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Alimova SM, Sharobaro VI, Avdeev AE, Sidorenkov DA, Guseva TS. Cone-Beam Computed Tomography for Objective Diagnosis of Age-Related Soft Tissue Changes in Lower Face and Neck. Aesthetic Plast Surg 2023; 47:2370-2377. [PMID: 37204468 DOI: 10.1007/s00266-023-03401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND An objective assessment of the causes of age-related contour deformities of the soft tissues of the face and neck is very important in esthetic surgery, especially as minimally invasive techniques gain increasing popularity. METHODS To visualize the tissues that cause age-related soft tissue changes, we performed cone-beam computed tomography (CBCT) in 37 patients who underwent facial and neck rejuvenation procedures in 2021-2022. RESULTS Vertical CBCT enabled visualization of the causes and degree of tissue involvement in age-related changes in the lower third of the face and neck. CBCT showed the location and condition of the platysma (hypo- [ptosis], normo-, or hyper-tonus), position, thickness, and location (above and/or below the platysma) of fat tissue, presence of ptosis of the submandibular salivary glands, condition of the anterior bellies of the digastric muscles, and the degree of their participation in contours of the cervicomandibular angle, and location of the hyoid bone. Moreover, CBCT enabled demonstrating for the patient the facial and neck contour deformations and discussing the suggested corrective methods using a clear objective visual image. CONCLUSIONS CBCT in the upright position enables objective assessment of each soft tissue in the age-related deformity of the cervicofacial region and provides an opportunity to plan the appropriate impact on the particular anatomical structures during rejuvenation procedures and estimate their results. This is the only study to date to objectively and clearly visualize the entire topographic anatomy of the soft tissues of the face and neck vertically for plastic surgeons and patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sekina M Alimova
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Valentin I Sharobaro
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexey E Avdeev
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitry A Sidorenkov
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana S Guseva
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Ling J, Zhao H. A Systematic Review and Meta-Analysis of the Clinical Efficacy and Patients' Satisfaction of Micro-focused Ultrasound (MFU) Treatment for Facial Rejuvenation and Tightening. Aesthetic Plast Surg 2023; 47:1806-1823. [PMID: 37198297 DOI: 10.1007/s00266-023-03384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Micro-focused ultrasound (MFU) is commonly used to improve facial relaxation and wrinkles. The objective of this study was to determine the efficacy of MFU for facial rejuvenation and patients' satisfaction with the treatment. METHOD Articles published before December 2022 were retrieved using PubMed, Embase, Web of Science, and Cochrane Library databases. The retrieved literature was screened according to strict criteria, and the risk of bias of each study was assessed. RESULT A total of 13 MFU studies for facial rejuvenation and tightening were included, involving 477 participants. Efficacy was assessed using the Global Aesthetic Improvement Scale (GAIS), and meta-analysis showed an overall response rate of 0.77 (95%CI: 0.58, 0.96) at 90 days after intervention and 0.69 (95%CI: 0.51, 0.87) at 180 days. 0.78 (95%CI: 0.61, 0.95) and 0.71 (95%CI: 0.54, 0.87) patients were satisfied and very satisfied overall at 90 days and 180 days, respectively. The pain score was on a 10-point scale, and the overall score was 3.10 (95%CI: 2.71, 3.94). There were no instances during treatment where patients could not tolerate pain. Sensitivity analysis showed that the results were robust. CONCLUSION In conclusion, MFU is an effective way to treat facial rejuvenation and tightening. More large-sample, multicenter and randomized studies are needed to determine the optimal treatment parameters in the future. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jiaqi Ling
- Department of Plastic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China
| | - Haiguang Zhao
- Department of Plastic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao, 266035, Shandong, China.
