Noninvasive Treatment of the Neck

Ultrasound Therapy for the Skin

Ultrasound energy is delivered to the dermal and subdermal tissue to induce thermal injury, leading to collagen remodeling and resulting in lifting and tightening of the skin. Ulthera and Sofwave are two Food and Drug Administration-approved systems that have demonstrated clinically significant results in providing eyebrow, submental, and neck lift and minimizing facial fine lines and wrinkles. Patient selection and management of expectations are important components to a successful treatment process. Both devices boast high patient satisfaction rates, minimal recovery time, and excellent safety profile. Ultrasound technology is an effective, nonsurgical option for facial rejuvenation.

Hi5 Protocol for the Use of Microfocused Ultrasound with Visualization

Background

Microfocused ultrasound with visualization (MFU-V) is used for lifting and tightening of facial tissues. Standard protocols are completed in a single session. Despite excellent outcomes, we identified several barriers of entry for a significant number of patients. Therefore, we devised an individualized pan-facial protocol that is delivered as a series of short, intense treatments to address these issues.

Methods

We enrolled 12 participants with mild-to-moderate skin and fibromuscular laxity to receive one superficial and one deep pass per visit (average 280 lines). Qualitative improvements were rated by both patients and physicians at 6 or 10 months due to COVID-19 delays. Changes in the submentum and eyebrow heights were quantified.

Results

Ten patients (age range: 31-61 years) underwent an average of four MFU-V treatments. Two patients were excluded after massive weight gain. Skin and fibromuscular ptosis and overall soft tissue laxity improved in all patients. Mean brow height increased by 1.7 mm, whereas the mean submental lift was 78.7 mm2. All patients and treating physicians rated an improvement in appearance, whereas independent physicians rated improvements in 87% of cases. Four patients self-rated as "markedly improved." Pain was rated at up to 6.2 (out of 10). Although mask-wearing was mandatory, loss of elasticity, wrinkles, and skin roughness all improved. Superficial welts (n = 5), erythema (n = 3), tenderness (n = 3), and mild bruising (n = 2) occurred, but all resolved within a few days and no severe or permanent adverse events occurred.

Conclusion

The Hi5 protocol was noninferior to standard single-session protocols and improved brow heights and submental lifting.

Neck rejuvenation using a multimodal approach in Asians

BACKGROUND

A multimodal approach is essential for neck rejuvenation because many factors contribute to the aging of the neck.

OBJECTIVES

We evaluated the effect of combined therapy using microfocused ultrasound with visualization (MFU-V), neuromodulator injection, and filler injection for neck rejuvenation.

METHODS

Subjects were sequentially treated with three kinds of interventions in a single session, as follows: (A) MFU-V or calcium hydroxyapatite injection for restoring skin laxity; (B) hyaluronic acid filler injection for horizontal neck lines; and (C) neuromodulator injection for platysmal bands.

RESULTS

All ten patients showed clinical improvement of neck aging after combined treatment. Patients with more aged neck at baseline were more likely to show greater improvement after treatment.

CONCLUSION

Neck rejuvenation using multimodal approach is effective in Asians.

A Randomized Evaluator-Blinded Trial Comparing Subsurface Monopolar Radiofrequency With Microfocused Ultrasound for Lifting and Tightening of the Neck

BACKGROUND

Both subsurface monopolar radiofrequency (SMRF) and microfocused ultrasound with visualization (MFU-V) have demonstrated the ability to lift and tighten the neck. No head-to-head comparison study exists of these 2 technologies.

OBJECTIVE

To compare the efficacy and safety of SMRF and MFU-V for the lifting and tightening of neck.

MATERIALS AND METHODS

Twenty subjects aged from 18 to 65 with moderate neck skin laxity were randomized to receive either one treatment of SMRF or MFU-V.

RESULTS

At Days 0, 30, 90, and 180, the mean (SD) investigator-assessed Neck Laxity Grade was 2.7 (0.67), 2.1 (1.1), 1.6 (1.2), and 0.86 (0.7), respectively, for patients treated with SMRF, and 2.8 (0.63), 2.4 (1.07), 1.5 (0.53), and 1.4 (0.7), respectively, for those treated with MFU-V. Both SMRF and MFU-V led to a significant decrease in the mean investigator-assessed Neck Laxity Grade by Day 90 and persistent to Day 180. Subject assessment of firmness, texture, and laxity also significantly improved by Day 90 and persistent to Day 180. Adverse events were mild and transient.

CONCLUSION

There were no were statistically significant differences between SMRF and MFU-V in investigator-assessed and patient-assessed measures of neck laxity, patient satisfaction, and adverse events. Microfocused ultrasound with visualization was associated with more procedural pain.

ATX-101 (deoxycholic acid injection) for reduction of submental fat

INTRODUCTION

The shape and contour of the chin and neck play an important role in facial esthetics. As such, excess fat within the submental area (double chin) can negatively affect facial esthetics and body image. Common treatments for submental contouring include invasive procedures such as surgical rejuvenation and targeted liposuction. Energy devices (lasers, radiofrequency, and ultrasound) may be used to improve submental skin laxity while cryolipolysis was recently cleared in the United States for use in the submental area. However, ATX-101 (deoxycholic acid injection) is the only injectable drug approved in the United States and Canada for reduction of submental fat.

AREAS COVERED

The efficacy and safety of ATX-101 have been extensively evaluated in a global clinical development program including multiple Phase I/II studies and four large Phase III trials. Available data from ATX-101 trials are reviewed. Expert commentary: Injectables have been well established for facial rejuvenation. Extending injectable treatment into the chin and neck is a major advance for nonsurgical cosmetic correction. Overall, the evidence supports ATX-101 as a safe and effective, minimally invasive treatment alternative for reduction of submental fat that will provide a major tool for the esthetic physician.

Noninvasive skin tightening: focus on new ultrasound techniques

Microfocused ultrasound (MFU) has been recently developed to meet the ever-growing public demand for achieving significant, noninvasive skin lifting and tightening. MFU can be focused on subcutaneous tissue where the temperature briefly reaches greater than 60°C, producing small (<1 mm³) thermal coagulation points to a depth of up to 5 mm within the mid-to-deep reticular layer of the dermis and subdermis. The intervening papillary dermal and epidermal layers of skin remain unaffected. The application of heat at these discrete thermal coagulation points causes collagen fibers in the facial planes such as the superficial musculoaponeurotic system and platysma, as well as the deep reticular dermis, to become denatured, contracting and stimulating de novo collagen. A commercially available device combines MFU with high-resolution ultrasound imaging (MFU-V), which enables visualization of tissue planes to a depth of 8 mm and allows the user to see where the MFU energy will be applied (Ultherapy^®; Ulthera Inc., Mesa, AZ, USA). Using different transducers, MFU-V treatment can be customized to meet the unique physical characteristics of each patient by adjusting energy and focal depth of the emitted ultrasound. By targeting the facial superficial musculoaponeurotic system, noninvasive tightening and lifting of sagging facial and neck skin and improvements in the appearance of wrinkles can be achieved. MFU-V can also improve lines and wrinkles of the décolleté. Treatment protocols for the use of MFU-V continue to be refined, and its use in combination with other rejuvenation techniques has been demonstrated. Brief discomfort that often occurs during treatment can be minimized with oral nonsteroidal anti-inflammatory drugs. Other treatment-related adverse events include transient erythema, edema, and occasional bruising. MFU-V is best suited for patients with mild-to-moderate skin and soft tissue laxity. For older patients with severe skin laxity and marked platysmal banding, surgical treatment should be considered.