Appointment-Booking Site Gets Big Investments, Has Drawbacks

CNET recently reported some new information about a New York-based start-up called ZocDoc. ZocDoc is an online doctor and dentist appointment-booking site that allows consumers to schedule visits based on time, specialty, location, and insurance coverage—at not extra charge. ZocDoc is looking to expand its service area with a $15 million Series B venture round led by the Founders Fund along with
contributions from Khosla Ventures.

Currently, ZocDoc only services the New York, San Francisco, Washington, D.C., and Chicago metropolitan areas. The website is currently promoting a user vote to choose what their fifth city should be from different options including Boston, Philadelphia, Seattle and Los Angeles.

Expanding won’t be easy, however. The staff at ZocDoc will have to aggregate new doctors and advertisers, set up medical profiles that are customized to the existing search criteria and enable users to book appointments online. Considering this service is free for patients, positive feedback from doctors and advertisers is required to make the expansion a success.

ZocDoc’s ambitions have grabbed the attention of some big names in eCommerce. Their first round of investors included Salesforce CEO Mark Benioff as well as Bezos Expeditions—the firm run by Amazon.com CEO Jeff Bezos. Khosla Ventures, who is investing for their second time
around, is run by Sun Microsystems founder Vinod Khosla. Khosla has been focusing a lot of attention lately on health care and clean technology.

The Founders Fund is another heavy hitter, with its principals including PayPal co-founder Peter Thiel and Napster co-founder, as well as Facebook, Inc. president, Sean Parker.

ZocDoc certainly has its benefits: book appointments from home, see doctor reviews, weeding out doctors by insurance plans accepted. However, how will this affect the plastic surgery industry if ever implemented? The ease of online booking might supersede the importance of having the patient discuss with with a patient coordinator prior to an in-office consultation. Deciding to undergo plastic surgery is a very personal decision, and taking the first step by book a consultation online is not the ideal way to go about it.

Body Contouring Market Trends 2009-2013

With rising rates of obesity, particularly in the U.S., North America will see a surge of interest in the body contouring market over the next few years. As the demand for body contouring devices increases, more plastic surgeons will adopt these technologies into their offices.

BusinessWire.com predicted the upcoming trends in the body contouring market from 2009 until 2013. With new and existing companies delving into new innovations, such as laser-assisted liposuction (LAL) and cryolipolysis, there will be a higher frequency of body contouring devices available to consumers.

The recession will, however, have a slight impact on the body contouring market growth. With a reduction in disposable incomes, patients will forego or postpone these elective procedures as a way to conserve cash. This will cause many surgeons to have a limited amount of revenue to invest these new devices that can cost upwards of $100,000.

While there was a decline in device sales from 2008 to 2009, Millennium Research Group assumes there will be an economic revival recorded for early 2010.

Cynosure launched SmartLipo MPX in the U.S. and Canada during the second quarter of 2008. SmartLipo MPX was the first dual-wavelength LAL device available in the market. Another big launch in the end of 2009 was CoolTouch’s CoolLipo, Palomar Medical Technologies' SlimLipo, Syneron's LipoLite, Elem Medical’s SmoothLipo and Sciton's ProLipo PLUS.

In addition, UltraShape’s Contour 1 was the first transdermal ultrasound device available in Canada. In 2009, Medicis received Health Canada approval for LipoSonix, which has had difficulty getting FDA approval. When transdermal ultrasound devices become available in the U.S., perhaps they will grab a hold of the body contouring market. Zeltiq cryolipolysis device has been available for off label fat removal since last summer. In many practices (including ours) it has taken off and provides consistent, safe non-surgical fat removal.


Furthermore, growing obesity rates and the more desirable results from body contouring devices suggest that there will be considerable market growth over the next few years.

A Forecast For the North American Facial Injectable Market

Cosmetic injectables are hands down the most popular aesthetic treatment in North America. The North American facial injectable market consists of four different types of fillers: collagen, Hyaluronic acid (HA) dermal fillers, botulinum toxin (BTX), and particle and polymer filler (PPF). There is a modest growth projected for facial fillers between 2010 and 2014 based on their rising popularity and the approval of new products.

According to BusinessWire.com, the more facial filler products that are available in the future, the greater the competition will be. Companies will have to spend more time and money on creating brand awareness. This will lead to a more informed audience, which can create a whole new set of challenges for the companies who make the injectables. While the recession may hinder the growth of filler companies slightly, it is predicted that they will still remain profitable over the next few years.

