Robot injectors.
(Let that sink in for a sec.)
This is just one of the far-out—yet entirely feasible—concepts that wowed us while reporting on the aesthetics industry’s most compelling in-the-pipeline technologies. While it will likely be years before we see AI-guided bots pushing needles in American doctors’ offices, carefully calibrated robotic arms engineered for this purpose are currently being developed by a French tech company (and preclinical studies are underway). The innovation “takes humans—and, I suppose, human error—out of injecting, but in doing so, it also takes the art out of injecting,” says Dr. Arisa Ortiz, a board-certified dermatologic surgeon in San Diego. Still, the concept is “very sci-fi,” she notes, and undeniably fascinating.
In the U.S., the horizon is bright, with hyperprecise machines and injectables promising thicker hair, tighter skin, safer shots, and maybe even the next big thing in body contouring. While some of these innovations are still in the early stages of testing and tinkering, others are inching ever closer to FDA approval. Here are five high-tech tools poised to take over the (aesthetics) world.
A smart needle aiming to prevent filler complications
Fillers, like Restylane and Juvéderm, are commonly portrayed as a quick fix for deflated faces and wanting features—but experts intimately acquainted with the gels and their anatomical targets know there’s nothing casual about injecting into the vascular terrain of the human face. “When doing injectables, the big concerns are blindness and vascular occlusion,” says Dr. Ortiz. If filler enters an artery, it can block blood flow to the skin, the retina, even the brain—a very rare but real risk doctors refer to as vascular compromise. While they do everything possible to prevent it, the potential for catastrophe always looms heavy.
Enter Blossom Innovations. The Boston biotech company has developed the industry’s first smart needle (currently dubbed S3Inject), “which can detect when it’s inside an artery, and in real time, give feedback—it either lights up or sends an alert to your phone or watch, whatever it’s connected to—warning you not to inject, so that you can stop and reposition [the needle],” explains Dr. Ortiz.
Along with board-certified Boston dermatologist Dr. Mathew Avram, Dr. Ortiz learned about the smart needle while cochairing the Shark Tank Aesthetic Innovations Forum at the IMCAS World Congress, a global aesthetics meeting held in Paris this past January. The smart needle won first prize, beating out 29 other game-changing hopefuls. “It could prevent serious adverse filler events, such as blindness and stroke,” notes Dr. Avram. While Blossom is still fine-tuning the tech, Dr. Ortiz expects the smart needle to “become standard of care” once available.
A fat-freezing injectable for body contouring
Dermatologists at Massachusetts General Hospital (MGH) may have discovered a way to one-up the fat-eradicating effects of CoolSculpting (which was invented by the same MGH lab). Think of it as a slushy in a shot: “We’ve already learned that cooling at certain temperatures can cause fat destruction,” says Dr. Avram, who alerted us to the discovery. “The idea here is that by directly injecting fat with this formulation of glycerol and saline at a particular temperature, we can destroy fat locally, without harming the surrounding tissues.”
For a study published in Plastic and Reconstructive Surgery, researchers led by board-certified Boston dermatologist Dr. Lilit Garibyan injected the slurry (at -4.8ºC) into the subcutaneous fat of pigs and noted a 55% reduction in the fat layer after a single treatment compared to control sites treated with a melted mixture of the same ingredients. (They used ultrasound imaging, photography, and histology to measure and monitor subjects before the injections and for up to eight weeks after.)
“In swine, we observed dents in the skin denoting loss of fat within four weeks after injection,” Dr. Garibyan explains. “We believe the fat cells undergo apoptosis [or cell death] and are cleared by the body.”
Researchers also saw collagen formation with treatment “that could contribute to tissue tightening through tissue remodeling,” the study notes.
While the injectable is thought to work much like CoolSculpting—crystallizing and killing fat cells—investigators note some clear advantages to the shot. “This work needs to be tested in humans to know the exact outcomes, but based on the swine data, we predict that the slurry injection will allow for more targeted fat removal from any site accessible by a needle,” says Dr. Garibyan, who has been working on this project since 2013 and anticipates that human trials will start within the next year or two. “We also predict it will be a faster treatment, as it will take minutes to inject a slurry versus 45 to 60 minutes of CoolSculpting.”
Since the cooling is delivered directly into the target tissue, she expects the injectable slurry to be more effective than CoolSculpting. It should also be able to treat a broader range of areas.
The icy shot didn’t cause any scarring or damage to skin or muscle in the areas treated during the swine study. Since human trials are still pending, “it’s too early to assess those potential risks” in people, notes Dr. Avram. If the injectable eventually wins FDA approval, doctors predict it will be an in-office treatment performed under local anesthesia.
A nonsurgical face-lifting machine
Meet the IMCAS Shark Tank runner-up: a micro-coring device from Cytrellis Biosystems that’s been shown to physically remove 5–8.5% of facial skin during treatment, firming the skin and smoothing wrinkles—all without surgery, explains Dr. Jason Pozner, a board-certified plastic surgeon in Boca Raton, Florida (who is both an investor in and consultant on the tech). Modeled after fractional lasers, the tool punches out hundreds of tiny cylinders of tissue using “22-gauge needles that act almost like a sewing machine,” he adds—but no energy is applied to the skin.
It’s this absence of heat that gives the face lifter its unique powers. “With fractional ablative laser resurfacing, we see some skin tightening but not as much as you’d think, given that we’re ablating 50% of the tissue,” says Dr. Ortiz. “The reason for that is, the laser causes heating and coagulation around the channels [that it creates in the skin], which prevents them from closing—and limits potential skin tightening.” (During healing, those vaporized channels fill in with new skin and collagen, to help with texture and wrinkles.) Cytrellis forgoes heat, instead drilling holes in the skin that gradually close without scarring. “We know that if you stay under 500 microns, there’s no scarring in the skin, visibly or on histology [microscopically],” she adds. “By not using heat, these holes are allowed to cinch closed—and this causes contraction of the skin,” for an obvious tightening effect.
