Evaluation of a microfocused ultrasound system for improving skin laxity and tightening in the lower face

Horizontal necklines correction with absorbable braided polydioxanone threads: Case series

INTRODUCTION

The prevalence of horizontal neck lines as a cosmetic concern is widely acknowledged, yet the available treatment options are limited, and no studies have investigated the use of polydioxanone-barbed threads. These threads, characterized by a finely braided structure, function as a scaffold to attract regenerative factors and facilitate the migration and proliferation of cells. This study aims to evaluate the outcomes of concurrent application of braided polydioxanone-barbed threads for addressing horizontal neck wrinkles.

METHODOLOGY

A retrospective case series involving four female participants (aged 41, 43, 45, and 46) treated with polydioxanone-barbed threads for horizontal neck wrinkles between January 2023 and July 2023 was conducted. Adult patients were assessed at an 8-week follow-up, revealing a significant reduction in wrinkle intensity based on the Horizontal Neck Wrinkle Severity Scale.

RESULTS

The analysis of horizontal neck lines demonstrated a notable decrease in wrinkle intensity according to the Horizontal Neck Wrinkle Severity Scale at the 8-week mark, and this improvement maintained statistical significance. Both patient Global Aesthetic Improvement Scale (GAIS) scores (90%-100%) and physician GAIS scores (100%) were rated as excellent.

CONCLUSION

The subdermal application of polydioxanone-barbed threads for horizontal neck lines proves to be a secure and efficacious approach for treating horizontal neck wrinkles, with no observed Tyndall effect. This technique shows promise for rejuvenating the skin in the horizontal neckline region.

Safety and Efficacy of High-Intensity Focused Ultrasound and Monopolar Radiofrequency Combination Therapy for Skin Tightening: A Retrospective Study in Malaysia

Background

High-intensity focused ultrasound (HIFU) and monopolar radiofrequency (MRF) are common treatment modalities that have shown significant results in skin tightening. Nevertheless, the novel combination of these two treatments is new to the Malaysian landscape. Thus, this study aims to investigate the safety and efficacy of this novel combination treatment for the Malaysian population.

Methods

This retrospective study included data on HIFU and MRF combination therapy for skin tightening collected from an aesthetic clinic in Johor Bahru, Malaysia from June 2018 to May 2021. Efficacy was assessed using the Global Aesthetic Improvement Scale (GAIS) and Glogau classification, while the safety of the treatment was analysed using pain scores and adverse events (AEs).

Results

A total of 56 patients with a mean age of 47.7 years old (SD 10.00) were included in this study. The majority of the patients had Fitzpatrick skin types III and IV. Most of the patients were Chinese, followed by Malay, Indian and others. Most patients (96.4%) showed clinically significant improvement in skin tightening after treatment, with 15 patients scoring 1 (very much improved) and 39 scoring 2 (improved). All patients reported transient mild erythema, with no serious AEs, such as burn, swelling, numbness or muscle weakness. Among the patients, 80% reported a pain score of 5, while 10% reported pain scores of 4 and 6.

Conclusion

Combining HIFU with MRF therapy improved GAIS scores by 96.4%, indicating a secure and efficient skin-tightening method. Transient erythema was shown to be the most common side effect of this combination.

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.

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.

A Systematic Review and Meta-Analysis of the Clinical Efficacy and Patients' Satisfaction of Micro-focused Ultrasound (MFU) Treatment for Facial Rejuvenation and Tightening

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 .

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.

Nonsurgical Rejuvenation of the Neck

Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic platysmal bands may benefit from botulinum toxin injections. Mild to moderately lax skin can be addressed with microfocused ultrasound or radiofrequency with microneedling. Significant sun damage and laxity can both be addressed with fractional ablative lasers. Options for submental preplatysmal fat include percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis. Of these, percutaneous radiofrequency has the highest patient satisfaction and lowest complication rate.

The Application of Subcutaneous Radiofrequency After Liposuction for the Lower Face and Neck Contouring Under Local Anesthesia

BACKGROUND

Radiofrequency-assisted liposuction (RFAL) is a new choice in energy-assisted body-contouring techniques. The purpose of this study is to observe the clinical effect and safety of RFAL on lower face and neck contouring under local anesthesia, and different outcome compared with traditional liposuction.

METHODS

From November 2016 to November 2020, a total of 72 patients with fat accumulation and skin laxity in lower face and neck, including 42 patients underwent subcutaneous radiofrequency after liposuction (group A) and 30 patients underwent traditional liposuction only (group B). The patient's parameters recorded involved age, sex, body mass index, the volume of fat aspirated, energy delivered, operative time, and complications. They were photographed for comparison before and after treatment. At 3 and 6 months after the operation, improvement in skin tightening and patient satisfaction was surveyed postoperatively and assessed by third-party surgeons.