The introduction of Sculptra Aesthetic and Dysport® in 2009 into the PPF and BTX markets created new competition for Botox® Cosmetic. While Botox® remains the king of the throne, the “Dysport® Challenge” helped increase the popularity of the new injectable.

It is also projected that the collagen filler market will shrink excessively in 2011 following Allergan and ColBar LifeScience’s withdraw from the market in 2010. With new products expected to gain Canadian and U.S. approval, it will be interesting to see how the market responds. New facial injectables, which can be introduced into any product segment, could theoretically affect average selling prices and heighten competition within the market.

Patients Need Less Botox® Over Time for Same Results

A recent study performed by Oregon Health & Science University shows that patients can decrease the frequency of Botox® injections after approximately two years and still see similar cosmetic benefits.

The study was run by Roger A. Dailey, M.D., F.A.C.S., professor and Lester Jones Endowed Chair of oculofacial plastic surgery in the OHSU School of Medicine. "After two years of treatment at recommended intervals, patients can potentially cut the frequency, and thus the cost, of their Botox® treatments by half," said Dailey.

Dailey’s study was presented at the American Society for Aesthetic Plastic Surgery conference in Washington, D.C., on April 24. Allergan, Inc., the maker of Botox® Cosmetic, sponsored the study with an unrestricted educational grant.

The study also found Botox® to have a wrinkle-preventing—or prophylactic—effect. Patients who were administered injections between their 30s and 50s not only eliminated existing wrinkles, but also prevent new wrinkles from forming.

Previous studies suggested that patients should be injected with Botox® every three months in the glabellar region—the area between the eyebrows—to maintain a wrinkle-free appearance. According to Dailey, the frequency and cost of the treatment deterred some patients from starting or continuing a Botox® regimen.

The study monitored 50 women between the ages of 30 and 50. The women were injected regularly with Botox® over the course of two years. "We found that after the patient receives Botox© Cosmetic injections every four months for two years, the frequency of the injections can be changed to every six months and still achieve good results," said Dailey. "This demonstrates patients have the ability to achieve good results with broader treatment schedules and ultimately at a lower overall treatment cost.”

According to the American Society for Aesthetic Plastic Surgery, 2,557,068 patients underwent Botox® treatments in 2009 (257,786 of which were men). Botox® was approved by the FDA for cosmetic purposes in 2002.

Botox® Competitor Approved by FDA For Medical Use

Earlier this month Merz Pharmaceuticals, a North Carolina-based company, announced the FDA approval of Xeomin® (incobotulinumtoxinA). Xeomin® is a botulinum toxin type A-based drug that is used to treat patients with blepharospasm (eye spasms) or cervical dystonia (neck spasms).

A recent epidemiology study conducted in Rochester, MN, found that focal dystonia, which includes both named conditions, affects 295 million people in the United States.

Two significant studies that were conducted on patients with cervical dystonia and blepharospasm were imperative to the FDA’s decision to approve Xeomin®. Findings from additional European studies comparing Xeomin® to Botox® were also included in the data that was submitted to the FDA.

Similar to Botox® and Dysport®, Xeomin® is injected into the muscle to control spasms from the nerve. The advantage of Xeomin® is that is allows more biological activity and it doesn’t require refrigeration to preserve its integrity.

As for right now, Xeomin® is only FDA approved for medical purposes and not cosmetic. Merz Pharmaceuticals is optimistic, however, that the drug will be approved for its secondary purposed in the future.

Hyperoxia Shown To Reduce UVB Wrinkles, Skin Thickening

According to Cosmetic Surgery Times, a new study suggests that oxygen treatments (hyperoxia) could prospectively battle skin damage and wrinkles caused by ultraviolet light.

Performed by researchers at the University of Tokyo, mice were place in oxygen chambers after extensive exposure to UVB radiation. The mice who showed who were treated with hyperoxia had fewer wrinkles and less thickening of the skin than those who were not treated.

The researchers split 24 hairless mice into three groups: the control group (no UVB exposure), UVB exposure (three times a week for five weeks) without treatment, and UVB exposure (three times a week for five weeks) followed by two hours of hyperoxia after each treatment. Researchers found that both the UVB and UVB-plus-oxygen groups showed changes to their skin, however, the wrinkling and thickening in the latter group’s skin was less severe.

“Although hyperoxia may be used for humans to prevent acute UVB-induced skin damage, potential oxidative damage should be considered. … Further studies to determine the possible oxidative side effects of hyperoxia are needed before it can be applied in humans,” the researchers wrote.

These finding are critical in developing new anti-aging treatments, however, more research is needed to analyze any side effects.