High-intensity focused ultrasound for the reduction of subcutaneous adipose tissue using multiple treatment techniques

Micro-Focused Ultrasound Therapy in Patients with Urogenital Atrophy and Vaginal Laxity

Vaginal laxity (VL) and genitourinary syndromes of menopause (GSM) create physical, psychological, and functional problem for women and their partners. We aimed to evaluate the efficacy and safety of micro-focused ultrasound (MFU) therapy performed twice in the vaginal canal in a patients with VL and GSM. A total of 20 women with GSM and VL were treated with MFU Ultravera by Hironic. The treatment course consisted of two vaginal applications of MFU at an interval of 6 weeks. The clinical effects of the protocol were evaluated using the Vaginal Laxity Questionnaire (VLQ), the Vaginal Health Index (VHI), and the Female Sexual Function Index (FSFI). The overall values of the vaginal laxity evaluation for the total subject population showed a statistically significant improvement between the baseline and the findings at 3 and 6 months after treatment. The effect of therapy was consistent across all domains of FSFI. It peaked at the 6 week follow-up visit (from 26.5 to 32) and plateaued at 12 weeks and 6 months. There was a significant VHI improvement over time, with the greatest and most significant change between the study entry and 21 days after treatment; the VHI score leveled off up to 3 months after the procedures. MFU therapy, performed twice in the vaginal canal, showed promising efficacy and safety profiles, meriting further investigation.

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.

The combination of extracorporeal shock wave therapy and noncontact apoptosis-inducing radiofrequency achieved significant waist circumferential reduction: a pilot study

BACKGROUND AND AIMS

A paradigm shift towards noninvasive body contouring has occurred over the past few years. Radiofrequency (RF) is one popular treatment method. Noncontact-type RF systems with frequencies in the tens of megahertz represent a novel approach. The current pilot study investigated the efficacy of an interesting combination of extracorporeal shock wave therapy (ESWT) and an apoptosis-inducing RF (AiRF) system for circumferential reduction.

SUBJECTS AND METHODS

Twenty-seven females, ages ranging from 13-69 years, (mean age 37.96 years) participated in the study. They were assigned to two treatment-based groups: Group A (n=19) and Group B (n=8). A voluntary daily dietary restriction plan of 500 kcal was put in place for all subjects. A combination of two different devices was used; an extracorporeal shock wave therapy (ESWT) system and a 27.12 MHz AiRF system. Either 4 (n=28) or 6 sessions (n=19) were given, one week apart. In Group A, the ESWT was applied before the RF with the reverse order of application in Group B. Weight and waist circumference were noted at baseline, then one week after the 4^th and the 6^th treatment sessions at which points clinical photography was also obtained.

RESULTS

All patients showed statistically significant waist circumferential loss in both the 4- and 6-week treated groups: Group A, 6.3 cm and 8.8 cm; Group B, 5.9 cm and 6.4 cm, respectively. Greater circumference loss tended to be seen in Group A in both groups, but without statistical significance. No patient complained of pain during or after the treatment sessions, and there were no adverse events.

CONCLUSIONS

This pilot study showed that the combination of ESWT and AiRF was safe and effective for significant waist circumferential reduction. The results tended to be better when ESWT was applied before AiRF, although the difference was not significant.

Assessment of equivalence of adipose tissue treatment with a noncontact field RF system delivering 200 W for 30 min and 300 W for 20 min: An in vivo porcine study

BACKGROUND AND AIMS

Abdominal circumferential reduction with noncontact high frequency apoptosis-inducing field RF (AiRF) is becoming very popular. The present study compared the treatment results from two different sets of parameters giving the same dose from the same system in an in vivo porcine model.

MATERIALS AND METHODS

Two 10 cm × 10 cm areas were symmetrically marked on both sides of the midline (total of 4 areas) over the rectus abdominis muscle of two anesthetized female micropigs. In Animal A (G1), 27.12 MHz AiRF treatment was given at 200 W for 30 min, and 300 W for 20 min in Animal B (G2). Four sessions were performed at weekly intervals. Gross observation by a veterinary specialist was performed on a daily basis. Temperature measurements (fat and skin), clinical photography and ultrasound imaging were carried out at each session. In addition, blood chemistry was performed before each session to check lipid levels, any adverse changes in markers for liver damage in addition to an enzyme-linked immunosorbent assay (ELISA) for raised levels of TNF-α and IL-1β. Biopsies were taken and routinely processed for hematoxylin and eosin, Toluidine blue and oil red O stains to examine for tissue damage at baseline and after each treatment. TUNEL assays were performed to check of apoptotic-related DNA damage. Follow-up assessments included photography, ultrasound, ELISA tests and biopsies which were taken regularly up to 90 days after the final treatment.

RESULTS

The maximum adipose tissue temperatures at and over the apoptotic threshold of 43°C were reached and maintained in both G1 and G2. The skin surface temperature was slightly higher in G2 after 20 min than in G1 after 30 min, but was still below 43°C. Gross and magnified observation revealed no appreciable differences or thermally-mediated damage between the skin of either of the two groups after the treatments or during the 90-day follow-up period. No lasting erythema or any other adverse event was seen in either group. The liver enzyme markers showed very similar patterns over the 4 weeks of treatment compared with baseline with no levels outside of the normal range. Triglycerides were all within normal rage with no significant differences between the groups. Remarkably similar patterns were noted for the ELISAs in both groups performed over the 4 weeks of treatment and at periods during the 90-day follow-up with no notable abnormal changes in levels. Staining patterns for both G1 and G2 specimens were similar for all stain types during treatment and the 90-day follow-up, showing decreased numbers of adipocytes by the 90-day point. The ultrasound findings revealed a 44.8% and 55.6% decrease in the adipose layer for G1 and G2, respectively, at the 90-day assessment.

CONCLUSIONS

The 200 W AiRF treatment for 30 min (G1) and the 300 W AiRF treatment for 20 min (G2) produced very similar results in the porcine model for all assessments and at all assessment points during and up to 90 days after treatment, with slightly better findings suggested for G2. Based on the above findings, the two different settings, delivering the same dose, produced good results with no skin damage and no adverse events. This has implications in busy clinics for AiRF treatment, where the shorter treatment time could represent time saving for the clinic and the patient without compromising safety and giving equal if not better efficacy.

MRI-guided focused ultrasound surgery in musculoskeletal diseases: the hot topics

MRI-guided focused ultrasound surgery (MRgFUS) is a minimally invasive treatment guided by the most sophisticated imaging tool available in today's clinical practice. Both the imaging and therapeutic sides of the equipment are based on non-ionizing energy. This technique is a very promising option as potential treatment for several pathologies, including musculoskeletal (MSK) disorders. Apart from clinical applications, MRgFUS technology is the result of long, heavy and cumulative efforts exploring the effects of ultrasound on biological tissues and function, the generation of focused ultrasound and treatment monitoring by MRI. The aim of this article is to give an updated overview on a "new" interventional technique and on its applications for MSK and allied sciences.

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.