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Al-Omair A, Bukhari A. Patient satisfaction of microfocused ultrasound treatments on the face and neck laxity: A narrative review. J Cosmet Dermatol 2023; 22:2671-2676. [PMID: 37128835 DOI: 10.1111/jocd.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Microfocused ultrasound with visualization (MFU-V) delivers focused ultrasound energy to heat tissue and has emerged as a fast and effective noninvasive method for treating skin laxity. After obtaining approval in 2009 by the Food and Drug Administration, satisfactory feedback was recorded using several scoring systems for MFU-V treatment for facial and neck laxity. AIM To evaluate the efficacy and satisfaction rates of MFU-V for facial and neck laxity treatment by providing a basis for developing a validated scoring system for MFU-V treatment. METHOD A constrictive survey was carried out by selecting relevant publications on MFU-V treatment of facial and neck laxity using PubMed, Medline, and Embase electronic databases from January 2017 to March 2022. RESULTS Of the 11 original articles used in this review, the majority of the scoring methods used were the subjective global aesthetic improvement scale and the 5-point scale rating global aesthetic improvement in appearance. Around half of the patients were described as much improved or very much improved on days 30 and 90, while most returned to baseline on Day 360. Most of the adverse events reported were mild bruising, redness, and pain. None of the patients reported serious adverse events. A burn occurred in one case because of improper application of the probe. CONCLUSION The MFU-V provides excellent and promising responses for treating facial and neck laxity. A few mild events were observed, such as erythema, pain, edema, and injection-site induration, all of which resolved within approximately 2-3 days.
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Affiliation(s)
- Abdullah Al-Omair
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abrar Bukhari
- Department of Dermatology, College of Medicine - Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Park JY, Lee JS, Lee SR, Lee DH. Combined Treatment with Micro-Focused Ultrasound with Visualization and Intradermal Incobotulinumtoxin-A for Enlarged Facial Pores: A Retrospective Study in Asians. Clin Cosmet Investig Dermatol 2023; 16:1249-1255. [PMID: 37215534 PMCID: PMC10198184 DOI: 10.2147/ccid.s402001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
Background Despite the increasing need for the improvement of enlarged facial pores, the treatment remains challenging. A few previous studies have reported the effects of micro-focused ultrasound with visualization (MFU-V) or intradermal incobotulinumtoxin-A (INCO) on enlarged facial pores. Objective To evaluate the efficacy and safety of combined treatment with superficial MFU-V and intradermal INCO for enlarged facial pores. Methods This single-center retrospective study included 20 patients treated with MFU-V and intradermal INCO to improve enlarged facial pores. Outcomes were evaluated 1, 4, 12, and 24 weeks after a single session of the combined procedure. Pore count and density were objectively quantitated using a three-dimensional scanner, and improvement was assessed using the physician and patient Global Aesthetic Improvement Scale (GAIS). Results The mean pore count and density decreased after one week and decreased by up to 62% until 24 weeks. After one week, almost all patients (100% in physician GAIS and 95% in patient GAIS) showed improvement with a grade 3 (much improved) or higher. All adverse events were transient. Conclusion Combined treatment with MFU-V and intradermal INCO could be effective and safe for reducing enlarged facial pores; the improvements can be sustained for up to 24 weeks.
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Affiliation(s)
- Je-Young Park
- Apkoo-Jung Oracle Dermatology Center, Seoul, Republic of Korea
| | - Ji Su Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Ran Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Hun Lee
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Human-Environment Interface Biology, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Hari-Raj A, Spataro EA. Evidence-Based Medicine for Nonsurgical Facial Rejuvenation. Facial Plast Surg 2023; 39:230-236. [PMID: 36584886 DOI: 10.1055/a-2005-0701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Options for nonsurgical facial rejuvenation treatment have increased significantly in both availability and popularity over the past two decades. However, there remains a paucity of clinical practice guidelines and evidence-based recommendations for these procedures. The purpose of this article is to assess the presence of current high-level research for various methods of nonsurgical facial rejuvenation using the Oxford Centre for Evidence-Based Medicine. Botulinum toxin injections remain the best-studied method, with several randomized controlled trials guiding recommendations for safety and efficacy. Several studies on injectable fillers document complications and recommendations to avoid these, but sample sizes are small and many are noncomparative. Deoxycholic acid has been well examined and Food and Drug Administration approved to address submental fat but has not been studied in other areas of the face. Although chemical peels, laser skin resurfacing, energy-based facial rejuvenation, microneedling, and platelet-rich plasma have a variety of facial rejuvenation applications with minimal side effect profiles, there is significant variability with treatment protocols, outcomes measures, and randomized controlled trials with extended follow-up to develop clinical practice guidelines.
