'Holy trinity': Trio concept offers patients complete skin rejuvenation package

Key Points

For dermatologist William Philip Werschler, M.D., the Thermage/Fraxel/fillers combo -which he calls the "holy trinity" of surface rejuvenation - is the nucleus of the emerging concept of nonsurgical total facial rejuvenation (NSTFR).

Dr. Werschler, assistant clinical professor of medicine and dermatology at the University of Washington School of Medicine, Seattle, has been an ardent NSTFR advocate, having written and lectured on the topic frequently over recent years.

Trio combination

"Though there's nothing new about the individual components of this technique, it's a relatively new concept in terms of putting the three together in a combination therapy," Dr. Werschler tells Dermatology Times.

For facial rejuvenation, he typically uses the Fraxel laser treatment for resurfacing of the skin, and the Thermage radio frequency heat therapy for skin tightening.

The third component, according to Dr. Werschler, is perhaps the most critical to the effectiveness of the Thermage/Fraxel/fillers technique.

"The crucial component is volume replacement, and this is best achieved with fillers," Dr. Werschler says, citing Juvéderm (Allergan) and Restylane (Medicis) as the most common examples of volume-replacement fillers, and Sculptra (Dermik) and Radiesse (Bioform Medical) as examples of collagen-stimulating injectable agents that, as he puts it, serve to thicken the collagen mask.

"The order each component is done in will vary with each individual patient," Dr. Werschler says. "Nothing is written in stone as far as sequence of therapy is concerned."

According to Dr. Werschler, what is written in stone is what should occur after the patient has undergone the Thermage/Fraxel/fillers therapy.

"I always encourage patients to use a prescribed follow-up regimen of topical skincare products," he says.

'Maintenance quartet'

Dr. Werschler advocates a skincare regimen made up of four components - an "anti-aging maintenance quartet" - to follow the initial Thermage/Fraxel/fillers trio therapy.

"This quartet of skincare maintenance products should include sunscreens, antioxidants, retinoids and topical growth factor agents," he says.

"And to prepare the skin for the anti-aging regimen, I'm a big advocate of Clarisonic, a sonic pulsing skin-cleansing device made by the company (Pacific Bioscience) that makes the Sonicare toothbrush," Dr. Werschler says.

"The Sonicare uses sonic pulses to clean the teeth without abrasion," he says. "The Clarisonic device uses the same principle. It uses sonic pulsing to clean the skin without abrasion, which makes it an excellent way to prepare the skin for the skincare maintenance quartet."

Synergy

The synergy between Fraxel and Thermage that exists medically recently was mirrored in the corporate world of mergers and acquisitions.

In January, California-based Thermage finalized the purchase of Fraxel maker Reliant Technologies, also based in California, in a combined stock-and-cash deal valued at $66.2 million. The merger results in a new company now known as Solta Medical Inc.

"I think this merger is an important one," Dr. Werschler says, "much like the merger of the two devices with fillers is an important therapeutic concept in facial rejuvenation."

Disclosure: Dr. Werschler has a consulting agreement with Pacific BioScience. He has no relevant financial interests with Solta Medical.