RESULTS

At 6 months after the operation, evaluations scores of the contouring outcome had significant difference between 2 groups (3.0±0.9 versus 2.5±1.0, P =0.045). There was no significant difference at 3 months (2.8±1.0 versus 2.6±1.0, P =0.265). Although the satisfaction rate of group A was higher than that of group B both at 3 months (76.2% versus 66.7%) and 6 months (80.9% versus 60.0%), there were no significant differences in average score ( P >0.05). No significant complications or adverse events requiring further medical or surgical intervention after treatment.

CONCLUSION

Subcutaneous radiofrequency after Liposuction is a safe and effective treatment that can achieve significant improvement of the fat accumulation and skin laxity of the lower face and neck under local anesthesia.

Association of PDO threads and technologies-Facial treatment protocols

BACKGROUND

Aging is part of the immutable characteristics of the human being, and the search for treatments to alleviate the undesirable effects of aging is frequent in the dermatological office.

AIMS

This work proposes the technique of association of PDO threads with technologies and the description of the facial treatment protocols.

METHODS

For contextualization, two case studies of two patients subjected to the procedure are analyzed.

CONCLUSIONS

In recent years, there have been marked changes in facial rejuvenation techniques using PDO threads and these have shown satisfactory results for collagen biostimulation. Having technologies in dermatological clinics is a frequent reality, and sometimes, some doctors are in doubt about when to use them associated with PDO wires and in which sequence it should be done, ensuring patient safety and maintaining the integrity of the wires. This article aims to bring clarity about how to use technology and when is the right time. It is also intended to clarify that the PDO wire can be used in conjunction with the microfocused ultrasound technology, since the melting point of the PDO polymer is between 110° and 115°C.

A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening

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.

The role of topical capsaicin gel in pain management during microfocused ultrasound treatment for neck laxity

BACKGROUND

The transient receptor potential vanilloid 1 (TRPV1) provides a heat and pain sensation (nociception). Capsaicin, a TRPV1 agonist, has been shown to induce a refractory period in the nerve terminal expressing TRPV1 and create long-term nerve terminal defunctionalization.

OBJECTIVE

To evaluate the efficacy of capsaicin for pain reduction during microfocused ultrasound with visualization (MFU-V) treatment.

METHODS AND MATERIALS

A randomized, split-side study including 24 subjects was conducted. A combined 0.025% capsaicin gel and topical anesthetic were randomly applied on one side of the neck, and a topical anesthetic monotherapy was applied on the contralateral side for 30 min before MFU-V treatment. Pain score (visual analog scale, 0-10) was evaluated at T1 (before MFU-V), T2a (after the 4.5-mm transducer treatment), T2b (after the 3.0-mm transducer treatment), and T3 (after the entire treatment). Side effects were recorded.

RESULTS

Mean pain scores at T2a for combined and single regimens were 5.19 (±2.26) and 6.91 (±1.72), respectively (p < 0.001). The capsaicin-treated side had a lower pain score at T2b and T3 (p < 0.001). Redness was longer on the capsaicin-treated side (112.67 vs. 10.68 min, p < 0.001). No other adverse events including contact dermatitis were reported.

CONCLUSION

A single application of a combined 0.025% capsaicin gel with topical anesthesia produces a significantly lesser pain score during the MFU-V treatment. Defunctionalization of TRPV1 may explain the alleviation of painful sensations caused by heat from MFU-V.

The Efficacy of Noninvasive 1060-Nm Diode Lasers for Submental Lipolysis: A Pilot Study

Background

Submental fat is a noticeable fat in the submental region that is of great concern aesthetically, especially to female patients. A 1060-nm diode laser is a clinically proven device for the laser lipolysis of subcutaneous fat cells. This study aimed to evaluate the safety and efficacy of a 1060-nm diode laser for submental fat reduction.

Methods

Twenty subjects with unwanted localized submental fat were treated with a single session of a 1060-nm diode laser with an energy setting between 0.95 and 1.40 W/cm², depending on each patient's tolerance. Submental fat thickness measurements were documented at baseline, and 1, 3, and 6 months after treatment. Clinical photographs, ultrasound images, and adverse events were evaluated at each follow-up visit. Subjects responded to a satisfaction questionnaire at the end of the study.

