Evaluation of a Novel Microfocused Ultrasound with Three-Dimensional Digital Imaging for Facial Tightening: A Prospective, Randomized, Controlled Trial

BACKGROUND

The excellent efficacy is mitigated by the limited safety profile of microfocused ultrasound procedures.

OBJECTIVE

We sought to assess the safety and tightening efficacy of a novel microfocused ultrasound.

METHODS

The randomized middle and lower face and submental region of the participants were treated with the novel device using the following transducers: M4.5, D4.5, M3.0, and D3.0. Improvement in paired comparison of pretreatment and posttreatment photographs, three-dimensional (3D) volumetric assessments, skin thickness measured by B-ultrasonography, and skin photoaging parameters were evaluated. Adverse events and patient satisfaction were also recorded.

RESULTS

A total of 20 participants (20 female) were enrolled. Fourteen of 20 participants (70%) were judged to show clinically significant facial tightening during 3-month follow-up (P < 0.05). The mean volumetric change in the lower face, as quantitatively assessed after 3 months was -0.29 mL compared with +0.42 mL on the control side (P < 0.05). The VAS pain score was 3.00 ± 1.19 without any oral or intramuscular anesthesia.

CONCLUSIONS

A small sample size, lack of clinical scales, and impersonalized treatment parameters. The novel microfocused ultrasound appears to be a safe and effective modality for lower-face tightening.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR 2200064666.

Update: Cellulite Therapies and Optimizing Treatment Combinations

Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens.

LEVEL OF EVIDENCE: 5

Cornea opacity, uveitis with iris atrophy and lens damage following cosmetic high-intensity ultrasound of the eyelid: a case report

BACKGROUND

High-intensity focused ultrasound (HIFU) is a cosmetic procedure that aims to tone the skin through thermal collagen coagulation. The energy is delivered in the deep layers of the skin, and because of these characteristics, the risks of severe damage to adjacent tissue and the ocular surface may be underestimated. Previous reports have demonstrated superficial corneal opacities, cataracts, increased intraocular pressure, or ocular refractive changes in different patients following HIFU. In this case, we report deep stromal opacities associated with anterior uveitis, iris atrophy and lens opacity formation following a single HIFU superior eyelid application.

CASE PRESENTATION

A 47-year-old female presented to the ophthalmic emergency department complaining of pain, hyperemia and photophobia in the right eye following a HIFU application to the superior right eyelid. A slit lamp examination showed three temporal-inferior corneal infiltrates with edema and severe anterior uveitis. The patient was treated with topical corticosteroids, and six months later, there was residual corneal opacity, iris atrophy and peripherical cataract formation. No surgical procedure was needed, and the final vision was Snellen 20/20 (1.0).

CONCLUSION

The risk of severe impairment to the ocular surface and ocular tissues may be underestimated. Cosmetic surgeons and ophthalmologists must be aware of the complications, and the long-term follow-up of these changes needs further investigation and discussion. Safety protocols of the HIFU intensity threshold for thermal lesions in the eye and the use of protective eye devices should be better evaluated.

The efficacy and safety of the high-intensity parallel beam ultrasound device at the depth of 1.5 mm for skin tightening

BACKGROUND

High-intensity parallel beam ultrasound (US) is a novel device equipped with Synchronous Ultrasound Parallel Beam (SUPERB) technology applied in anti-aging treatment. The system is aimed at pathways stimulating neocollagenesis and neoelastinogenesis in the dermis leading to skin tightening and rejuvenation.

AIMS

Evaluate the efficacy and safety of the high-intensity parallel beam US device at the depth of 1.5 mm for skin tightening treatment.

METHODS

Thirty-six participants were enrolled in the study. Digital photographs and Antera 3D photographs were taken at baseline, 1 and 3 months post-treatment. The depression volume of nasolabial folds (NLFs) and marionette lines (MLs) in each visit was evaluated using Antera 3D imaging program. Pain was evaluated by pain measurement scales immediately after treatment. Any procedure related side effects were documented and examined.

RESULTS

Post-treatment results were compared to the baseline; statistically significant mean depression volume (MDV) change of NLFs and MLs were found at 1 and 3 months post-treatment. No significant MDV change from 1 to 3 months post-treatment could be demonstrated. The mean pain score was 6.64 on a 0-10 scale. No adverse events were reported.

CONCLUSIONS

Our study demonstrates that the novel high-intensity parallel beam US device is clinically safe and effective for skin tightening in the lower face area. We noticed a reduction in NLFs and MLs in more than 60% of our participants already as early as 1 month post-treatment.

Ultrasound for Aesthetic Applications: A Review of Biophysical Mechanisms and Safety

Aesthetic ultrasound is used for fat reduction and to improve skin appearance. In this review, the fundamental mechanisms by which ultrasound can alter tissue are outlined. The technologies that are commercially available or under development are discussed. Finally, recommendations are made for safe and effective use of aesthetic ultrasound.

Prospective Study on Clinical Efficacy and Safety of a Single Session of Microfocused Ultrasound With Visualization for Collagen Regeneration

BACKGROUND

Recent studies have shown that transcutaneous microfocused ultrasound with visualization is beneficial for noninvasive skin tightening, collagen regeneration, and lower face contour improvement.

OBJECTIVES

The primary study endpoint was the improvement of the laxity and ptosis face skin; the secondary endpoint was the improvement of wrinkles, texture, and hemoglobin content; and the third endpoint was the patient's responses to a patient satisfaction questionnaire.

METHODS

Patients with soft to moderate skin laxity and ptosis of the face and neck were enrolled and their sex, ethnicity, age, Fitzpatrick skin type, and smoking habit recorded. Patient assessment was made by digital macro-photographs, Vectra H2, and Antera 3D, and strict exclusion criteria were set up.

