Patients desire cosmetic procedures that are noninvasive and offer minimal downtime and reliable results. Until recently, such options for facial and neck skin tightening were limited to broadband light and monopolar or bipolar radiofrequency devices. Introduction of an exciting application of ultrasound technology is changing this paradigm.
An advantage of Ulthera is its ability to deliver thermal energy while sparing the epidermis, reducing the risk of inadvertent injury. IUS is also sharply focused. With monopolar RF, heat energy is delivered diffusely and involves the dermis as well as the subcutaneous tissues (Abraham MT, Ross EV. Facial Plast Surg. 2005;21(1):65-73).
In 2007, a group with Massachusetts Eye and Ear Infirmary introduced the device to the scientific literature with a gross and histologic study of its effects on the facial skin of six human cadaveric heads (White WM, Makin IR, Barthe PG, et al. Arch Facial Plast Surg. 2007;9(1):22-29). They showed the device produced discrete zones of thermal-induced coagulative necrosis with thickened collagen bundles, sparing surrounding tissue including the epidermis and deep to the SMAS. It produced a dose-response pattern whereby increased energy led to increased size of the cigar-shaped TIZs.