Results

The subjects had a mean age of 34.55 ± 6.19 years, a mean body weight of 70.66 ± 10.55 kilograms, and most (95%) were women. The average energy setting was 0.95-1.40 W/cm², with a pain score of 3.90 ± 1.30 on a 0-to-10 scale. A significant reduction in submental fat thickness measured by ultrasound was noted at post-treatment month 3 (falling to 0.46 ± 0.13; P = 0.013). However, there was a slight increase in the submental fat thickness at the 6-month follow-up (to 0.48 ± 0.12); the change in the thickness relative to the baseline was nonsignificant (P = 0.121). Most subjects reported an improvement 6 months after the treatment. No severe adverse events were observed throughout the study period.

Conclusion

Our study demonstrated the potential role of 1060-nm Diode laser for the treatment of localized submental subcutaneous adiposities. It is a promising alternative treatment modality for patients seeking an in-office, nonsurgical procedure for fat reduction without severe complications.

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.

Molecular and Histological Evidence Detailing Clinically Observed Skin Improvement Following Cryolipolysis

Background

In addition to body contouring, there is anecdotal and clinical evidence of reduced laxity caused by skin tightening after cryolipolysis. However, it has not been established how cryolipolysis triggers dermal changes.

Objectives

The aim of this study was to investigate the fundamental mechanisms behind clinically observed dermal changes by molecular and immunohistochemistry (IHC) analytical methods.

Methods

This feasibility study involved 7 subjects who received cryolipolysis treatment. Tissue samples were harvested from 3 days to 5 weeks after treatment. RNA-sequencing examined differential gene expression of major collagens. RNA in situ hybridization (RNA-ISH) investigated the distribution of 1 of the gene markers for collagen type I (COL1A1). IHC for procollagen type I, heat shock protein 47 (HSP47), transforming growth factor β (TGF-β), and tropoelastin was performed and quantified.

Results

Gene expression analysis highlighted a gradual upregulation of collagen mRNA genes. RNA-ISH confirmed upregulation of COL1A1 mRNA and showed a homogeneous distribution through the dermis. IHC showed increases in protein expression. Quantification revealed a 3.62-fold increase of procollagen type I (P < 0.0071), a 2.91-fold increase of TGF-β (P < 0.041), a 1.54-fold increase of HSP47 (P < 0.007), and a 1.57-fold increase of tropoelastin (P < 0.39) compared with untreated areas.

Conclusions

This study revealed significant induction of molecular and protein markers of type I collagen, which supports neocollagenesis and may play an essential role in clinically relevant skin improvement. A dermal remodeling process driven by increased TGF-β and higher expression of HSP47 was observed. Overall, these data provide the first evidence of dermal remodeling and clarify the mechanism by which cryolipolysis may induce skin improvement.

Level of Evidence: 4

A Systematic Review of the Clinical Efficacy of Micro-Focused Ultrasound Treatment for Skin Rejuvenation and Tightening

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.

Tightening and Reduction of Unwanted Submental Fat Using Triple-Layer High-Intensity Focused Ultrasound: Clinical and 3-Dimensional Imaging Analysis

BACKGROUND

Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence of their use.

OBJECTIVE

The authors sought to evaluate the safety and efficacy of a novel triple-layer high-intensity focused ultrasound (HIFU) regimen for SMF reduction.

METHODS

Forty Korean subjects with moderate/severe SMF were evaluated after receiving a session of triple-layer HIFU treatments (using 3.0-, 4.5-, and 6.0-mm focusing transducers). The objective evaluation based on the 5-point Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) and patients' satisfaction based on the 7-point Subject Self-Rating Scale (SSRS) were determined 8 weeks after treatment. Three-dimensional image analysis was also performed.

RESULTS

At the follow-up visit, the proportion of treatment responders defined as subjects with ≥1-point improvement in CR-SMFRS was 62.5%, and the proportion of patients satisfied with appearance of their face and chin (score ≥4 on the SSRS) was 67.5% of the total patients. The results of 3-dimensional analysis were consistent with clinical observations. Only mild and transient side effects were observed for some patients with no serious adverse effects.

CONCLUSION

The triple-layer HIFU regimen including the novel 6.0-mm transducer has benefits for tightening and rejuvenation of the area with unwanted SMF, showing reasonable safety profiles.

Temperature-Controlled Monopolar Radiofrequency in the Treatment of Submental Skin Laxity: A Prospective Study

BACKGROUND

Laxity of the submental area is a common cosmetic complaint of the aging population.

OBJECTIVES

The aim of this study was to determine the safety and effectiveness of a temperature-controlled, minimally invasive percutaneous monopolar radiofrequency device to improve dermal laxity and achieve lift.

METHODS

A total of 72 subjects (35-65 years old) with mild to moderate skin laxity in the submental area were included in this single-center prospective study. All subjects received 1 treatment at baseline with an average subdermal temperature of 63°C. The primary endpoint was the proportion of subjects with at least a 20-mm2 decrease in surface area at Day 90 based on 3-dimensional photography. Secondary endpoints included skin elasticity measured by Cutometer, assessment by a blinded physician panel from 2-dimensional photographs, and physician- and subject-reported outcomes.

