The use of Ultrasound energy in facial rejuvenation
Most Energy Based Anti-ageing Treatments are limited by penetration depth, however most recently a novel technology has been introduced to the treatment armamentarium based on microfocused ultrasound and provides a promising surgical alternative for patients with mild to moderate signs of facial laxity and deflation.
The Ulthera system harnesses the power of sound waves to target the deep foundation of the skin to stimulate the body’s own regenerative response, without disrupting the surface of the skin.
The Ulthera device is capable of imaging the facial anatomy, much like ultrasound scans used in pregnancy, so that it can specifically target different tissue layers (muscle and dermis) with the ultrasound energy. Energy is delivered only at precise focal points (Thermal Coagulation Points) without affecting the intermediary tissues. This is similar to how a magnifying glass focuses sunlight to a point, where a significant temperature is reached only at the focal point.
These TCPs are recognized by the body as an “injury” thereby initiating the wound healing response. This response involves tissue repair and synthesis of new collagen by fibroblasts, which undergo organization and cross-linking, enabling it to have more visco-elastic properties and better resist mechanical stresses.
Dr. White and colleagues in the USA played a pivotal role in the development and clinical applications of this technology, as they were the first to report collagen and elastin fiber remodeling (with increase in overall dermal thickness) and selective contraction of the SMAS (Superficial Muscular Aponeurotic System). By 2009 a series of studies led to FDA approval for eyebrow lift, an approval that fostered further development of the device as a non-invasive tool for full facial rejuvenation. Results are usually noticeable at 3 to 6 months following treatment, with further improvement still noted at 6 to 12 months, giving patients a natural result. Careful candidate selection and expectation management are paramount to achieving satisfactory results.
The ideal patient has mild to moderate facial laxity with mild submental fat descent and early jowling. Some patients may require additional sessions focusing on specific areas. Judgment should be exercised in patients with extensive elasticity loss and significant fat prolapse as they might be candidates for a surgical facelift. As anticipated, a younger patient has a more vibrant biostimulatory response and an inherent skin elasticity that yields better results.
Typically the treatment protocol involves a dual plane at 4.5mm – 3mm depth and can be customized to each patient’s regional facial anatomy. A degree of discomfort is expected but this is variable in quantity and depending on each patient’s individual pain threshold. Mild erythema (inflammation of the fat cells) and edema (swelling caused by fluid retention) are expected but this resolves rapidly. In rare occasions temporary paresis of the facial nerve branches has been noted.
Ultherapy can offer certain advantages over a wide range of non-surgical alternatives; the ability to achieve biostimulation in the deep dermis and selective SMAS contraction appears to be a promising non-surgical rejuvenating option. Ongoing perspective clinical experience and research with this technology will further define its efficacy.