Uses for micro-focused ultrasound (Ultherapy, Merz Aesthetics), the only FDA-cleared device with a nonsurgical skin lifting indication, are expanding, researchers are finding the device actually does make a difference to skin physiology and most patients give the treatment a thumbs up.
The keys, one expert says, are making sure patients have realistic expectations and using ultrasound visualization during treatment.
Ultherapy is FDA cleared for lifting of the brow, tightening the submental skin and improving wrinkles of the décolletage, according to Sabrina Fabi, M.D., a dermatologist in San Diego.
“But I also use it off-label for improving the laxity along the knees, which many women are bothered by, as well as the laxity that contributes the appearance of cellulite along the buttocks and posterior thighs. I also use it for the laxity of the abdomen and the posterior arms,” she says.
Science & Best Practices
Dermatologist researchers reported as early as 2012 that transcutaneous intense focused ultrasound was safe and effective when used to improve the clinical appearance, including texture and contour, of the upper arms, extensor knees and medial thighs.1 In 2014, researchers published a study suggesting, “Similar to its safety and efficacy for tightening facial skin and reducing wrinkles, [micro-focused ultrasound with visualization] MFU-V is an effective, noninvasive method for reducing skin laxity and improving the appearance of skin above the knee.”2
Ultrasound visualization allows users to target tissue by visualizing where they’re applying the micro-focused ultrasound energy. That’s important because patients’ skin thickness and anatomical features vary, according to a paper published online October 30, 2017 in the journal Clinical, Cosmetic and Investigational Dermatology.3
Providers can achieve optimal results by customizing Ultherapy treatment using visualization versus applying a standard protocol with no regard for the tissue being treated, Dr. Fabi says.
“That’s why [Ultherapy has] an indication for real-time visualization of tissue,” she says. “I think that people generally think that if you just deliver heat, you’ll get the result. …if you visualize the tissue that you’re intending to treat — not just fat or firing in air or firing in gel, but you actually can visualize superficial muscular aponeurotic system (SMAS) or any superficial fascial system, as well as dermis — you will get superior results.”
Dr. Fabi is an investigator and consultant for Merz, Allergan, Galderma, Valeant, Revance, Evolus and other companies.
Dr. Davis is a speaker and trainer for Allergan and Galderma.
1. Alster TS, Tanzi EL. Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound. Dermatol Surg. 2012;38(5):754-759.
2. Gold MH, Sensing W, Biron J. Use of micro-focused ultrasound with visualization to lift and tighten lax knee skin. Journal of Cosmetic and Laser Therapy. 2014;16(5):225-229
3. Fabi S, Pavicic T, Braz A, Green JB, Seo K, Van loghem JA. Combined aesthetic interventions for prevention of facial ageing, and restoration and beautification of face and body. Clin Cosmet Investig Dermatol. 2017;10:423-429.
4. Hilton, Lisette. Skin physiology post Ultherapy. Dermatology Times. February 29, 2019. Available at: https://www.dermatologytimes.com/facial-rejuvenation/skin-physiology-pos... Accessed: April 11, 2019.
5. Montes JR, Santos E. Patient Satisfaction Following Treatment With Microfocused Ultrasound With Visualization: Results of a Retrospective Cross-Sectional Survey. J Drugs Dermatol. 2019;18(1):75-79.
6. Alhaddad M, Wu DC, Bolton J, et al. A Randomized, Split-Face, Evaluator-Blind Clinical Trial Comparing Monopolar Radiofrequency Versus Microfocused Ultrasound With Visualization for Lifting and Tightening of the Face and Upper Neck. Dermatol Surg. 2019;45(1):131-139.