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Kwack MH, Lee WJ. Efficacy of a home-used high-intensity focused ultrasound device on wrinkle reduction. Skin Res Technol 2023; 29:e13266. [PMID: 36704876 PMCID: PMC9838762 DOI: 10.1111/srt.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) has been developed for the treatment of skin wrinkles on the face, neck, and body. OBJECTIVES This study aimed to evaluate the effects of a home-used HIFU device on wrinkles in mice based on the expression of fibrosis-related genes and proteins. METHODS The backs of 20-week-old mice were treated with a home-used HIFU using the following probes: 4 MHz, 1.5 mm focal depth. The treated mice were compared with young mice by histological examination, real-time polymerase chain reaction (PCR), and immunohistochemistry. Histological examination was performed by trichrome staining. Real-time PCR and immunohistochemistry were conducted to determine the expression of collagen types I and III, matrix metalloproteinase (MMP)-1, and tissue inhibitor of metalloproteinase (TIMP)-1. RESULTS Dermal thickness was increased after treatment with the home-used HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks on trichrome. Gene and protein expression of collagen types I and III and elastin were increased after treatment with HIFU at all options of 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks. Gene and protein expressions of MMP-1 and TIMP-1 were decreased after treatment with HIFU device at 30 and 60 s per day for 1 week or 30 and 60 s per day for 2 weeks. CONCLUSION The home-used HIFU device can be an effective therapeutic modality for skin tightening.
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Affiliation(s)
- Mi Hee Kwack
- Department of ImmunologySchool of MedicineKyungpook National UniversityDaeguSouth Korea
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, School of MedicineKyungpook National UniversityDaeguSouth Korea
| | - Weon Ju Lee
- Department of Dermatology, School of Medicine, Kyungpook National UniversityKyungpook National University HospitalDaeguSouth Korea
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Araco A, Araco F. Preliminary Prospective and Randomized Study of Highly Purified Polynucleotide vs Placebo in Treatment of Moderate to Severe Acne Scars. Aesthet Surg J 2021; 41:NP866-NP874. [PMID: 33755110 DOI: 10.1093/asj/sjab125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Managing acne scars is a challenge and therapies are divided into nonsurgical and surgical. Highly Purified Technology Polynucleotides (PN-HPT) is a compound that contains a mixture of DNA polymers of different lengths. Numerous studies have shown that PN-HPT also serves as an energy source, thus influencing cellular growth and cell vitality. OBJECTIVES The authors aimed to assess the improvement in dermal quality and acne scars after PN-HPT vs placebo according to Antera 3D and the patient responses to the patient satisfaction questionnaire after a comparison of pretreatment and posttreatment photographs at 1 and 3 months. METHODS Included were women aged 30 to 50 years with grade 3 to 4 moderate-to-severe atrophic scars according to the Goodman classification; nonsmokers; and had not had active acne during the past 5 years. Ten patients (PN-HPT group) were treated with 4.0 mL of PN-HPT, and 10 patients (control) were treated with 4.0 mL of normal saline. All medical treatments were performed in a double-blinded manner; neither the injection doctor nor the patient knew if the PN-HPT or the placebo was being administered. RESULTS Twenty women who fit the inclusion criteria were enrolled in this study. Only patients in the PN-HPT group improved significantly at 1 and 3 months after treatment compared with baseline. CONCLUSIONS This prospective and randomized study showed that PN-HPT in monotherapy was safe and effective treatment for atrophic scar acne compared with placebo. Prospective and randomized studies will be necessary to investigate the clinical effectiveness in a larger cohort of patients and for a longer follow-up. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Antonino Araco
- Department of Aesthetic Medicine, University Tor Vergata of Roma, Rome, Italy
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Araco A. Prospective Study on Clinical Efficacy and Safety of a Single Session of Microfocused Ultrasound With Visualization for Collagen Regeneration. Aesthet Surg J 2020; 40:1124-1132. [PMID: 32324851 DOI: 10.1093/asj/sjz363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
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
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Affiliation(s)
- Antonino Araco
- Department of Aesthetic Medicine, University Tor Vergata of Roma, Rome, Italy