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Affiliation(s)
- Amrita Hari-Raj
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Emily A Spataro
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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Contini M, Hollander MHJ, Vissink A, Schepers RH, Jansma J, Schortinghuis J. A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1522. [PMID: 36674277 PMCID: PMC9861614 DOI: 10.3390/ijerph20021522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Objective: to systematically review the efficacy of microfocused ultrasound (MFU) for facial skin tightening. Methods: A systematic search was performed (Pubmed, Embase) to assess the efficacy of single MFU treatments for facial skin tightening. Eligible studies included randomised controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Objective and subjective outcomes were assessed. Results: A total of 693 studies were identified of which 16 studies were eligible. All the studies involved female patients. MFU is capable of tightening the skin, as observed in studies measuring the results of brow lifts (0.47−1.7 mm) and submental lifts (measured as a 26−45 mm2 reduction in the submental area on lateral photographs). Data from the Global Aesthetic Improvement Scale (GAIS) were pooled, and the day 90 pooled subjective investigator reported scores (IGAIS) (n = 337) showed that 92% of the patients demonstrated an improvement in skin tightening and/or in wrinkle reduction which continued up to one year. Longer-term follow-up data are not available. The patient-reported pooled scores (SGAIS) (n = 81) showed that the skin improvements were mild and continued to increase from 42% (90 days) to 53% (360 days) post-treatment. The MFU treatment was moderately painful and caused transient erythema with or without oedema. Other adverse effects were rare (2%), including dysesthesia (numbness or hypersensitivity), bruising and stinging, mandibular burns, striations and contact dermatitis. Various device settings, treatment protocols and energies were applied. Excessive skin laxity and a BMI > 30 were posed as relative contraindications for MFU treatment because positive results declined with an increase in laxity and BMI. Conclusions: MFU treatment is effective in tightening female patients’ mildly to moderately lax facial skin. Future studies should focus on objective treatment outcomes, optimising treatment regimens and male patients.
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Affiliation(s)
- Mark Contini
- JC Kliniek, Boermarkeweg 44C, 7824 AA Emmen, The Netherlands
| | - Marijke H. J. Hollander
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Rutger H. Schepers
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
| | - Johan Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen (UMCG), 9700 RB Groningen, The Netherlands
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Engerer N, Frank K, Moellhoff N, Alfertshofer M, Giunta RE, Green JB, Lorenc PZ, Chaney GK, Ehrl D, Cotofana S. Aging of the Neck Decoded: New Insights for Minimally Invasive Treatments. Aesthetic Plast Surg 2022; 46:1698-1705. [PMID: 35701594 DOI: 10.1007/s00266-022-02961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many signs of aging manifest in the neck region, including platysmal bands, excess skin, horizontal neck lines and decreasing contour of the neck. While the clinical signs of an aged neck are well-known, data determining the underlying aging process are limited. OBJECTIVE To decode aging of the neck. MATERIALS AND METHODS This prospective study investigated elasticity and firmness of skin, muscle activity and skin displacement upon muscular contraction in the neck in 77 young-, middle- and old-age individuals. Objective outcome measures, including 3-dimensional imaging, cutometry and surface electromyography, were utilized for all assessments. RESULTS Mean firmness of skin decreased significantly from young to old individuals (0.37 ± 0.13 mm, 0.30 ± 0.12 mm and 0.26 ± 0.12 mm in young, middle and old subjects, respectively; p < 0.001). Gross elasticity decreased significantly from 75.1 ± 13.0% in young subjects, to 64.53 ± 15.7% in middle-aged subjects and 55.79 ± 13.0% in old subjects (p < 0.001). The mean y-axis skin displacement increased from 2.48 ± 4.33 mm in young subjects, to 3.11 ± 4.49 mm in middle-aged subjects and 3.61 ± 5.38 mm in old subjects (p = 0.006). The mean signal-to-noise ratio decreased significantly from 16.74 ± 5.77 µV in young subjects, to 14.41 ± 4.86 µV in middle-aged subjects and to 12.23 ± 5.99 µV in old subjects (p < 0.001). CONCLUSION This study provides insights into the interplay between skin elasticity, muscular activity and the reflected movement of the skin of the neck. Appreciation of these age-related changes lays the fundament for aesthetic treatments in this delicate region. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Nina Engerer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Riccardo E Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute, Coral Gables, Florida, USA
| | | | - Grace K Chaney
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA
| | - Denis Ehrl
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Stabile Building 9-38, 200 First Street, Rochester, MN, 55905, USA.
