The Aesthetic Guide Primary Care Edition Autumn 2009 : Page 1

Autumn 2009 Circulation 25,000 www.miinews.com This past year has challenged the aesthetic industry, with reduced consumer spending resulting in dramatically lower rev- enues for many practices. Declining practice incomes have, in turn, resulted in lower physician spending for advertising, pro- motion, supplies and equipment.Manufacturers of high-priced aesthetic devices have been particularly hard hit, with most experiencing double digit sales declines. However, things are turning around and, according to more than 150 physicians responding to the Aesthetic Practice Survey, conducted by THE Aesthetic Practice Association (Aliso Viejo, Calif.), pur- chasing of aesthetic systems should rise over the next 12 months as practitioners experience an upswing in patient bookings. continued on page 3

Early Recovery Predicted For Aesthetic Industry

This past year has challenged the aesthetic industry, with reduced consumer spending resulting in dramatically lower revenues for many practices. Declining practice incomes have, in turn, resulted in lower physician spending for advertising, promotion, supplies and equipment. Manufacturers of high-priced aesthetic devices have been particularly hard hit, with most experiencing double digit sales declines. However, things are turning around and, according to more than 150 physicians responding to the Aesthetic Practice Survey, conducted by THE Aesthetic Practice Association (Aliso Viejo, Calif.), purchasing of aesthetic systems should rise over the next 12 months as practitioners experience an upswing in patient bookings.

Respondents represented the bread and butter of the aesthetic industry: small to mid-sized practitioners with 15 or fewer employees, less than five nurses and one or two physicians who have been in practice for one to ten years.

Most survey respondents were dermatologists, plastic surgeons or family physicians with a weekly patient volume of 20 to 40 aesthetic clients. BOTOX from Allergan (Irvine, Calif.), dermal fillers and light-based skin rejuvenation were most widely offered, followed by lightbased hair removal, chemical peels and microdermabrasion.

Over the past 12 months, 55% of respondents have added new aesthetic products or equipment. Of these, device based skin rejuvenation was added most often, followed by device based skin tightening and physician-dispensed cosmeceuticals.

Moreover, 72% of respondents plan to add new products or services to their practice in the coming 12 months. This indicates a sense of optimism and suggests rising patient volumes, if not currently, then in the near future.

Less than half of survey respondents now offer device based body shaping, as shown in Figure 1.

However, over the next 12 months, 33% plan to begin offering it, as shown in Figure 2. New skin rejuvenation devices, skin tightening equipment and dermal fillers also ranked high on the list of treatments that respondents said they would be bringing into their practices.

Many survey respondents cited a need to keep up with industry trends and remain cutting edge as key reasons for expanding; in each of these market segments, new product activity and manufacturer promotion has been strong, resulting in rising awareness of new products and technologies among both physicians and consumers. Smartlipo from Cynosure (Westford,Mass.), for example, has been extensively featured throughout the U.S. on more than 300 news and lifestyle programs.

Interestingly, this intention among physicians to increase their investment in new products and equipment is occurring despite rising price sensitivity among patients. More than 75% of respondents said that their patients have become more cost conscious and almost half noted that patients are scheduling less frequent retreatments.

Over 30% of respondents said more of their patients now prefer treatments that don’t require retreatment at all.

In addition to asking respondents about overall purchase plans and patient trends, the survey also zeroed in on user satisfaction with different products and devices. Among practices offering light-based hair removal, for example, the most commonly used device was the LightSheer from Lumenis (Santa Clara, Calif.), with almost onefifth of respondents saying that this was their primary laser hair removal system.

LightSheer was also believed by most respondents to be the best for lightbased hair removal, with many practitioners, who don’t even own the device, citing it as the best for this use.

LightSheer was referred to as a “workhorse that creates no pain and is very fast on most hair and skin types.” For light-based skin rejuvenation, many different devices were used, but satisfaction was especially high with ProFractional from Sciton (Palo Alto, Calif.). Approximately 11% of respondents believe that ProFractional is best for light-based skin rejuvenation even though just 6% have actually used it.

“ProFractional appears to produce equivalent results to a CO2 without prolonged downtime and can also be used on many different skin types,” said one respondent.

Similarly, respondents used a wide variety of devices for light-based treatment of vascular lesions, many of which were not optimized for that application.