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Antonino A, Francesco A. Prospective and randomized comparative study of calcium hydroxylapatite vs calcium hydroxylapatite plus HIFU in treatment of moderate-to-severe acne scars. J Cosmet Dermatol 2020; 20:53-61. [PMID: 32385943 DOI: 10.1111/jocd.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acne scars are the most common sequelae of the severe inflammatory process of acne, and its managing is a challenge. Objective of this study was to assess safety and effectiveness of calcium hydroxylapatite monotherapy and its association with high-intensity microfocused ultrasound for treating moderate-to-severe atrophic acne scars. METHODS Women with moderate-to-severe atrophic scars of the face were enrolled on the study. Assessments were made by digital macrophotographs, Vectra H2, and Antera 3D. RESULTS From October to December 2019, twenty women which fitted the inclusion criteria signed a consent form and received 3.0 mL of calcium hydroxylapatite and after 4 weeks, 400 lines of HIFU. No major side effects were reported during the study, and all patients completed the follow-up after 6 months. At 1 month, patients treated with calcium hydroxylapatite (group 1) improved wrinkles and skin texture compared to placebo (group 2). At 3 and 6 months, all patients improved acne scars. CONCLUSION Our study showed that that both calcium hydroxylapatite and HIFU in monotherapy were safe and effective treatments for atrophic scar acne. Calcium hydroxylapatite was clinically effective when compared with placebo, though the combination of calcium hydroxylapatite and HIFU did not enhance the clinical efficacy compared to monotherapy.
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Affiliation(s)
- Araco Antonino
- Aesthetic Medicine Department, Cosmetic Surgeon at Univeristy Tor Vergata of Roma, Rome, Italy
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A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology. Dermatol Surg 2018; 44:949-963. [DOI: 10.1097/dss.0000000000001551] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of horizontal neck lines before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Transverse Neck Lines Scale. METHODS The Allergan Transverse Neck Lines Scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each scale grade. The clinical significance of a 1-point score difference was evaluated in a review of multiple image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject rating validation study (N = 297) completed during 2 sessions occurring 3 weeks apart. RESULTS A difference of ≥1 point on the scale was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.22 [1.09–1.35] for clinically different image pairs and 0.57 [0.42–0.72] for not clinically different pairs). Intrarater agreement between the 2 live-subject rating validation sessions was substantial (mean weighted kappa = 0.78). Interrater agreement was substantial during the second rating session (0.73, primary end point). CONCLUSION The Allergan Transverse Neck Lines Scale is a validated and reliable scale for rating of severity of neck lines.
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Abstract
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.
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Affiliation(s)
- Eun Jin Doh
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea
| | - Jiwon Kim
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea
| | - Dong Hun Lee
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea.,b Institute of Human-Environment Interface Biology , Seoul National University , Seoul , Korea
| | - Je-Young Park
- c Apkoo-Jung Department , Oracle Dermatology Center , Seoul , Korea
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Marr K, Carruthers JD, Humphrey S. Transient Nerve Damage After Microfocused Ultrasound With Visualization. Dermatol Surg 2017; 43:894-896. [DOI: 10.1097/dss.0000000000001032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Park JH, Lim SD, Oh SH, Lee JH, Yeo UC. High-intensity focused ultrasound treatment for skin: ex vivo evaluation. Skin Res Technol 2016; 23:384-391. [PMID: 27868241 DOI: 10.1111/srt.12347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE High-intensity focused ultrasound (HIFU) has been used for skin tightening. However, there is a rising concern of irreversible adverse effects. Our aim was to evaluate the depth of thermal injury zone after HIFU energy passes through different condition. MATERIALS AND METHODS To analyze the consistency of the HIFU device, phantom tests were performed. Simulations were performed on ex vivo porcine tissues to estimate the area of the thermal coagulation point (TCP) according to the applied energy and skin condition. The experiment was designed in three orientations: normal direction (from epidermis to fascia), reverse direction (from fascia to epidermis), and normal direction without epidermis. RESULTS The TCP was larger and wider depending on the applied fluence and handpieces (HPs). When we measured TCP in different directions, the measured area in the normal direction was more superficially located than that in the reverse direction. The depth of the TCP in the porcine skin without epidermis was detected at 130% deeper than in skin with an intact epidermis. CONCLUSION The affected area by HIFU is dependent on the skin condition and the characteristics of the HP and applied fluence. Considerations of these factors may be the key to minimize the unwanted adverse effects.