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Lio ML, Chang CC, Chuang ADC, Tsai LC, Chen CC. Quantified Facial Rejuvenation Utilizing High Intense Focus Ultrasound with Multiple Penetrative Depths. Clin Cosmet Investig Dermatol 2022; 15:489-496. [PMID: 35368623 PMCID: PMC8968221 DOI: 10.2147/ccid.s350556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Multiple penetration depths of high-intensity focused ultrasound (HIFU) treatment for facial rejuvenation have not been quantified. Methods We enrolled 12 participants (n=24) to undergo one session of HIFU rejuvenation between January 1, 2019, and January 10, 2020. We used a 2-, 4.5-, and 6-mm focal depth transducer on the upper and middle face. We evaluated efficacy on days 60 and 90 by using our specific assessment system. Results The average eyebrow peak and pupil-eyebrow peak angles significantly increased by 2° (p < 0.0005) and decreased by 1° (p < 0.0001), respectively, at day 90. The shortened eyebrow-iris length indicated that the forehead tissues had lifted and moved medially to the central face. Supraorbital tissues were also vertically elevated, marked by the eyebrow-orbital (p = 0.0016) and vertical palpebral fissure lengths (p = 0.0052), which both exhibited a 0.8-cm elevation. For the midface, the increased canthus-oral-nasal angle (p = 0.5881) and decreased tragus-oral length (p = 0.5881) indicated that laxity had been corrected through lifted oral commissure, though the data were not statistically significant. No serious side effects were observed. Conclusion HIFU treatment with multiple depths quantitatively improved both upper-facial rejuvenation and midface rejuvenation after a single session.
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Affiliation(s)
- Man-Lok Lio
- Department of General Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Chang-Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Cosmeceutics and Graduate Institute of Cosmeceutics, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan
| | - Andy Deng-Chi Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Li-Cheng Tsai
- Department of Dermatology, China Medical College Hospital, Taichung, Taiwan
| | - Chien-Chou Chen
- Department of Dermatology, Joe Chen Beauty Skin Clinic, Taichung City, Taiwan
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Khan U, Khalid N. A Systematic Review of the Clinical Efficacy of Micro-Focused Ultrasound Treatment for Skin Rejuvenation and Tightening. Cureus 2021; 13:e20163. [PMID: 35003992 PMCID: PMC8722640 DOI: 10.7759/cureus.20163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/23/2022] Open
Abstract
The demand for non-invasive skin-tightening techniques is continuously on the rise, as now numerous patients seek safe and effective alternative body, neck, and facial aesthetic surgical procedures. Micro-focused ultrasound (MFU) has been recently introduced as a novel energy modality for skin rejuvenation to produce a more significant wound healing response at various levels, including strong collagen remodeling and long-lasting clinical response. This literature study was intended to find the role and efficiency of using micro-focused ultrasound therapy in male and female patients aged 35-65. A total of 139 articles were extracted from the PubMed and Science Direct electronic databases. After a thorough evaluation and following the exclusion and inclusion criteria, 10 full-text articles were relevant to the study. The goal was to analyze and examine the effects and benefits of MFU treatment to improve the skin. In addition, all of the patients were evaluated to report the harms and risks associated with MFU treatment. The literature study results revealed that significant improvements in the overall aesthetics of sagging of the mid and lower face could be accomplished by using a micro-focused ultrasonic treatment plan. Patients report no considerable side effects, and the results were also long-lasting. MFU treatment can activate deeper tissues without causing injury to the epidermis, which sets it apart from all other skin tightening methods. Better improvements rates have been reported by both patients' self-assessment and clinical investigators' evaluation.