RESULTS

At Day 90, 72.1% (95% CI: 62.2%-84.0%; P < 0.001) of subjects achieved at least a 20-mm2 lift of the submental area. All Cutometer-measured skin elasticity values (R2, R5, R7) showed significant improvement by 180 days. The independent panel graded 74.2% of subjects as "improved" at 90 days (95% CI: 62.0%-84.2%; P < 0.001). The treatment was well tolerated, and only 1 possibly related serious adverse event was reported (pharyngeal inflammation).

CONCLUSIONS

Treatment with temperature-controlled monopolar radiofrequency alone is a safe and effective treatment to achieve submental lift for at least 6 months.

LEVEL OF EVIDENCE: 4

Paired facial treatment with 755nm picosecond laser with diffractive lens array and 1060nm laser lipolysis of the submentum: An open-label prospective trial

BACKGROUND

Performing multiple cosmetic treatments in a single session to target different aspects of facial rejuvenation is an effective regimen. Picosecond lasers with a fractionated handpiece can target fine lines, which can supplement submental fat reduction procedures. However, limited data exist on the safety and efficacy of single-session treatment strategies.

AIMS

To assess the safety and utility of paired facial treatment with 755 nm picosecond laser with diffractive lens array (DLA) and 1060 nm laser lipolysis of the submentum.

PATIENTS/METHODS

A prospective clinical study investigated the utility of paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm diode laser lipolysis of the submentum. Subjects received treatments during the same session. Subjects were enrolled to receive up to 3 picosecond laser and 2 lipolysis treatments at 2-8-week intervals.

RESULTS

Eleven subjects completed the study. Mean age was 52.1 years, and 81.8% were female. Fitzpatrick skin types II-VI were represented. For investigator global aesthetics improvement scores (GAIS), 63.6%, 81.8%, and 85.7% had improvement from baseline at 30-, 90-, and 180-day follow-up, respectively. At 180-day follow-up, 100% maintained improvement from 90-day follow-up. At 90-day follow-up, calculations for neck laxity showed a significant improvement of 11.7% from baseline (p < 0.001) with a mean amount of lift of 42.7 mm² , which was above the predetermined threshold (20 mm² ). No serious or unexpected treatment effects were observed.

CONCLUSION

Paired facial treatment with 755 nm picosecond laser with DLA and 1060 nm laser lipolysis of the submentum improved clinical aesthetic outcomes. This treatment regimen was demonstrated to be safe, well-tolerated, and well-liked by subjects.

Single Treatment, Single Depth Superficial Microfocused Ultrasound with Visualization for Rhytid Improvement

Background

Standard lifting and tightening protocols with microfocused ultrasound with visualization (MFU-V, Ultherapy) comprise the use of multiple transducer depths. We developed a shortened, single depth treatment protocol for patients seeking skin rejuvenation.

Methods

Single-center, prospective case series. Subjects with static periorbital wrinkles, perioral wrinkles, or accordion lines had a single MFU-V treatment comprising up to 340 lines (periorbital 120, perioral 100, and accordion 120) with the superficial depth transducer (10.0 MHz/1.5 mm). Efficacy was assessed using established rating scales as well as clinician- and subject-reported Global Aesthetic Improvement Scales at baseline, 90, and 180 days, and each subject served as their own control. Adverse events were documented.

Results

Nine subjects, women aged 38-64, received treatment. At 180 days, post treatment clinicians reported visible improvements in periorbital lines (6/6 cases), accordion lines (5/6 cases), and perioral lines (3/6 cases). Subjects' self-assessments mirrored those of the clinicians, reporting improvements in accordion lines (5/6 cases improved, 1/6 cases much improved), periorbital lines (3/6 cases improved, 3/6 cases much improved) and perioral lines (2/6 cases improved, 2/6 cases much improved). Subject-rated satisfaction was high (accordion lines 6/6 cases, periorbital lines 4/6 cases and perioral lines 4/6 cases). All subjects experienced mild, transient erythema; in one subject, wheals persisted for 24 hours, resolving on application of mild topical corticosteroid.

Conclusions

Shortened protocol, single depth MFU-V treatment was well-tolerated. It provided aesthetic improvements in periorbital and accordion lines, and to a lesser extent in perioral lines. Its utility as a noninvasive therapy for superficial skin rejuvenation warrants further investigation.