Skin tightening has long been considered a sort of last frontier in nonsurgical treatments—which is why some dermatologists and plastic surgeons are calling micro-coring a breakthrough. Is it a true substitute for surgery though? Not so much. “It doesn’t treat the same amount of tissue or offer the same effect as a facelift,” notes Dr. Avram. While the device does permanently excise an impressive portion of skin, it has zero effect on the underlying muscle layer, which is routinely trimmed and tacked up during facelift surgery in order to create the most natural and lasting results.
The micro-coring procedure reportedly takes less than 30 minutes and incurs only a few days of downtime (primarily, for redness and swelling). “Cytrellis has performed multiple studies, and the results of those studies will be submitted to the FDA for device approval sometime in 2020,” adds Dr. Pozner.
A growth-factor shot that grows new hair
PRP scalp injections turn on hair follicles, using the platelets found in one’s own blood. While the treatment has become a social media sensation of late, it often comes with disclaimers warning that the Vampire spin-off may not work for every person or every type of thinning. Promising greater predictability is a new hair-growing injectable, currently called HSC, being developed by the regenerative medicine company Histogen.
“PRP contains four growth factors that are mostly associated with supporting new blood flow and blood vessel growth,” says Dr. Craig L. Ziering, a board-certified hair restoration surgeon in West Hollywood, California. Since “there’s variability between patient preparations, the hair growth data varies as well. To my knowledge, a controlled, blinded clinical study against a placebo has not been conducted for hair growth with PRP, so it’s not possible to know the true patient response.”
According to Dr. Ziering, who was an investigator on the HSC proof-of-concept study and has since conducted an independent trial of the product, the data conducted thus far on HSC shows that the formula “contains over 100 growth factors—including ones that are specific to stimulating stem cells and stimulating the cells that actually form the new hair—and that it has great reproducibility, which is key in any treatment.”
It’s the growth-factor procurement process that’s said to make HSC revolutionary. “We place highly tested newborn fibroblast skin cells on specialized beads made of starch, then surround the beads with a nutrient solution that helps the cells to grow and secrete the growth factor solution, which we collect every day and concentrate,” explains the company’s founder, Gail K. Naughton, PhD, a leading stem cell scientist and inventor of the growth factor blend in SkinMedica’s cultish TNS serums. “By growing the cells under low oxygen and in suspension—conditions that mimic the environment of the womb—the [resulting] growth factor solution is very embryonic-like and has been shown to stimulate stem cells in the body.”
Of the myriad growth factors released, six are most critical to hair growth. Follistatin activates the stem cells, she notes, while KGF (keratinocyte growth factor) causes the cells composing the upper layer of skin and hair “to migrate into the hair shaft and either convert a baby-fine vellus hair into a thicker hair or form a new hair altogether.” The other four factors encourage blood vessel formation and increase blood flow and are equally essential, since “having enough nutrients coming to the hair follicle [via circulation] is key to the hair growth process.”
The formula is currently in clinical trials, and to date, most of the company’s data comes from men. In the first study, Dr. Ziering explains, 26 men with androgenetic alopecia received four injections of HSC on one side of their front scalp and four injections of placebo on the other side. “The HSC treatment sites showed a statistically significant increase in hair shaft thickness and terminal hair density at 12 weeks and a continued increase in the total number of hairs at one year”—with 85% of the men seeing a positive response in hair growth. In Dr. Ziering’s follow-up study of five men and five women with hair loss, subjects received 120 injections over 18 weeks, and all showed new growth by 24 weeks—whether they were experiencing post-/perimenopausal hair loss, chemical shocking of the hair follicle, or diffuse hair loss, he says.
In the studies, he adds, the product worked all over the scalp, including the notoriously hard-to-treat temples, “where nothing outside of transplantation has been effective.” Subjects reported little or no pain (thanks to the use of short, small-gauge needles that penetrate only two millimeters into the scalp), and the primary side effect was minimal, short-lived itching.
“If the upcoming dosing studies in men continue to demonstrate the same safety and efficacy seen to date, I believe that HSC will be a breakthrough,” says Dr. Ziering. “Unlike current products approved by the FDA for hair growth, which need to be used once or twice daily—and if you stop, you have great hair loss within two weeks—HSC has long-lasting results.”
A device that freezes away sunspots
Heat is a notorious double-edged sword in the fight against discoloration. Dermatologists routinely use lasers and light-based devices to vaporize sunspots and splotches, but in folks with highly reactive melanocytes—those with deep skin tones, typically, or conditions like melasma—that “solution” can backfire, triggering more pigment to bloom in the long run.
Set on solving this dilemma, R2 Technologies is investigating a dermal cooling system, which “uses controlled, precise cooling to lighten sunspots, with no downtime and a lower risk of hyperpigmentation,” explains Dr. Ortiz, who coauthored a small company-sponsored study on the device last year. “The technology is based on liquid nitrogen, which is an old-fashioned way to remove pigment,” she notes. This new tool, however, would offer far more control than the classic cryospray, allowing doctors to set specific temperatures and treatment durations.
In the study, most subjects saw improvement of flat to slightly raised sunspots about one month after treatment. Typically, “the spot gets a little pink [right away], and then, 20 minutes later, it looks like nothing happened. It typically takes three to four weeks for [the spot] to lighten,” notes Dr. Ortiz, but more than one session may be needed. For those who prefer one-and-done spot removal, derms can deliver a stronger treatment—but healing may be more noticeable. “The spots look darker and typically wipe away after about four days,” says Dr. Ortiz, much like they would following certain laser treatments.
