves roughly from 4 to 200 microns of clean vaporization while at the same time zero to more than 125 microns of coagulation in a single pass; the physician can independently control each of these two variables.

The system will improve the outcomes of facial plastic surgery by targeting the central part of the face, improving skin color and texture, and eliminating perioral/periorbital wrinkles.

MicroLaserPeel®—A minimal-downtime, light resurfacing treatment limited to the epidermis that evens out skin tone, texture, and color.

ProFractional Therapy™—A minimal-downtime treatment that creates micro-ablated channels deep into dermal tissue (to treat a variety of pathologies and stimulate new collagen growth), surrounded by islands of untreated skin (to promote rapid healing).

Deep Resurfacing—A more aggressive procedure that literally erases wrinkles, pigmented lesions, and other skin irregularities in the epidermis and dermis.

The Contour TRL can be used with a short ablative pulse or with a variable or long pulse. In its variable pulse mode, the device imitates the thermal damage created by CO2 lasers. In practice, the thermal damage can be applied where needed to tighten skin, but not at the amounts produced by CO2 lasers, thereby avoiding complications such as hypopigmentation.

Research has shown that the side effects common with CO2 lasers (hypopigmentation and prolonged erythema) are caused by thermally induced inflammation and tissue necrosis. This will always be a concern for physicians when using CO2 resurfacing technology, because there is no way to separate the heat from the ablation.

Sciton’s resurfacing lasers are different—you can ablate with virtually no heat deposition because of extremely high-energy absorption in water. Therefore, the side effects common with other technologies are rarely observed with a Sciton laser, even in very deep treatments.

In addition to providing more precise treatments than other resurfacing approaches, the Contour TRL is safer for the patient’s face and body, treats more skin types, and provides shorter recovery times as well as consistent, predictable results.

The Contour TRL’s indications include the following:

  • Deep wrinkles (even in difficult-to-treat areas like around the mouth and eyes);
  • Solar spots;
  • Actinic keratosis; and,
  • Poor skin tone/texture.

  • Deep wrinkles, fine lines, perioral and periorbital rhytides
  • Actinic keratosis
  • Pigmented lesions; and
  • Poor skin tone and texture.

For complete fractional resurfacing applications, the ProFractional module can also be added to systems with a Contour TRL. Furthermore, by adding BroadBand Light (BBL) and SkinTyte, physicians can offer their patients unique combinations using a single system.

The ProFractional solution can achieve excellent resurfacing results with minimal downtime. Unlike full-field resurfacing, which removes the entire surface area of a treatment site, ProFractional ablates narrow-diameter channels into the skin, covering a fraction of the total treatment area.

This action initiates the body’s wound-healing response, which stimulates fibroblasts to produce new collagen and elastin while leaving the surrounding tissue intact for rapid healing. The benefits of ProFractional include increased patient comfort, shorter healing times, and tunable results that can range from subtle to dramatic.

Ulthera Inc

2150 S Country Club Dr, Suite 21, Mesa, AZ 85210 (877) ULTHERA www.Ulthera.com

Prior to Ultherapy treatment. (left) Ninety days after Ultherapy treatment. (right)

Ulthera offers the first and only energy-based device for aesthetics to receive an FDA-approved indication for noninvasive lifting. The Ulthera System™ uses micro-focused ultrasound to target not only dermal tissue, but also deep subdermal structures such as the SMAS to measurably lift skin. The technology is also unique in combining DeepSEE™ ultrasound imaging with energy delivery, so physicians can visualize the precise tissue layers being targeted for treatment.

Because it uses micro-focused ultrasound instead of traditional light or radiofrequency (RF) energy-based approaches, the Ulthera system has created an entirely new category of device. “Ultherapy goes deeper, providing a different dimension to rejuvenation,” says Manhattan, NY-based facial plastic surgeon W. Matthew White, MD. “Unlike traditional lasers and RF devices of the past, Ulthera is able to deposit ultrasound energy at very precise depths, creating independent Thermal Coagulation Points (TCPs). In addition, those TCPs reach a precise temperature (65°C to 75°C) in the therapeutic zone, which leads to aggressive neo-collagenesis in the deep soft tissues and ultimately produces a lift from below.”

