|
Let's face it: we're getting older.
But just because we're aging doesn't mean we have to
look the part – especially since cosmetic medicine is undergoing a
remarkable technological renaissance, which makes the old days of face lifts
and liposuction look like bloodletting with leeches by comparison.
The shift also represents a remarkable opportunity for
investors, as demographics and technology collide to revitalize a market.
The Older We
Get…
Not only is each of us individually aging, of course,
but so is US society as a whole. According to the Census Bureau, the median
age in the US today is over 37 years, compared to about 29 years back in
1960.
And today, thanks to dropping birth rates and the
continual aging of the baby-boomer generation, there are now more seniors as
a percentage of the population than ever before. The proportion of the US
aged 62 years and over is now 16.2%; it was less than 12% in 1980. Today,
there are 40 million people in the US aged 65 and older; and this figure is
projected to more than double to 89 million by 2050.
That's partially because we are all living much longer
than we once did. Thanks to advancements in medicine and a higher overall
standard of living, the average person born in the US today can expect to
live to about 79, according to the CDC. That number was just 70 in 1960 and
60 in 1930.
This is much more than just a US phenomenon. It's a
firmly established trend taking place throughout the world. In 1970, the
world's median age was 22.1. That figure has climbed nearly 30% in the past
four decades to 28.4.
For those of us who enjoy life, this is, of course,
good news. But our vanity can often cause us to see it as a double-edged
sword of sorts. With age comes some obvious
drawbacks – wrinkles and fat deposits in unwanted places, to name a
couple. In other words, many of us want to live longer lives, but we don't
really want to look the part.
And many of us are willing to spend big bucks to keep
that trim, youthful appearance.
Traditionally, however, plastic surgery has been the
realm of scary, often dangerous procedures, limiting its appeal to only the most
desperate or risk tolerant among us. While plastic surgery was big business,
its total market was capped by our own fear of going under the knife.
However, all of that is changing dramatically today,
with the advent of noninvasive and minimally invasive laser- and light-based
procedures. These newfangled cosmetic techniques are putting the goal of
eternal (or at least extended) beauty within reach for millions more, thanks
to less downtime and recovery, and significantly lower costs compared to
traditional cosmetic surgery.
This combination of new technology and demographics is
driving a resurgence of interest in cosmetic procedures, and thus the
equipment to perform them. Worldwide, demand is on the rise, as this graph of
the market for aesthetic surgical devices from BCC Research highlights:
The End of an
Era
Before he became an Internet star at the popular
financial website Zero Hedge, Tyler Durden was
a character on the big screen in the 1999 film Fight Club. That Tyler Durden was the proprietor of a soapmaking
business unlike any other, because instead of crafting soap bars from, say,
beef tallow, Durden used human fat that he
scavenged from dumpsters behind liposuction clinics.
Far-fetched? Sure. But were a real-life Tyler Durden to try entering the soapmaking
game, he'd find his source of raw materials on the decline.
That's because long term, the idea of sucking fat into
a bag is probably on the wane. It's uncomfortable, unpredictable, and, well, sorta gross. Luckily, technology has a way of improving
on the earliest efforts at any kind of transformative change, and often those
improvements come at high speed. That's what's at work here.
Less and less invasive. Cheaper. That's the future.
Not that standard liposuction is a complete horror
show. It's extremely popular – second only to breast augmentation as
the most commonly performed cosmetic procedure in the US – for a
reason. It removes fat through very small skin incisions, with atraumatic, blunt-tipped tubes called cannulas. It's
simple, the quality of results is generally acceptable, and complications are
relatively rare. All have contributed to its success.
But that was not always the case; and there is still
massive room for improvement.
There is no definitive history of "vacuum-assisted
lipoplasty," as liposuction is more properly
termed. Any number of people claim to have invented
it or first used it to do certain types of work. But the initial documented
instances of suctioning fat are attributed to a French surgeon named Charles Dujarier, who practiced way back in the 1920s.
Unfortunately, one of Dr. Dujarier's treatments
went badly awry, after he performed the procedure on a famous Parisian model
in 1926. She subsequently developed gangrene in her leg and died.
The unfortunate model's death pretty much canceled
interest in this sort of body contouring for four decades, although some
surgeons continued to employ the brute-force method: slicing open the patient
and simply cutting away fat with a scalpel. This never gained much public
acceptance, for obvious reasons.
