Ultrasound device could be useful for facial rejuvenation

Chicago - A recent study suggests that modest doses of transcutaneous ultrasound appear safe and surprisingly effective for tightening forehead, cheek and neck tissues, says its principal investigator.

"In the last decade, there's been an increasing drift toward minimally invasive cosmetic therapies for facial rejuvenation," says Murad Alam, M.D., chief, section of cutaneous and aesthetic surgery, and associate professor of dermatology, otolaryngology and surgery, Northwestern University, Chicago.

Traditional CO₂ resurfacing remains effective, but patients shy away from the two weeks of downtime it requires for healing, he says.

Sound wrinkle therapy?

"The problem that has arisen is that while we're getting minimal downtime, we're also getting minimal efficacy" with the latest minimally invasive devices, he says.

Devices typically produce a few millimeters of tightening at best, he says.

"Additionally, there's wide variation in outcomes, and we don't have a way of predicting which patients are likely to get more benefit than others," he adds.

Theoretically, ultrasound could outperform modalities including radiofrequency, visible light and intense pulsed light, because ultrasound energy delivers peak heat at a point where multiple energy beams focus, Dr. Alam says.

This enables the technology to apply heat extremely deeply within the skin without damaging superficial skin, he says. He likens the effect to that achieved by the submuscular aponeurotic system (SMAS) lift, which targets not facial skin but the fascial layer beneath it for longer-lasting results.

"Ideally," Dr. Alam says, "one wants to deliver heat energy far below the skin into the SMAS, potentially, so that one can get the same tightening response" nonablatively that CO₂ lasers and a facelift can achieve.

Because ultrasound is an entirely different energy from those currently available for skin rejuvenation, he says, "It can be expected to provide benefits that are quantitatively and markedly qualitatively different than other devices."

Ultrasound could also provide an effective option for patients in whom other technologies have failed. Patients seem to find the thought of ultrasound treatment comforting, because they're familiar with its use in other therapeutic indications, Dr. Alam adds.

Testing theories

To test the safety of transcutaneous ultrasound for tightening and lifting of the face, Dr. Alam and his colleagues enrolled 36 patients, mostly female, and treated them with the Ulthera device (Ulthera Inc.).

Researchers treated the full face and neck with a single pass using a 7.5 MHz probe with a 4.5 mm focal depth in the temple, preauricular and submental/neck areas or a 4.4 MHz probe with a 4.5 mm focal depth for the cheeks.

Treating physicians began by imaging the treatment area with the device's handpiece, then delivering energy (after applying a topical anesthetic) in linear arrays up to 25 mm long, spaced about 5 mm apart, Dr. Alam says. Patients received total energy levels between 0.4 and 1.2 J.

Because this was a safety study, he says, "We treated patients at low to moderate doses to begin with. And we had good results, in that there were no significant adverse events."

Twenty-five patients experienced minor erythema and swelling, both of which were transient, Dr. Alam says. Additionally, two patients developed small linear white stripes in treated areas. However, he says applying topical steroids resolved the problem in both cases overnight.

Patients' reports of pain varied, Dr. Alam says. While patients typically assigned pain scores of 3 on a 10-point scale, a small proportion rated their pain around 7.

"We couldn't find any reason for that in the amount of energy they got" or which probe was used, he says.