Single Treatment Protocol With Microneedle Fractional Radiofrequency for Treatment of Body Skin Laxity and Fat Deposits

Background and Objectives

Treatment modalities have been developed to address patient concerns with skin laxity and focal adipose excess. A previously published multicenter clinical trial reported improvement in cellulite severity after a single dermal and subcutaneous treatment on the upper thigh with a microneedle radiofrequency device. In the current study, this device was used to improve the esthetic appearance of body skin laxity and localized fat deposits above the knee, upper arms, and upper‐mid back/axillary region (“bra‐line”).

Study Design/Materials and Methods

Subjects with cellulite, skin laxity, and/or subcutaneous adipose excess in the suprapatellar region of the anterior thigh, upper arms, and bra‐line underwent a single dermal and/or subcutaneous treatment. Investigators and subjects assessed outcome at 1‐, 3‐, and 6‐month follow‐up, using 5‐point Likert scales for global esthetic improvement, skin laxity improvement, and satisfaction.

Results

In total, 31 females (mean age 51 ± 9 years) with Fitzpatrick skin types I–IV received a single treatment on 62 treatment areas: 22 upper arms, 34 suprapatellar, and 6 bra‐lines. Investigator assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms and bra‐line demonstrated improvements in 100% of subjects at all timepoints; for the suprapatellar region, these values were 69%, 92%, 65%, and 85%, 92%, 65%, respectively. Investigator satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 90% for upper arms; 80%, 80%, 80% for bra‐line; and 50%, 81%, 65% for suprapatellar region. Subject self‐assessments at 1, 3, and 6 months for global esthetic improvement and skin laxity for the upper arms demonstrated improvements in 100% of subjects at all timepoints; for the bra‐line, these values were 40%, 60%, 80%, and 60%, 60%, 80%, respectively; for the suprapatellar region, these values were 81%, 92%, 88%, and 69%, 85%, 88%, respectively. Subject satisfaction at each timepoint was satisfied or very satisfied in 80%, 100%, 100% for upper arms; 40%, 40%, 80% for bra‐line; and 50%, 77%, 65% for suprapatellar. Treatments were well tolerated with subjects reporting transient erythema and edema associated with 69% and 46% of treatments, respectively. Mild bruising, resolving within 5 days, was reported after 32% of the treatments.

Conclusion

Microneedle fractional radiofrequency provides a single treatment protocol to improve the esthetic appearance of body skin laxity and localized adipose excess to the upper arms, bra‐line, and suprapatellar regions. Further study is warranted to evaluate the degree of improvement and long‐term effect beyond 6 months post‐treatment. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC

Comparison of microfocused ultrasound with visualization for skin laxity among vegan and omnivore patients

BACKGROUND

The aging of facial structures depends on genetic, anatomic, chronologic, and environmental factors that affect the skin and underlying tissues. Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and effective treatment for skin laxity. As the nutritional status may contribute to skin aging, it would be interesting to evaluate whether different dietary patterns can also influence the response to MFU-V treatment for skin laxity.

AIMS

The aim of this study is to compare the outcome of MFU-V therapy between omnivore and vegan patients.

METHODS

Twenty-seven vegan and twenty-seven omnivorous women who underwent MFU-V treatment for laxity of lower face and neck were enrolled. The clinical outcome was evaluated using the FLR (Facial Laxity Rating) scale after 3 and 6 months from treatment.

RESULTS

At baseline, no significant differences were found in terms of FLR scale in both treated sites. After 3 months, reduction in FLR scale was significantly lower for vegans both on face (P = .04) and neck (P = .004). At 6 months, vegan patients had a worse clinical outcome on lower face (P = .001) and neck (P < .001).

CONCLUSION

The present study suggests that a vegan diet may negatively influence the outcome of a MFU-V treatment.

Nonsurgical Treatment of Postpartum Lower Abdominal Skin and Soft-Tissue Laxity Using Microfocused Ultrasound With Visualization

BACKGROUND

Microfocused ultrasound with visualization (MFU-V) is a well-established treatment modality for skin tightening. There is a paucity of evidence for its use in body treatments, such as the lower abdomen.

OBJECTIVE

To investigate the effectiveness and safety of MFU-V in treating lower abdominal skin and soft-tissue laxity in postpartum women.

METHODS

The lower abdomen of 20 female patients between 6 and 24 months postpartum are treated with MFU-V using 1.5-, 3.0-, and 4.5-mm transducers. Data are prospectively collected and analyzed at 3 and 6 months using subject-reported and investigator-reported outcome measures. One additional patient underwent planned abdominoplasty 6 weeks after MFU-V treatment with tissue assessed intraoperatively and histologically.

RESULTS

There was a mean improvement of 1.0 and 1.3 grades at 6 months using the investigator-reported and patient-reported skin laxity scale, respectively (p < .001). Patient-reported outcomes and satisfaction survey showed consistent improvement at 6 months. Histological examination of pretreated tissue showed increased total collagen, increased number and thickness of fibrous septae, and no change in fat cells within pretreated tissue compared with the control. No significant adverse events were recorded.