In the late 1960s, there was a brief flurry of interest
in the work of some European surgeons who experimented with using a curette
to scrape away fat; that eventually led to the reemergence of liposuction
from history's dustbin, through the efforts of a father-son team of Italian
gynecologists, Drs. Giorgio Fischer and Giorgio Fischer, Jr., in 1974.
The Fischers took the basic
dilation and curettage procedures used in gynecology and applied the same
techniques to fat removal. Their instrument was an electric-powered rotating
scalpel, contained within a thin metal cannula that was introduced through
small incisions in the skin. The oscillating blade destroyed fat cells, which
were then suctioned out (no doubt along with other tissue, fluid, and blood)
through rubber tubing by a vacuum machine.
It was exceedingly primitive – and it often
involved grisly side effects such as a great deal of blood loss, permanent
numbness in the treated areas, asymmetry, and distressingly unpredictable
results. But from these humble, clumsy beginnings does all of modern
liposuction descend.
The real breakthrough came in 1982, when a French
surgeon, Dr. Yves-Gerard Illouz, introduced the
first tumescent liposuction, a technique which remains the most popular
method today. Basically, this involves infusing (or "tumescing")
the target area with fluid, then vacuuming it out. The fluid composition has
varied over time. Illouz originally used a simple
saline solution, but today it most commonly consists of saline, epinephrine
to constrict blood vessels, and lidocaine as an
anesthetic.
Within this model, variations emerged, according to how
much fluid is infused: the "wet" technique, where there is less
solution than the amount of fat removed; "super-wet," which
involves about the same amount of tumescent solution as the amount of fat
removed; and the "tumescent," where two to three times the amount
of solution is introduced, relative to the amount of fat removed. All remain
in use today.
Other techniques also evolved.
Water-assisted liposuction (WAL) uses a thin,
fan-shaped water beam, which loosens the structure of the fat tissue so that
it can be removed by a special cannula. During the liposuction, the water is
continually added and almost immediately aspirated via the same cannula. WAL
requires less infiltration solution and produces less immediate edema from
the tumescent fluid.
Ultrasound-assisted liposuction (UAL) was introduced in
1987. High-frequency ultrasound waves are emitted from a paddle or pads that
are held near the skin. These waves penetrate the skin and heat up and
destroy the membrane of a fat cell and literally liquefy the fat, after which
it can be aspirated through a cannula. In a variation of this technique, an
incision is made and a tiny metal rod is inserted right below the skin. The
rod emits the ultrasonic energy that emulsifies the fat. With UAL, there are
burn risks and the potential for damage to other tissue from thermal wounds,
so this method has not been enthusiastically embraced.
In 1998, power-assisted liposuction (PAL) arrived. It
uses a high-speed, vibrating cannula that pushes through even very dense,
fibrous fatty tissue with less trauma than
traditional techniques and with none of UAL's burn risks. Fibrous tissue has
always been a problem in the buttocks, saddlebags, back, and the male breast.
The PAL cannula moves through these areas faster, with less work and strain
for the surgeon and less pain and a faster recovery for patients. It's also
particularly useful for highly precise fat removal from a small area.
The Problems
There are several downsides to these traditional liposuction
techniques, including the need (sometimes) for general anesthesia, stitches,
tissue trauma, and scarring. In the early days, there were even some deaths;
and the risk of serious complications – puncture of an internal organ,
thromboembolism, lidocaine toxicity, or fluid
imbalances – is now quite small, although not nonexistent. (Many of us
probably remember the sad story of musician Kanye
West's mother, who died in 2007 following complications from a combined
surgery which included liposuction.)
The safety of the technique relates not only to the
amount of tissue removed, but to the choice of anesthetic and the patient's
overall health; it is considered ideal for the patient to be as fit as
possible before the procedure and not to have smoked for several months.
Although incisions are a consideration, since they
always leave a scar, a great deal of progress has been made in this area. In
times past, incisions were usually an inch or more long and therefore hard to
conceal. But now, they are in most cases barely an eighth of an inch, and surgeons have learned where incisions can be
placed so that they are as inconspicuous as possible after they heal.
Nevertheless, as with any skill, some practitioners are
better at it than others. One surgeon may be able to get to numerous areas
using just a few, small, well-planned incisions, while the doctor next door
may require significantly more cuts to get good results. Very much a caveat
emptor situation.