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Vachiramon V, Namasondhi A, Anuntrangsee T, Kositkuljorn C, Jurairattanaporn N. A study of combined microfocused ultrasound and hyaluronic acid dermal filler in the treatment of enlarged facial pores in Asians. J Cosmet Dermatol 2021; 20:3467-3474. [PMID: 34352146 DOI: 10.1111/jocd.14360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enlarged facial pores are a common cosmetic complaint in practice. Microfocused ultrasound with visualization (MFU-V) and low-degree crosslinked hyaluronic acid filler (L-HA) injection has recently become a popular procedure for skin rejuvenation. The effectiveness of the combined MFU-V and L-HA injection in the treatment of enlarged pores has not been evaluated. OBJECTIVES To compare the efficacy of MFU-V monotherapy (single technique) and MFU-V combined with L-HA injection (combined technique) for the treatment of enlarged facial pores in Asians. METHODS We conducted a randomized, single-blinded, split-face study on participants with enlarged facial pores. Each side of the face was randomly assigned to treatment with one session of single technique or combined technique. Pore volume was objectively measured by an Antera 3D® system. Subjective assessment was evaluated by one-blinded physician using a pore grading score (0-4). Patients rated the improvement in terms of satisfaction using the visual analog scale (VAS, 0-10). RESULTS Forty-six participants completed the study. The mean pore volume of both sides declined with statistical significance at every visit compared to baseline, with the lowest mean at 4 months post-treatment. The combined technique showed a lower mean pore volume than single technique throughout the follow-ups. Physician's subjective evaluation showed no statistically significant difference between the two techniques. The patient satisfaction score showed a similar trend to the mean pore volume, with a statistically significant difference at 4 and 6 months post-treatment. CONCLUSIONS Both techniques are effectively minimize enlarged facial pores. The combined technique resulted in more patient satisfaction.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Amornrut Namasondhi
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanaporn Anuntrangsee
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Yalici-Armagan B, Elcin G. Evaluation of microfocused ultrasound for improving skin laxity in the lower face: A retrospective study. Dermatol Ther 2020; 33:e14132. [PMID: 32770566 DOI: 10.1111/dth.14132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/24/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Basak Yalici-Armagan
- Department of Dermatology and Venereology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gonca Elcin
- Department of Dermatology and Venereology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Wanitphakdeedecha R, Yan C, Ng JNC, Nokdhes Y, Tantrapornpong P, Techapichetvanich T, Eimpunth S, Manuskiatti W. The efficacy of macro‐focused ultrasound in the treatment of upper facial laxity: A pilot study. J Cosmet Dermatol 2020; 19:1955-1961. [DOI: 10.1111/jocd.13550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Chadakan Yan
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Janice Natasha C. Ng
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Ya‐Nin Nokdhes
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Thanya Techapichetvanich
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Sasima Eimpunth
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | - Woraphong Manuskiatti
- Department of Dermatology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
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Ayatollahi A, Gholami J, Saberi M, Hosseini H, Firooz A. Systematic review and meta-analysis of safety and efficacy of high-intensity focused ultrasound (HIFU) for face and neck rejuvenation. Lasers Med Sci 2020; 35:1007-1024. [PMID: 32026164 DOI: 10.1007/s10103-020-02957-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/02/2020] [Indexed: 11/26/2022]
Abstract
High-intensity focused ultrasound (HIFU) is widely used for skin rejuvenation and tightening. The aim of this study was to determine the safety and efficacy of HIFU for face and neck rejuvenation. A systematic search of peer reviewed articles published before December 2017 was performed using Medline, Web of Science, and Scopus databases. Retrieved studies were screened, and clinical trials or follow-up studies which were evaluated the effect of HIFU on rejuvenation treatments of face and neck area were included. Risk of bias for each study was assessed and was reported. Safety and efficacy variables, which were reported more often in papers, were included in meta-analysis. Seventeen studies involving 477 participants were included in the analysis. Meta-analysis showed moderate improvement as scores of 2.74 (95% CI 2.06-3.43) and 2.68 (95% CI 1.92-3.45), out of 5 maximum score, for objective improvement score and subjective satisfaction score, respectively. Meta-analysis of mean pain score, assessed by a 0-10 Likert score, was 4.2 (95% CI 4.27-5.19). Edema and erythema showed considerable heterogeneity, and no hyperpigmentation was reported by included studies. Included studies used multiple and different outcome variables with different scoring at various time points. Long follow-up was not reported by majority of studies. HIFU is safe procedure in short term and has a moderate effect on rejuvenation of face and neck areas.
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Affiliation(s)
- Azin Ayatollahi
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saberi
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Hosseini
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
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Chang YC, Croix J, Javvaji S, Hernandez S, Chapas AM, MacGregor J. Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments. Lasers Surg Med 2019; 51:495-499. [PMID: 30664263 DOI: 10.1002/lsm.23058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2018] [Indexed: 11/10/2022]
Abstract
PURPOSE Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. DESIGN Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. SUMMARY Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. CONCLUSION Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Yunyoung C Chang
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
| | - Jennifer Croix
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
| | - Srimanasi Javvaji
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
| | - Shannon Hernandez
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
| | - Anne M Chapas
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
| | - Jennifer MacGregor
- Union Square Laser Dermatology, 19 Union Square West, 5th Floor, New York, New York
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