Vbeam from Candela (Wayland, Mass.)

Was cited by several as offering “quicker effacement in fewer sessions than other systems.” In clinical studies, treatment with the Vbeam pulsed dye laser resulted in a 70% reduction of smaller telangiectases with just one treatment session, although other studies have demonstrated similar efficacy in vein treatment with a pulsed dye laser compared to StarLux from Palomar Medical Technologies, Inc. (Burlington, Mass.). Although it remains a smaller application, light-based treatment of acne is rising in popularity as practitioners use multifunctional equipment such as eMax, eLight and eLaser from Syneron (Irvine, Calif.), Palomar’s StarLux, Harmony from Alma Lasers (Buffalo Grove, Ill.) And Isolaz from Aesthera (Pleasanton, Calif.) For treatment. A clinical study titled Treatment of Acne with Photopneumatic Therapy published in the March 2009 issue of the Journal of Drugs and Dermatology found an 88% reduction in papular, pustular, comedonal and nodular acne after four Isolaz treatments, without any of the side effects associated with systemic medications such as Accutane from Roche Pharmaceuticals (Nutley, N.J.). Skin tightening also continues to expand, with ThermaCool from Solta Medical, Inc. (Hayward, Calif.) Used by 40% of survey participants. Users noted that, “ThermaCool produces great, predictable results,” although other devices such as AccentXL from Alma Lasers and StarLux were also cited. In fact, the plethora of devices used for skin tightening now includes Candela’s QuadraLASE, a CO2 laser launched in early 2009 that incorporates an innovative scanning system giving practitioners a total solution for treating uneven skin tone and texture, sun damage, acne scarring, the removal of skin tags, benign lesions and more.

Candela is also marketing QuadraLASE for skin tightening, which it says is accomplished by treating wrinkles.

For light-based treatment of pigmented lesions and tattoos, the MedLite C3 and MedLite C6 from HOYA ConBio (Fremont, Calif.) Were used by one-quarter of survey respondents, making them the most popular devices for this procedure.

In addition to addressing pigmented lesions and tattoos, the MedLite C6 can also remove unwanted facial and body hair. By doubling the power output and adding two additional wavelengths – 585 nm and 650 nm – the system is able to effectively target pigment in the hair follicle. This also enables removal of a wider-range of tattoo colors, including Black, red and green ink. This is important, since many tattoos are multi-colored.

However, survey respondents also noted that, “there is not a perfect laser for pigmented lesions and tattoos.” BOTOX was used by a very high percentage of survey respondents – 81% – with the vast majority quite satisfied with results. However, 54% said that they either have tried or will try Medicis’s (Scottsdale, Ariz.) New Dysport, mainly to see how well the product compares with BOTOX. “I want to see if there is a difference between the two products and be able to offer it if a patient asks for it,” said one respondent.

Dysport was launched in the U.S. on June 15, 2009 as the first direct U.S. competitor to BOTOX. Allergan has responded with a popular rebate program, wherein BOTOX patients can receive $25 off their next treatment.

This has helped build customer loyalty, particularly in a weak economy and when many consumers are re-evaluating their spending habits. Many physicians are also reluctant to incur additional costs related to Dysport training and explaining the differences between products to patients, especially when they don’t perceive a clear difference between the two products.

Among dermal fillers, Juvéderm from Allergan was used by more than 80% of survey respondents, with several saying that patients specifically asked for this product. Juvéderm has been FDA approved to market for wrinkle reduction lasting up to one year, and many practitioners say that for some patients, results can last even longer.

Restylane from Medicis followed with about 71% share among survey participants and Radiesse from BioForm Medical, Inc. (San Mateo, Calif.) Was third with 60%. A number of respondents said that they try to limit their usage of new dermal filler materials, since one or two usually cover the full spectrum of patient needs.

Just 20% of survey respondents used Sculptra from sanofi-aventis (Bridgewater,

N. J.), despite the product’s recent FDA clearance for the correction of shallow nasolabial folds and long lasting results.

In a randomized, comparative, evaluator- blinded, parallel group, multi-center study of 233 patients, Sculptra treatment effects were maintained up to 25 months after the last treatment session, while the collagen used in comparison was effective only up to three months.