CONCLUSION

MFU-V is an effective and safe treatment modality for lower abdominal skin laxity in postpartum patients.

Practical Considerations in Adopting New Technology for Facial Cosmetic Procedures

The field of facial plastic and reconstructive surgery encompasses both surgical and nonsurgical facets, creating a supplemental level of care and an additional layer of complexity. Determining the "best course of care" can be very difficult in experienced situations, but even more so when considering adopting an emerging technology. A basic and practical method of analyzing a new technology requires investigating the risk-to-benefit assessment, the utility and clinical outcomes compared with other treatment options, and an introspective ethical appraisal of whether the technology is foremost for patient care purposes. Even after employing a new technology, constant monitoring and reevaluation of the results is necessary to determine if it should be continued or altered.

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.

Nerve Blocks Prior to Microfocused Ultrasound Treatment are Safe and Reduce Patient Discomfort

BACKGROUND

Microfocused ultrasound with visualization has become one of the more popular nonsurgical facial rejuvenation therapies available. Although the treatment has gained wide acceptance, providing adequate pain relief during the procedure can be challenging.

OBJECTIVES

The aim of this study was to test our hypothesis that nerve blocks prior to treatment would be well tolerated and significantly reduce patient discomfort.

METHODS

Subjects undergoing microfocused ultrasound were offered the choice of participating in a split face nerve block, bilateral block, or a control group. Nerves targeted included infraorbital, supratrochlear, supraorbital, zygomaticofrontal, mental, great auricular, and cervical plexus. Pain assessment was based on a 10-point Wong-Backer FACES Pain score.

RESULTS

A total of 65 patients were included in the study: 28 in the split face group, 19 in the bilateral block group, and 18 without a block. The mean [standard deviation] pain score of the bilateral block cohort was 3.9 [1.2], and that of the control group was 5.1 [1.7] (P = 0.001). Patients in the split face cohort reported a higher pain score on the unblocked side of the face (7.5 [1.3]) than on the blocked side (2.9 [1.0]) (P < 0.001). The mean pain score for local anesthetic injection was 2.7 and 1.4 for the split face and the bilateral groups, respectively. There were no adverse events.

CONCLUSIONS

Nerve blocks are well tolerated and significantly improve patient comfort during microfocused ultrasound treatment without compromising outcomes or increasing adverse events.

LEVEL OF EVIDENCE: 2

Systematic review and meta-analysis of safety and efficacy of high-intensity focused ultrasound (HIFU) for face and neck rejuvenation

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.

Practical Guidance for Optimizing Patient Comfort During Microfocused Ultrasound with Visualization and Improving Patient Satisfaction

BACKGROUND

Microfocused ultrasound with visualization (MFU-V; Ultherapy®) is an effective method for correction of skin laxity through lifting and tightening skin on the face, neck, and décolleté as well as on other parts of the body such as the knees, arms, and abdomen. In addition to being a noninvasive modality for tissue tightening, MFU-V has a biological effect on tissue, rejuvenating the skin through stimulation of elastogenesis and neocollagenesis. MFU-V is also commonly combined with other interventions such as fillers, neuromodulators, and absorbable suspension sutures.

OBJECTIVES

The aim of this study was to share the extensive experience of the authors in optimizing comfort for their MFU-V patients in order to provide guidance to the broader community surrounding optimal patient comfort with this procedure.

METHODS

The authors discuss their approaches to patient comfort and satisfaction. Elements of each approach include patient selection, pharmacologic and nonpharmacologic comfort measures, and how prioritization of patient comfort affects both their individual patients and practices.

RESULTS

The authors share their approaches for optimizing patient comfort during the procedure and provide an overview of both pharmacologic and nonpharmacologic measures that can be adopted to support patient comfort and satisfaction. The similarities and differences of each approach are discussed.

CONCLUSIONS

In addition to diligent patient selection, the authors find that attention to patient comfort is directly related to satisfaction and appears to be a primary factor in patients' decisions to return for additional treatments.

Treatment of Horizontal Neck Wrinkles with Hyaluronic Acid Filler: A Retrospective Case Series

Supplemental Digital Content is available in the text.

Horizontal neck wrinkles are a common aesthetic deficiency but limited treatment options exist and none have been studied with follow-ups of over 2 months.

High-Intensity Focused Ultrasound: A Satisfactory Noninvasive Procedure for Neck Rejuvenation

BACKGROUND

High-intensity focused ultrasound (HIFU) is an advanced technology that has been developed in response to the growing demand for noninvasive face rejuvenation.

