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happen in which I share my own personal experiences of it; and during treatment I employ what I call ‘talkanaesthesia’ – a distraction technique using conversation if a patient appears anxious – as well as oral painkillers that take into account recommended protocols and depend on a patient’s individual medical history, if necessary. For up to an hour or so following treatment a small proportion of patients may experience redness, swelling, tingling or tenderness to the touch in treated areas, but these side effects are mild and temporary. 3,20 When complications arise, they are invariably practitioner-dependent rather than treatmentdependent, and I believe if a practitioner manages this process well, the patient will not experience problems or require downtime. While there is some tightening of the skin immediately after treatment, the wound-healing response stimulates tissue remodelling over 90-180 days.21 The results are most visible after about three months, and beneficial effects are durable and generally reported to last between six and 18 months.22 Research and safety Pre-clinical studies demonstrate the ability of MFU to reach the subcutaneous fat, facial superficial musculoaponeurotic system (SMAS), the fan-shaped area where the facial muscles connect with the dermis, to cause tissue contraction.5,6,9 It has been indicated in a study by Alam et al that the Ulthera device can tighten the brow by treating the full face and neck.3 One study, by Oni et al, indicated overall improvement in skin laxity in 63.6% of evaluated patients when using the device on the lower face/neck and at day 90, 65.6% of patients had perceived improvement in the skin laxity.23 In another study, by Fabi et al, which evaluated the safety and efficiency of MFU-V for treating the face and neck for skin laxity 180 days after treatment, it was suggested that 77.7% of women treated achieved noticeable improvement.16 The Food and Drug Administration cleared the Ulthera MFU-V device in 2009 for eyebrow lift following full-face treatment; in 2012 it gained approval for lifting the tissue beneath the chin and neck; and in 2014 for treating the chest to improve the décolleté.24 A number of studies, of which some are mentioned in this article, have indicated that the use of focused ultrasound is safe and effective for tightening and lifting skin in the neck, but also in other anatomical regions such as the upper arms, thighs, and knees.25 An evaluation of MFU-V for the treatment of décolletage laxity and rhytids has suggested this is also safe.26,27 While discomfort is commonly reported, one study suggested that this pain was not significantly different to that endured during other forms of skin-tightening.3,19, 28 Conclusion To gain valuable tips and guidance I have recently spent a week at one of the leading MFU clinics based in the US and have learnt that, as both a practitioner and a patient, the treatment can be enhanced in several ways. I would recommend fellow practitioners also take part in continued training to develop their knowledge and understanding of MFU treatments. My experience has taught me that, first, the practitioner should manage the patient’s expectations with candour – someone who requires a more invasive approach, such as a facelift, should be advised accordingly. Secondly, during treatment, a practitioner should observe a patient’s body language to respond to signs of tension. Finally, it is important for the practitioner to maintain an ongoing relationship with the patient following treatment in order to reassure them, as the results will take time to manifest and side effects may occur. In my opinion, MFU is an effective and safe non-invasive form of treatment to lift and tighten skin, which gives patients a fresher, natural look with minimal discomfort and no downtime. Please note
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that, as with all aesthetic procedures, its effectiveness depends on the skill and technique of the practitioner, which should be continually developed and improved upon through comprehensive training. Dr Galyna Selezneva is an aesthetic medical doctor currently practising at the Dr Rita Rakus clinic in London. She is a specialist in non-invasive procedures for face and body, using the latest technology including energy devices and laser treatments. Dr Selezneva specialises in the fat-freezing CoolSculpting treatment.