Another benefit of using micro-focused ultrasound is that energy is delivered precisely to a single point below the skin’s surface, leaving intervening tissue unaffected. This makes Ultherapy extremely safe and allows patients to see significant results in just one treatment. More patients are willing to undergo the procedure because it doesn’t have the complications or downtime associated with other energy-based devices.

“Ultherapy treats facial laxity without surgery, and nothing else does that. This is tailor-made for the large market composed of patients who may not need or want surgical intervention, but still want results,” states Wisconsin-based facial plastic surgeon Andrew C. Campbell, MD.

By treating the underlying facial tissue (SMAS) as well as the dermis, Ultherapy represents an entirely unique approach to rejuvenating the aging face. Practitioners can offer Ultherapy as an alternative treatment that allows patients to postpone facial surgery or, for younger patients, to delay the clinical onset of ptosis. It also provides a means for secondary corrections of unsatisfactory surgical results that may be technically challenging for surgical revision.

“I’ve tried other technologies purported to serve this segment of the patient population, and the results were underwhelming at best. Ultherapy is remarkably consistent in that it regenerates collagen in everybody; in that sense, there are no nonresponders,” Campbell says.

Ultherapy is also an excellent opportunity for physicians to expand the reach of their practices. “Ultherapy has been a gateway treatment for my practice,” White says. “It quadrupled new patient traffic, which we’ve been able to maintain, giving people an opportunity to see the spectrum of my expertise. About 90% of them undergo some type of procedure, so Ultherapy has grown other aspects of my practice such as facial injectables and even facelifts. It paid for itself within a few months. Ultherapy has also given me a chance to build relationships with my patients. They come in, we get to know each other, they see results they can get excited about, and that patient stays in my practice. It’s very rewarding.”

Ultherapy has also been successfully integrated into the aesthetic offerings of plastic surgeon and educator Gordon Sasaki, MD, of Pasadena, Calif. In his practice, Sasaki frequently combines Ultherapy with a variety of other aesthetic procedures, from dermal fillers and neurotoxins to light-based therapies, recommending that Ultherapy be performed first.

“Treatment in our office takes approximately 45 minutes,” Sasaki says. “Pain can be easily managed to ensure the safe and tolerable delivery of therapeutic energy levels. Side effects are minimal and transient. The duration of response after a single treatment is estimated to last about 1.5 years.”

In addition to the clinical and practice-related benefits of using the Ulthera system, White is very pleased with the support offered by the manufacturer. “Ulthera has done a great job promoting this nationally,” he states. “Once it was featured on the larger talk shows, our phones were ringing off the hook and have continued to do so.”

The Ulthera system has allowed physicians to achieve previously unattainable noninvasive clinical results, without patient downtime or complications. It also helps physicians expand the reach of their practice, since Ultherapy treatments complement other services already being offered. With its many benefits, Ultherapy has truly become a new dimension in facial rejuvenation.

More Coverage On The Web!

The Truth About Laser Lipolysis” (March 2011). What the technology can and cannot do, and why.

Hair Today, Gone Tomorrow” (November 2010). Yael Halaas, MD, on the fine points of baldness in females.

Striving for the Bust” (February 2010). State-of-the-art views of a veteran of the art of body contouring.

Laser Hair-Removal Technologies” (October 2009). The new gold standard is found in radio frequency-based devices, and the diode laser-based device is best for light skin, according to our expert.

Body Contouring Comes of Age” (November 2009). Spotlighting five major firms with the latest technologies.

Surgical Strategies for the Body” (May 2005). How to select the right procedure from a wide spectrum of surgical options.

PSP Body Contouring Podcast Series” (September 2008). An in-depth discussion of new technologies and the use of liposuction in body contouring.

More Than Just Skin Deep” (August 2007). For massive-weight-loss patients, recovery encompasses not only physical but also psychological and behavioral aspects.

PSP Laser- and Light-Based Technologies Podcast Series” (July 2009). A lively discussion on how to buy and sell a laser, as well as support-related concerns.