OBJECTIVES

The aim of this study was to evaluate the rejuvenation effects, patient satisfaction, and safety of HIFU treatment of the neck in a European population.

METHODS

This was a prospective study of 20 patients. The patients were treated with HIFU, and the outcomes were investigated. The modified FACE-Objective Assessment Scale, developed by our team, and the subjective Investigator Global Improvement Assessment Scale (IGIAS; -1 to 3) were used to judge the results of HIFU. Five blinded evaluators scored the procedure outcomes based on photographs taken before and 6 months after the procedure. Side effects were reported and pain was evaluated on a visual analog scale of 0 to 10.

RESULTS

Clinical results, such as better definition of the cervicomental angle, were observed in the treated areas. The pretreatment and posttreatment evaluation scores for double chin and skin laxity were evaluated by 4 of 5 evaluators as significantly improved. The IGIAS score was between 1 and 5 in 2 patients, between 6 and 10 in 7 patients, and between 11 and 15 in 11 patients. No patients had a score between -5 and 0. No major complications were reported. The mean pain scores for the D4, M7, and S7 transducer treatments were 5.6 (range, 4.5-6.7), 4.2 (range, 2.5-5.9), and 2.05 (range, 1.05-3.05), respectively.

CONCLUSIONS

HIFU may be considered a satisfactory, simple, reproducible, rapid, and safe procedure for neck rejuvenation.

Level of Evidence: 4.

Molecular Mechanisms of Dermal Aging and Antiaging Approaches

The dermis is primarily composed of the extracellular matrix (ECM) and fibroblasts. During the aging process, the dermis undergoes significant changes. Collagen, which is a major component of ECM, becomes fragmented and coarsely distributed, and its total amount decreases. This is mainly due to increased activity of matrix metalloproteinases, and impaired transforming growth factor-β signaling induced by reactive oxygen species generated during aging. The reduction in the amount of collagen hinders the mechanical interaction between fibroblasts and the ECM, and consequently leads to the deterioration of fibroblast function and further decrease in the amount of dermal collagen. Other ECM components, including elastic fibers, glycosaminglycans (GAGs), and proteoglycans (PGs), also change during aging, ultimately leading to a reduction in the amount of functional components. Elastic fibers decrease in intrinsically aged skin, but accumulate abnormally in photoaged skin. The changes in the levels of GAGs and PGs are highly diverse, and previous studies have reported conflicting results. A reduction in the levels of functional dermal components results in the emergence of clinical aging features, such as wrinkles and reduced elasticity. Various antiaging approaches, including topicals, energy-based procedures, and dermal fillers, can restore the molecular features of dermal aging with clinical efficacy. This review summarizes the current understanding of skin aging at the molecular level, and associated treatments, to put some of the new antiaging technology that has emerged in this rapidly expanding field into molecular context.

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments

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.

Skin physiology and safety of microfocused ultrasound with visualization for improving skin laxity

Purpose

The efficacy of microfocused ultrasound with visualization (MFU-V; Ultherapy^®) has been demonstrated in clinical studies and daily practice. However, data addressing skin physiology after MFU-V treatment are lacking. This observational evaluation was aimed to assess skin physiology before and after MFU-V treatment using noninvasive biophysical measurements.

Patients and methods

Twenty-two female patients with moderate-to-severe skin sagging at the jawline and submental region on the Merz Aesthetics Scale obtained a single MFU-V treatment according to protocol. Skin function measurements focused on short-term effects up to 3 days and long-term effects up to 24 weeks after treatment. Skin temperature, transepidermal water loss, skin hydration, erythema, elasticity, and skin thickness and density were evaluated under standardized conditions. Pain was assessed using a validated numeric visual analog scale.

Results

Skin temperature remained in a physiologic range and no significant increase was noted at day 3 after MFU-V treatment. Transepidermal water loss, hydration, and erythema values were fairly stable and showed no significant differences at short- and long-term measurements vs baseline. At week 4 after a single MFU-V treatment, gross and net elasticity values were significantly decreased (P=0.003 and P=0.0001, respectively), followed by significantly increased values at week 12 (P=0.015, P=0.046) and week 24 (P=0.001, P=0.049). Edema due to MFU-V treatment resolved without sequelae. For all patients, pain diminished shortly after treatment. No adverse events occurred during the 24-week follow-up period.

Conclusions

MFU-V treatment is well tolerated and it does not alter the epidermal barrier function or physiology of skin. Significant increase in the elasticity of skin was observed at 12 and 24 weeks after a single treatment, which reflects improvement in dermal tissue function. These short- and long-term effects are congruous with the mode of action of MFU-V due to a proven intrinsic tissue remodeling process.

