Let us take a look at the history of development in the field of lifting and tightening treatments in Japan.
Cool Touch and Nlite, etc. were introduced around 2000, enabling treatment of wrinkles or sagging that had been difficult to tackle with non-surgical treatments. However, the efficacy was limited and unsatisfactory. Thermage, which was developed later, caused less problems and pain than previous methods and became widely popular in Japan. The number of Thermage devices in Japan came to match that of the US. Nd:YAG laser, near infrared or various RF devices have entered the market to offer painless treatments with subtle effect. From this time, many plastic surgeons as well as dermatologists have ventured into the aesthetic market. These devices also became wide spread in Japan.
The advent of fractional laser with Fraxel opened a new chapter of skin rejuvenation. The fractional CO₂laser that followed offered better efficacy. However, due to downtime, it is used mainly in acne treatment and its skin tightening effect is not readily accepted. Currently, CPT, the third generation Thermage, is vastly more popular that its predecessors. The Ulthera system is also being wide spread due to its excellent lifting effect despite severe pain. However, the popularity of these devices still falls far behind that in Korea. Devices with similar effects are rarely seen in Japan.
[Advertisement] FCR® (Fractional Prickle CoralCalcium Regentron) – Manufacturer: (www.illglobal.com)]
The most widely used filler material hyaluronic acid. Some doctors like to use hydroxyapatite Radiesse. Others like AteloCollagen containing bovine collagen produced in Japan. I use all three for differing purposes. Each product has unique advantages and one treatment cannot tackle all indications.
Global trends in minimally invasive treatments are moving from injections for local volumizing effect toward contouring the entire face. This shift was based on the improvement of anatomical knowledge of the facial volume change and sagging with age. However, the injection method is still not wide spread in Japan as there still exists aversion to filers. Methods that cannot be described as lift are still the mainstream.
The use of botulinum toxin is limited to the glabella wrinkles. The intradermal injection with lifting action is used by only some specialists. Thread lift is not readily accepted by the Japanese patients due to pain and fear of foreign body. Only a few doctors including myself specialize in the thread lift.
From the next article, I will discuss each of the above procedures in greater detail; HIFU (face), radio frequency, filler and botulinum toxin, and short thread].
Currently, the most widely used procedures involve use of laser devices. Most private practices focus on treatment of diseases with insurance coverage and carry out simple treatments that can sometimes be delegated to nurses. Patients prefer this and doctors are not willing to venture into high-risk procedures as the competition is less fierce. In Japan, it is common to see community clinics offering aesthetic procedures as part of supplementing income from insurance reimbursements. Doctors at these clinics sometimes see dozens to even 200 patients a day. These doctors are not specialists of aesthetic medicine. They only perform the simplest procedures that entail few side effects. Patients are quite satisfied with this.
The most widely used devices are Cutera’s Genesis that irradiates high Hz Nd:YAG laser, radio frequency devices that heat gradually and is less painful (Tenor, Exilis, Pelleve, and Maximus, etc.), RF ＆IPL (e-light·e-max·e-plus), as well as near infrared (Titan). However, photomedical device treatment has limited efficacy. As for lifting, the change occurs only within 5mm from the surface where the subcutaneous fat lies and there is no effect on the deeper layers where aging changes set it. The tightening effect is not as drastic as surgery either.
An effective lifting and tightening treatment uses combination of surgical and various non-surgical methods. Lifting alone does not complete a youthful look and skin tightening alone brings only subtle changes. Comprehensive consideration of facial bone atrophy, deep fat reduction, epidermal fat sagging and volume change, skin relaxation and thinning, etc. is needed for realizing a youthful, attractive face. Lifting and skin tightening are important aspects of this comprehensive approach but they alone do not solve all problems. In the future, we will see new treatment techniques that address all these goals at the same time.
-To be continued-