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Affiliation(s)
- J-H Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - S-D Lim
- Department of Pathology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - S H Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J H Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - U C Yeo
- Jongno S&U Dermatologic Clinic, Seoul, Korea
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Consensus Recommendations for Combined Aesthetic Interventions Using Botulinum Toxin, Fillers, and Microfocused Ultrasound in the Neck, Décolletage, Hands, and Other Areas of the Body. Dermatol Surg 2016; 42:1199-1208. [PMID: 27668925 DOI: 10.1097/dss.0000000000000869] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The popularity of aesthetic procedures in the face has led to greater disparity between treated areas and those that still show evidence of true age. Although many areas of the body often require multiple treatment procedures for optimal rejuvenation, combination therapy for specific areas is not yet well defined. OBJECTIVE To develop recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite (CaHA), and microfocused ultrasound with visualization in nonfacial areas across all skin phototypes. METHODS Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus. RESULTS Recommendations have been provided for the neck, décolletage, and hands and include the timing and sequence of specific procedures when used concurrently or over several treatment sessions. Position statements are offered in lieu of consensus for the upper arms, abdomen, buttocks, and knees. CONCLUSION Nonfacial rejuvenation often requires multiple procedures for optimal results in individuals with significant age-related changes. Further clinical studies are recommended to raise awareness of non-facial indications and provide clinicians with the best evidence for best treatment practices.
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A Combination Approach with Lasers, Light, and Energy-Based Devices for Ultimate Rejuvenation of the Aging Face. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Combining Microfocused Ultrasound With Botulinum Toxin and Temporary and Semi-Permanent Dermal Fillers. Dermatol Surg 2016; 42 Suppl 2:S168-76. [DOI: 10.1097/dss.0000000000000751] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harris MO, Sundaram HA. Safety of Microfocused Ultrasound With Visualization in Patients With Fitzpatrick Skin Phototypes III to VI. JAMA FACIAL PLAST SU 2016; 17:355-7. [PMID: 26313402 DOI: 10.1001/jamafacial.2015.0990] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A microfocused ultrasound (MFU) system is a safe and effective aesthetic treatment for tightening and lifting skin in the facial and neck areas. This open-label, nonrandomized trial was performed to further demonstrate the safety of MFU for improving laxity of the skin of the face and neck in 52 adults with Fitzpatrick skin types III to VI. OBSERVATIONS Before treatment with MFU, the skin tissue of each participant was assessed and ultrasound imaging was performed on the treatment area to ensure appropriate acoustic transducer coupling. Treatment was performed from March 23, 2011, to July 20, 2011. Following treatment, there were 3 reported adverse events described as raised areas of mild edema or welts (2 events) and moderately severe prolonged erythema with mild scabbing (1 event). All events resolved after 90 days without sequelae. Analysis was conducted from Janaury 18, 2012, to March 13, 2013. CONCLUSIONS AND RELEVANCE The adverse events that occurred in this trial were temporary and associated with treatment technique. When performed by trained physicians, MFU is safe in patients with Fitzpatrick skin types III to VI. LEVEL OF EVIDENCE 4. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01368965.
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Affiliation(s)
- Monte O Harris
- Center for Aesthetic Modernism, Chevy Chase, Maryland2Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC
| | - Hema A Sundaram
- Dermatology, Cosmetic & Laser Surgery, Rockville, Maryland4Dermatology, Cosmetic & Laser Surgery, Fairfax, Virginia
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