Dr Galyna Selezneva will present a BTL Aesthetics Expert Clinic at the Aesthetics Conference and Exhibition 2016. Visit www.aestheticsconference.com/programme to find out more. REFERENCES 1. MacGregor, J & Tanzi, E, (2013) Microfocused Ultrasound for Skin Tightening, Unionderm, <https:// www.unionderm.com/documents/SCMS_Vol_32_No_1_Microfocused_Ultrasound.pdf> 2. Fabi S.G, (2015a) Noninvasive skin tightening: focus on new ultrasound techniques, Clinical, Cosmetic and Investigational Dermatology, 8 pp. 47–52 3. Alam M, White L.E, Martin, N et al, (2010) Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study, Journal of the American Academy of Dermatology, 62 pp. 262–69 4. Dubinsky T.J, Cuevas C, Dighe M.K, Kolokythas O, Hwang J.H, (2008), High-intensity focused ultrasound: current potential and oncologic applications, AJR. American Journal of Roentgenology, 190 pp. 191–99 5. White W.M, Makin I.R, Barthe P.G, Slayton M.H, Gliklich R.E, (2007), Selective creation of thermal injury zones in the superficial musculoaponeurotic system using intense ultrasound therapy: a new target for noninvasive facial rejuvenation, Archives of Facial Plastic Surgery, 9 (1) pp. 22-29. 6. Laubach H.J, Makin I.R, Barthe P.G, Slayton M.H, Manstein D, (2008), Intense focused ultrasound: evaluation of a new treatment modality for precise microcoagulation within the skin, Dermatologic Surgery, 34, pp. 727–34 7. White et al (2007) Clinical pilot study of intense ultrasound therapy to deep dermal facial skin and subcutaneous tissues, Archives of Facial Plastic Surgery, 9 pp. 88–95 8. Bozec L, Odlyha M, (2011) Thermal denaturation studies of collagen by microthermal analysis and atomic force microscopy, Biophysical Journal, 101 (1) pp. 228–36 9. White W.M, Makin I.R, Slayton M.H, Barthe P.G, Gliklich R, (2008), Selective transcutaneous delivery of energy to porcine soft tissues using Intense Ultrasound (IUS), Lasers in Surgery and Medicine, 40 (2) pp. 67–75 10. Ferraro G.A, De Francesco F, Nicoletti G, Rossano F, D’Andrea F, (2008), Histologic effects of external ultrasound-assisted lipectomy on adipose tissue, Aesthetic Plastic Surgery, 32 pp. 111–15 11. Ulthera, Ultherapy: Mechanism of Action (MOA), White Paper, n/d, Mesa, AZ: Ulthera Inc, <www. ultherapy.com/uploads/document/professional/MOA%20Whitepaper%20-%201002845B.pdf> 12. Christiansen D.L, Huang E.K, Silver F.H, (2000) Assembly of type I collagen: fusion of fibril subunits and the influence of fibril diameter on mechanical properties, Matrix Biology, 19 pp. 409–20 13. Mosser D.M, Edwards J.P, (2008), Exploring the full spectrum of macrophage activation, Nature Reviews Immunology, 8 (12) pp. 958–69 14. Rosenberg C.S, (1990), Wound healing in the patient with diabetes mellitus, Nursing Clinics of North America, 25 (1) pp. 247–61 15. Greenhalgh D.G, (2003), Wound healing and diabetes mellitus, Clinics in Plastic Surgery, 30 (1) pp. 37–45 16. Fabi S.G, Goldman M.P, (2014), Retrospective evaluation of micro-focused ultrasound for lifting and tightening the face and neck, Dermatologic Surgery, 40 (5) pp. 569–75 17. Dahan, S & Pusel, B, (2014) Microfocused ultrasound, Facial Rejuvenation: Lasers, lights and energy based devices, John Libbey; Paris 18. Tennant F, (2014) Benzodiazepines in Pain Practice: necessary but troubling, Editor’s Memo, PPM Practical Pain Management, <http://www.practicalpainmanagement.com/treatments/pharmacological/ non-opioids/benzodiazepines-pain-practice-necessary-troubling> 19. Reddy S, Pat, R.B, (1994) The benzodiazepines as adjuvant analgesics, Journal of Pain and Symptom Management, 9 (8), pp. 510–14 20. Lee et al (2012) Suh D.H, A intense-focused ultrasound tightening for the treatment of infraorbital laxity, Journal of Cosmetic and Laser Therapy, 14 pp. 290–95 21. Ulthera Inc, (2016) How does ultherapy work? Lasers in Surgery and Medicine, 37 (5), pp. 343–49 <http://uk.ultherapy.com/Physicians/Science-Of-How-Ultrasound-Skin-Lift-Works [accessed February 2016]. See also Meshkinpour A, Ghasri P, Pope K, et al (2005) Treatment of hypertrophic scars and keloids with a radiofrequency device: a study of collagen effects> 22. Fabi S.G, (2015); Fabi S.G, (2015b) Micro-focused ultrasound skin tightening, PRIME: International Journal of Aesthetic and Anti-ageing Medicine, May 14, <https://www.prime-journal.com/microfocused-ultrasound-skin-tightening> 23. Oni G, Hoxworth R, Teotia S, Brown S, Kenkel J.M, (2014), Evaluation of a microfocused ultrasound system for improving skin laxity and tightening in the lower face, Aesthetic Surgery Journal, 34 (7) pp. 1099–110 24. Dayan S.H, Fabi S.G, Goldman M.P, Kilmer S.L, Gold M.H, Prospective, multi-center, pivotal trial evaluating the safety and effectiveness of micro-focused ultrasound with visualization (MFU-V) for improvement in lines and wrinkles of the décolletage, Plastic and Reconstructive Surgery, 134 (4, s1) (2014), pp. 123–24 25. Alster T.S, Tanzi E.L, (2012) Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound, Dermatologic Surgery, 38 pp. 754–59 26. Fabi S.G, Massaki A, Eimpunth S, Pogoda J, Goldman M.P, (2013), Evaluation of microfocused ultrasound with visualization for lifting, tightening, and wrinkle reduction of the décolletage, Journal of the American Academy of Dermatology, 69 pp. 965–71 27. Fabi S, Bolton J, Goldman M.P, Guiha I, (2012), The Fabi-Bolton chest wrinkle scale: a pilot validation study’, Journal of Cosmetic Dermatology 11 (3) pp. 229–34 28. Kakar R, Ibrahim O, Disphanurat W, et al, (2014), Pain in naïve and non-naïve subjects undergoing nonablative skin tightening dermatologic procedures: a nested randomized control trial, Dermatologic Surgery, 40 (4) pp. 398–404
Reproduced from Aesthetics | Volume 3/Issue 5 - April 2016