In addition, several factors limit the amount of fat that
can be safely suctioned in one session. The more fat is removed, the higher
the surgical risk. There are also negative aspects to removing a larger
amount of fat. Unusual "lumpiness" and/or "dents" in the
skin can be seen in those patients who have been "over-suctioned."
Then there is the post-op downtime. The earliest that
liposuction recipients are able to return to work is usually two days after
the procedure. Depending on the extent of the surgery, however, that recovery
period can stretch to as long as two weeks. An added annoyance is that a
compression garment must be worn for two to four weeks. Swelling can last
anywhere from two weeks to two months, and numbness may endure for several
weeks.
Finally, one of liposuction's main limitations is the
minimal skin retraction achieved after the procedure. The loose skin left
hanging around, so to speak, can present a decidedly unnatural appearance.
Thus the common choice of combining liposuction with abdominoplasty,
popularly known as the "tummy tuck," thereby adding a second
surgical layer – with all associated risks and potential side effects
– to the cake.
Long story short, standard liposuction has been a boon
for some people, but not so much of one for others. So, at the end of the 20th
century, the market was open to some method of fat removal that would be non-
or minimally invasive, while resolving as many of the negatives of
liposuction as possible.
We are a decidedly impatient people. What we most want
is the elusive pill that will cure all of our ills, including unwanted fat.
Lacking that, how about a magic wand that you could just wave over the
offending area? Well, maybe…
Enter the next generation.
SmartLipo
What was formerly seen as a pipe dream is now a
brand-new science – still in its toddler stage, to be sure. But the
techniques are here now, and at least until that miraculous fat-dissolving
pill becomes a reality (if it ever does, and if
the side effects are not horrendous), they're poised to give traditional
liposuction a run for its money.
A small startup called Cynosure pioneered the
laser-assisted lipolysis market in 2006, when the FDA approved release of its
SmartLipo system, the most minimally invasive
procedure on the market at the time. The original device utilized a laser
housed inside a cannula, which was directed at the target cells. The newest
version, SmartLipo Triplex, uses a more effective
triple-beam laser setup. In either instance, laser energy is employed to
liquefy the undesired fat, but here there is no need for suction, as the fat
is allowed to be absorbed and removed by the body.
The result is an improved system that uses smaller
cannulas and requires smaller incisions, thus reducing scarring. It's a
method that's kinder and gentler on the body, and can be done under local anesthetic.
It also has the added benefit that, as the body eliminates the fat, its own
healing response causes tissues to contract, leaving skin tighter and
smoother than would be the case with traditional liposuction. With this
technique, downtime is dramatically reduced, with most patients able to
return to work within 24 hours.
A little over a pint of fat at one time can usually be
absorbed by the body. But if the desire is to remove larger amounts, the
laser-assisted treatment can be followed by traditional aspiration.
Cynosure also makes the Cellulaze,
approved by the FDA this past January. It's the world's first minimally
invasive surgical device designed for the long-term reduction of cellulite,
by restoring the normal structure of the skin and underlying connective
tissue.
CoolSculpting
Another new approach is simply to freeze fat away. It
apparently had its antecedent in 1970, when an effect called "popsicle panniculitis" was first described. It was another of
those serendipitous moments so common in science: Someone noticed that a cold
popsicle held against the skin froze the fat underneath, producing a hard
bump of inflamed fat. The bump would subsequently shrink, leaving a temporary
dent where the fat used to be. And that led to the idea of intentional
freezing, a technique that was developed by a company named Zeltiq Aesthetics in 2005, and originally approved by the
FDA to anesthetize the skin before dermatological procedures. But after its
fat-removal properties were observed, it increasingly began being used
"off label." In 2010, the FDA went ahead and cleared it for that
purpose as well.
With Zeltiq's method, dubbed
"CoolSculpting," the patient sits in a
chair and the technician attaches multiple suction cups which
"grab" a fold of skin with fat beneath, and a gel patch begins to
freeze the fatty tissue. The surface skin itself is not frozen.
You can take a snooze for about an hour, at the end of
which the fat cells will have self-destructed. But they aren't suctioned out.
They're left in place, to be digested internally by the body and excreted...
which takes time – up to several months for the effects to show. But it
works. One study of 10 patients who underwent CoolSculpting
showed an average reduction of fat layer thickness of 22.4% in the treated
area.