In the fragmented microdermabrasion market, survey respondents were particularly satisfied with treatment results, with most believing that the equipment they owned offered the best results available. Almost 15% use Parisian Peel from Aesthetic Technologies, Inc. (Golden, Colo.) And another 10% use Ultrapeel from Mattioli Engineering (McLean, Va.). Many devices received praise, and one respondent stated that, “my DermaSweep system from DermaSweep / Cosmetic R & D, Inc. (Roseville, Calif.) Has never broken down once.” Microdermabrasion continues to represent a mainstay of aesthetic treatment, both as a stand-alone solution for mild skin damage and in combination with laser, intense pulsed light or other skin rejuvenation procedures to optimize results.

Although they weren’t used as often as ThermaCool, or VelaSmooth and VelaShape from Syneron, ProLipo from Sciton and SlimLipo from Palomar were among the best regarded body shaping devices. Approximately 3% of survey respondents use ProLipo but 6% believe it to be the best body shaping system; similarly, 3% use SlimLipo but 8% think it is the best for body shaping.

VASER from Sound Surgical Technologies (Louisville, Colo.) Also received high marks, with 6% of respondents using it but 8% saying it was the best body shaping device.

“With VASER, the true definition of body shaping can be achieved,” noted one physician.

While many physicians have postponed the purchase of new light-based hair removal or skin rejuvenation systems, they are continuing to invest in body shaping devices. In fact, this segment is seeing a proliferation of technologies, as new companies emerge to offer consumers a means to both eliminate small, stubborn fat deposits as well as larger pockets of fat. With rising rates of overweight and obese people around the world and no pharmaceutical or other alternatives that can quickly and easily remove fat, body shaping devices are uniquely able to address a large and growing concern. As a result, most of the leading device makers either offer or are developing laser lipolysis systems and many emerging players are introducing radiofrequency, ultrasound, acoustic wave and other body shaping systems.

The survey also underscored the growing importance of physician-dispensed cosmeceuticals, with 79% of respondents saying that they sell products from their practices. Leading lines include Obagi (Long Beach, Calif.), sold by 38% of respondents; SkinCeuticals (Garland, Texas), sold by 34%; and Allergan products, sold by 31%. Product satisfaction is extremely high, with more than 90% of respondents saying that they and their patients are either satisfied or very satisfied with the products they sell. This suggests growth in the coming months for physician-dispensed skincare products.

Eyelash enhancement products, such as Latisse from Allergan and RevitaLash from Athena Cosmetics (Henderson, Nev.), will contribute to strong growth as consumers are able, for the first time, to increase the length and thickness of their original eyelashes. Though much of the sales benefit from the dozens of new brands will accrue to Internet merchants, drug stores, specialty stores and others who retail these products, physicians are increasingly selling these products to patients from their offices and therefore will participate in this market, which in total sales is expected to exceed $500 million by 2013.

Growth for breast implants, however, will slow significantly. While this segment was previously expanding at a compound annual growth rate of 7.6% per year, growth will decrease to just

3. 7% per year. Like other relatively high priced plastic surgery procedures, breast implants are suffering from decreased consumer spending. Although many plastic surgeons have begun offering special pricing and/or procedure financing, in addition to implants remaining a highly desirable treatment, consumers are nonetheless re-thinking large discretionary expenditures and many are postponing or altogether forgoing such procedures.

These survey results were incorporated into, and fully consistent with, the findings of Medical Insight’s Global Aesthetic Market Study VII (GAM VII), a 500 page report updated twice yearly that tracks sales, companies and technologies across nine key product areas.

Covering lasers and light-based devices; skin tightening systems; emerging devices such as oxygen therapy, micro current and lymphatic drainage; neuromodulators; dermal fillers; body shaping equipment, including liposuction tools and body contouring devices; breast implants; and physician-dispensed cosmeceuticals, GAM VII estimates that total industry sales of $4.3 billion in 2008 will expand by 7.5% per year to reach $6.1 billion in 2013.

This is lower growth than predicted in GAM VI, a study released just six months earlier that estimated five year growth of 11.7%. However, it is still a bright spot since, despite rising unemployment and decreased consumer spending, the industry is continuing to expand while many other sectors such as housing and financial services remain flat or are contracting.

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