RESULTS

From November 2017 to November 2018, 47 women and 3 men with a mean age of 52.8 ± 7.43 years and Araco's Ptosis Scale System 2.7 ± 0.46, which fit the inclusion criteria, were enrolled in the study. All patients signed a consent form and received 1200 spot-lines (400 lines from each transducer) of microfocused ultrasound with visualization. No major side effects were reported during the study and all patients completed the follow-up after 6 months. Wrinkles, texture, Surgeon Assessment Scoring System scores, and patient satisfaction questionnaire scores improved significantly. Patients found the treatment tolerable according to the patient pain scale rate. No statistically significative differences were found among homogenous groups of smokers and nonsmokers.

CONCLUSIONS

The study proves that microfocused ultrasound with visualization in a single session of treatment in monotherapy is safe and effective for the treatment of face laxity and ptosis when a proper number of energy spot-lines is delivered in the correct tissue layer.

LEVEL OF EVIDENCE: 4

Evaluation of microfocused ultrasound for improving skin laxity in the lower face: A retrospective study

To evaluate the efficacy and safety of a newer microfocused ultrasound (MFU) device on the lower face laxity. Subjects who underwent MFU therapy for skin tightening were enrolled in the study. The primary outcome measure was overall improvement in skin laxity of the lower face that was evaluated by improvement on jawline irregularities, marionette line, and submental laxity. Assessments were obtained from two blinded dermatologists paired pre- and post-treatment photographs with Investigator-Global-Aesthetic-Improvement-Scale (IGAIS) and from subjects with Subject-GAIS (SGAIS). A total of 24 subjects were evaluated on a median of 4.3 months after 1 session MFU application. According to IGAIS, 5 subjects (20.9%) demonstrated improvement and 15 subjects (62.5%) had no change. Four subjects (16.7%) were scored as worsening. According to SGAIS, 11 subjects (45.9%) reported an improvement whereas 9 subjects (37.5%) reported no change. There was a statistically significant difference between the improvement rate assessed by the investigators and the subjects, where investigators scored lower (P = .006). No serious adverse effects were observed. The relatively high improvement rate observed by the subjects' self assessments compared to investigators evaluation from the photographs suggested that we need to find new evaluation methods other than photography which may reflect what subjects feel but we cannot see.

Improving mandibular contour: A pilot study for indication of PPLA traction thread use

Background: The request for less-aggressive procedures to improve mandibular contour is increasing. Several kinds of threads have been used for this purpose. Nevertheless, PLLA (poly-L-Lactic acid) traction thread procedure has not been previously described. Aim: To investigate the role of PLLA traction threads in improving mandibular contour. Methods: Twenty women were enrolled in the study. They were differentially classified for skin laxity. Patients were treated in a single session with two PLLA traction threads per side. Specific post-procedure instructions were given to patients, and complications occurred after the procedures were estimated. A Fisher's t-test was performed to identify criteria related to longevity of results. Results: We found longevity of results to be associated with younger age (p = 0.001), absence of severe skin laxity of jawline and neck (p = 0.001), and aesthetic satisfaction (p = 0.024). Edema, swelling, and temporary skin contour irregularities were found in most cases (N = 16; 80%), whereas paresthesia resolving without sequelae in 2-4 weeks was found in two cases (10%). Conclusions: Our results show that selected patients, younger than 51 and showing a mild-moderate degree of skin laxity of jawline and neck angle represent ideal candidates for PLLA traction thread treatment. Further studies will be performed to confirm our results.

Safety, tolerability, and efficacy evaluation of the SlimME device for circumference reduction

OBJECTIVE

To assess the short- and long-term thermal impact of subclinical and clinical regimens of a single, non-invasive uniform ultrasound treatment session on subcutaneous adipose tissue (SAT).

STUDY DESIGN

Prospective, open-label, single-arm, split-side study.

METHODS

Patients (n = 17) were subjected to uniform ultrasound treatment, delivered in a single session with the SlimME device. The device was set to one of four treatment regimens, which differed in their durations and energy fluences during the raise and maintenance phases. Up to six abdominal regions were treated, with six patients receiving a different treatment on each side of the abdomen. Safety was assessed by measuring skin surface temperature, evaluating expected skin responses immediately and 30 min after treatment and via patient ratings of pain and discomfort. Efficacy of raising and then maintaining SAT temperatures at 48°C, was determined by routinely measuring SAT temperatures during the treatment session and by histological analysis of samples collected 7 (n = 13) or 90 (n = 4) days after treatment.

RESULTS

Trace to mild erythema was observed in up to 48% of the treated zones, which, in most cases, resolved within 30 minutes. No significant rise in mean skin surface temperature (≤26.5°C) was recorded following any of the four tested regimens. Overall, patients reported tolerability to treatment, with the highest mean pain score registered for the moderate and high intensity regimens (4.4 ± 1.5 and 4.9 ± 1.4, respectively). Mean SAT temperatures did not exceed 48.4 ± 2.5°C and were effectively maintained throughout the maintenance phase of the treatment session. Low-energy fluence led to localized fat coagulative necrotic lesions, surrounded by subacute rim of inflammation, while high-energy fluence induced fat coagulative necrosis alongside granulomatous panniculitis, which resolved within 90 days.

CONCLUSION

The tested uniform ultrasound regimens elicited SAT temperature elevations, with a subsequent energy-dependent increase in degree of fat necrosis. At the same time, the unique design spared the surrounding tissue from thermal damage and was associated with minimal discomfort. Taken together, the SlimME device constitutes an effective tool for destruction of stubborn hypodermal fat deposits. Lasers Surg. Med. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.