There are few side effects. Most users find it only
slightly uncomfortable, and there may be some bruising or redness for a few
days afterward. It's generally best suited to those with a few small problem
areas.
The Wand Wannabe
The ultimate goal is to invent that magic wand that you
simply wave over the body and fat disappears. We don't have that yet, and may
never. But what we do have is Zerona.
Zerona is a system developed by privately held Erchonia Medical, Inc. It in no way resembles a wand,
looking more like a four-legged spider dangling from a miniature construction
crane. That spider houses portable red diode lasers that are positioned above
the body and pass their light in a sweeping motion over the target area. They
generate no heat and cause no tissue damage.
If you're the patient, all you need do is take a
40-minute nap while the laser plays its tune on you. No scalpel, no
anesthetics, no pain. Do it five more times over a two-week period, and
you're finished. Sounds like voodoo, but it apparently does work.
Zerona traveled much the same path as Zeltiq.
This new application of Erchonia's laser was
discovered by accident, after the FDA approved the device in 2002 for the treatment
of musculoskeletal pain. But when practitioners found out what else it did,
they quickly began using it off label. In 2010, the FDA gave it formal
approval for fat reduction.
How it works isn't completely understood, but it
appears that the laser stimulates adipose (fatty) cells, causing a transitory
pore to open in the cell membrane. Fat droplets (triglycerides and fatty
acids) then migrate out of the cell and into the interstitial space between
cells. From there they are carried out of the body through its normal
flushing process – this requires extra water intake, with two liters
per day recommended.
As with all other treatments described here, there are
pluses and minuses to Zerona. It may be painless
and leave no scars, but still, it's not for everyone.
For one thing, it doesn't always work, though
practitioners do claim an 80-85% success rate. Like Zeltiq,
it also affects only subcutaneous fat, the stuff that's just under the skin
– it can't reach any deeper. It isn't a replacement for liposuction
surgery, which can remove a much greater amount of fat. Nor does it
substitute for diet and exercise; those who don't make the appropriate
lifestyle changes will soon find themselves back where they started quite
fast. Physicians stress that, in the final analysis, this is not a
weight-loss method; it is a "contour-enhancement procedure." And,
as with any new medical technology, it hasn't been around long enough to
reveal any side effects that take time to surface.
A Growing
Market
Each of these technologies has a niche in what is
certain to be a growth market. We are a vain society to begin with, and that
is only going to increase as our largest demographic – the baby boomers
– arrives at the point when people begin worrying that they might
actually look as old as they are. Couple that with the vastly increasing size
of the wealthy and upper-middle class populations in places like China,
India, and South America, and the market for cosmetic procedures is set to
increase dramatically over the next few decades.
The global marketplace for aesthetic products is
expected to show a compound annual growth rate of 13-15% over the next five
years, according to industry analysts. The result will be annual sales in
excess of $9 billion.
Laser cosmetics are expected to at least keep pace with
that growth, , increasing from a value of $1.4
billion in 2011 to more than $3 billion by 2018.
Traditional liposuction is not going away. Its
advantages mean that it will remain a major player in the plastic surgery
field. However, it will increasingly be relegated to the more extreme cases,
as procedures such as SmartLipo, CoolSculpting, and Zerona prove
safer, cheaper, and more palatable to those looking for a less extreme type
of makeover. Ultimately, whichever fat-removal technique gets the
preferential nod in any given instance matters little. In this environment,
there is likely going to be room for all of them to prosper.
While the technology is amazing, only one of the
companies in this sector is making all the right moves financially too.
Inside the pages of Casey Extraordinary Technology, our
investment-research service dedicated to identifying the most promising
up-and-coming technology companies, we have complete coverage of the laser
and light cosmetics market – and have identified one company that is a
definite Buy today. To find out which one and why, subscribe now. And rest
assured with our unconditional 90-day satisfaction guarantee: if you don't
think our research will pay back the subscription price many times over,
we'll refund the complete cost of your subscription.
Before we move on to the Bits & Bytes, it would be
sacrilege for us as technophiles to not at least mention that the 2013
International Consumer Electronics Show (CES) – during which more than
3,000 companies will showcase their newest innovations – is now taking
place in Las Vegas. If you're not lucky enough to attend but want to stay in
the know about what's going on at CES, you might want to check out CNET's coverage of the event.
|