Clinical and Biophysical Outcomes of Combining Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite Filler for Facial Treatment

Introduction

Combined cosmetic treatments are becoming increasingly popular. The objective of this clinical evaluation was to assess the long-term safety and efficacy of combining microfocused ultrasound with visualization (MFU-V) treatment with a calcium hydroxylapatite (CaHA) dermal filler to tighten skin at the submental region and contour the jawline.

Methods

Women with loss of contour and skin laxity in the lower face received MFU-V treatment. If subjects did not respond satisfactorily after 12 weeks, they received CaHA to the jawline. Evaluations—which were performed by blinded raters at baseline and after 12, 24, and 48 weeks—included live Global Aesthetic Improvement Scale (GAIS) ratings, Merz Aesthetic Scale (MAS) ratings, skin parameters, and tolerability.

Results

Of the 22 subjects, 9 received combined treatments. GAIS scores showed that subjects were much and very much improved (50% each) at 48 weeks. The MAS score was decreased by at least one point in 89% of subjects. Skin thickness was significantly improved after 24 weeks (p < 0.05) and remained above baseline after 48 weeks. Skin firmness was significantly improved after 48 weeks (p < 0.05). No unexpected adverse events were reported.

Conclusion

Combined MFU-V and CaHA treatments for laxity in the lower face did not alter skin barrier function, improved appearance, and slowed visible skin aging processes for at least 48 weeks.

Funding

Merz Pharmaceuticals GmbH.

Microfocused ultrasound in combination with diluted calcium hydroxylapatite for improving skin laxity and the appearance of lines in the neck and décolletage

BACKGROUND

Skin laxity and wrinkling on the neck and décolletage reveal age as reliably as the face.

OBJECTIVE

To evaluate the combined use of microfocused ultrasound with visualization (MFU-V; Ultherapy^® ) and diluted calcium hydroxylapatite (CaHA; Radiesse^® ) for treating the neck and décolletage.

METHODS

Subjects with moderate-to-severe lines on the neck and/or décolletage were retrospectively enrolled. MFU-V was applied using 7 and 10 MHz transducers followed by subdermal injection of CaHA diluted 1:1 with lidocaine solution. Photographs at baseline and 90 days were assessed by two independent, blinded evaluators using three scales: Merz Aesthetics décolleté wrinkles, Fabi-Bolton chest wrinkle, and Allergan transverse neck lines scales.

RESULTS

A total of 47 subjects were treated as follows: 29 (neck only), five (décolletage only), and 13 (both areas). Mean neckline score improved from 2.6 (moderate-to-severe lines) at baseline to 1.3 (mild lines) 90 days after treatment (P < .001). Mean décolletage scores improved from 2.6 and 3.3 (moderate-to-severe wrinkles) on the Merz Aesthetics and Fabi-Bolton scales, respectively, to 1.1 and 1.8 (mild wrinkles), respectively, after treatment (both P < .001). Both procedures were well tolerated with high subject satisfaction.

CONCLUSIONS

Combining MFU-V with 1:1 diluted CaHA is effective for improving the appearance of neck and décolletage lines and wrinkles.

Age and Hydration dependence of jowl and forearm skin firmness in young and mature women

BACKGROUND

Quantitative assessment of possible linkages between skin's firmness and water content is useful for cosmetic and clinical purposes and to better understand features of advancing age.

OBJECTIVES

Our goals were to characterize age-related differential features in skin firmness in women and determine the relationship between skin firmness and indices of skin water.

METHODS

Skin firmness was quantified using handheld devices that measure the force to indent skin 0.3 and 1.3 mm (F0.3 and F1.3). Skin hydration was quantified using handheld devices that measured tissue dielectric constant (TDC) at 300 MHz to skin depths of 0.5 and 2.0-2.5 mm. All parameters were measured bilaterally in the jowl area and volar forearm of 60 women grouped by age <45 years (YOUNG) and ≥45 years old (MATURE).

RESULTS

All measured parameters were bilaterally symmetrical at jowl and forearm. Forearm and jowl indentation forces were greater in YOUNG with statistically significant declines with advancing age with regression relations most evident at shallower indentation depths (P < .001). Quantitative relations for arm and jowl were F_0.3 = 0.256 × AGE + 32.7 mN and F_0.3 = -0.07 × AGE + 17.7 mN. Firmness was related to TDC values only when indentation force and TDC were assessed on the arm at the shallowest skin depths, as weakly related to firmness and was observed to change with age only when measured to a depth of 0.5 mm represented by TDC5 = 0.096 × AGE + 32.7.

CONCLUSIONS

Experimental finding show clear differences in skin firmness between age-groups with skin hydration playing a minor role. Possible explanations and suggestions for further studies are provided.

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.