High-Intensity Focused Ultrasound or HIFU is a non-surgical treatment to tighten the skin using ultrasound energy. Also known by the name of the device as Ultherapy (Merz Aesthetics), Ulche (Bison), Ultraformer (Classy), Ultraskin (Won Tech) to mention a few. HIFU technology was originally used as a non-invasive modality for selectively destroying tumour cells of internal organs by thermal coagulative necrosis for many decades. In 2009 HIFU technology was cleared by the U.S. Food and Drug Administration (FDA) for noninvasive eyebrow lift, noninvasive neck and submental area (under the chin) and later to improve lines and wrinkles of the décolletage (chest area). Nowadays it is widely used for many off-label facial rejuvenation procedures, skin whitening, and lipolysis. As clinically proven and to some degree efficient non-invasive treatment with no downtime it gained enormous popularity in recent years. Inevitably the market became flooded with different HIFU appliances ranging from home use portable gadgets to advanced professional devices used by doctors in clinical settings. Even though the same technology is used machines vary considerably in efficacy, treatment protocols and safety margins. With no doubt a serious HIFU machine has a place in the array of minimally invasive facial rejuvenating procedures but in the era of uncompromised aggressive marketing patients must be cautious of false promises, fake results and inexperienced providers.
As for all aesthetic procedures the best patients to select are those with appropriate expectations. If the patient is expecting elimination of the laxity, he/she will be unhappy, but if he/she is expecting a natural modest improvement of 10-20 %, then it is likely that the patient will be satisfied. Patients who are surgery adverse, poor surgical candidates, younger patients (30+) with minimal laxity, or patients who have had a facelift in the past and want to prolong the effect of surgery are proper candidates. Patients who need additional tightening after neck lift or neck liposculpture are good candidates as well.
High Intensity Focused Ultrasound (HIFU) therapy has FDA approval for lifting of the eyebrows, neck, and submental region. It is also beneficial in the treatment of lines and wrinkles of the décolletage and for tightening and lifting of the cheek tissue, improving jawline definition and reducing submental skin laxity.HOW DOES HIFU WORK?The mechanism of HIFU is transcutaneous heat delivery to the deep dermis, sub-dermal connective tissue, and fibromuscular layer in precise depths sparing the overlying epidermis and intervening tissue. As the US waves travel through the tissue they are coalesced into distinct areas called thermal coagulation points. These thermal coagulation points form because of a buildup of heat from friction between rapid vibrations of molecules caused by the ultrasonic waves and are approximately 1 mm3 in volume. The thermal insult of 65-70 deg C leads down a similar path of collagen damage, collagen shrinkage, and finally neocollagenesis as part of the healing response. Clinical studies have demonstrated tightening and lifting of facial and neck skin over the course of 3 to 6 months after treatment in 60-70% of patients. The hand-piece used to administer the intense focused ultrasound applies up to 25 thermal coagulation points per 25 mm long row, otherwise known as a line of treatment. The depth of 1.5, 3.0, 4.5 or 6.0 mm is predetermined by the transducer and delivered energy is adjusted according to skin quality, degree of ptosis and patient sensitivity to pain, ranging up to 3 J.
A face appears aged when it has undergone loss of volume, surface changes, reduced elasticity, and increased skin laxity. The goal of antiaging procedures is to create a more youthful appearance through lifting, tightening, and excising redundant tissues in the face and neck. Although rhytidectomy remains the gold standard for consistent long-term results in facial rejuvenation, many patients seek alternatives to this procedure because of the associated recovery times, morbidity rates, financial implications, and/or concerns about surgery in general. Chemical peels, microdermabrasion and ablative lasers typically address issues in the external layers of the skin (e.g. fine lines, wrinkles, pigment changes). Whereas HIFU addresses the deep skin layer and the foundational layer addressed in cosmetic surgery that lift and lends support to the skin. Therefore, the two technologies are quite complementary but are different in their own way. HIFU also seems to be superior to other preexisting skin tightening technologies (non-ablative lasers, radio-frequency) because of its capability to generate therapeutic temperatures in deeper structures without heating and damaging the overlying tissues.
HIFU is considered to be the safest technique known for tightening of the facial skin if performed by a trained and qualified professional. The procedure has been cleared after demonstrating safety in clinical studies, and tens of thousands of treatments have been performed safely worldwide. A review of the literature focusing on the safety of HIFU confirmed that side effects are generally mild and transient in nature. Sensations of heat and tingling typically subside soon after the procedure. The treated skin areas can sometimes become flushed or red in the hours after the procedure, and short-term sensations including tingling, swelling, and tenderness may occur. On rare occasions, there may be some bruising or numbness, but these typically go away within a few days of the procedure. Several cases of post inflammatory hyper-pigmentation and fat atrophy have also been described in the scientific literature. However HIFU avoids the adverse post-treatment effects that are always present after more superficial treatments.
As with any noninvasive aesthetic treatment, not all patients and clinicians see an improvement. A summary of follow-up clinical studies indicates that on average 60-70 % of patients report some degree of improvement between 2 and 6 months after treatment. The results depend on energy density settings, number of treatment lines but also on patient characteristics and expectations.Collagen contraction immediately after treatment may in some patients result in an initial tissue “lift.” There is also mild oedema that contributes to the early aesthetic improvement seen by patients. Ultimately lifting and firming will take place over approximately 2-3 months, as the collagen is renewed and replaced with new, stronger collagen. As this collagen-building process continues, continued improvements can appear for up to 6 months. Some people find results last 1-2years, although yearly touch-up treatments are recommended to stay ahead of the ageing process. One shortcoming of HIFU is that it has been found to be less efficacious in patients with higher body mass index (greater than 30 kg/m2 ).
HIFU isn’t recommended for people with infections and open skin lesions at the target area, severe or cystic acne, metallic implants in the treatment area and active systemic or local skin disease that may alter wound healing.
Preparation for the procedure is minimal. Regular eating, drinking, exercise, and work routines can be maintained before and immediately after the procedure.You should remove makeup and other skin care products from the target area prior to treatment. Pain medication can be administered to alleviate discomfort during treatment. If these medications affect your ability to drive, plan to be picked up from the office after the treatment. Prior to treatment, your doctor will consult with you to assess your suitability for HIFU treatment and discuss any concerns or questions you may have.
The target area is cleaned and ultrasound gel applied. The hand-piece of HIFU device is placed against the skin and ultrasound energy is delivered in short pulses to the targeted areas. You might experience quick, intermittent feelings of heat and tingling during treatment. Some people describe it also as tiny electric pulses or a light prickly sensation. At the end of the procedure, the applicator is removed. A single procedure can last up to 90 minutes, depending on the size of the treated area.
There is usually no downtime associated with HIFU treatment. Regular activities such as work, exercise, or socialising can be resumed immediately after treatment.You can start noticing the first results within a few days, depending on your body’s ability to produce new collagen. Improvement typically continues for up to three to six months. The results will last as long as your body continues to produce new collagen and until the natural ageing process takes over again. Based on your skin’s response to HIFU treatment, you can decide if additional sessions are necessary and worthwhile.
Aggressively but falsely marketed as non-surgical facelift, non-invasive facelift, the lunchtime facelift, ultrasound facelift and instant facelift, HIFU treatment can hardly be compared to facelift surgery.HIFU treatment is a viable option for younger patients with mild to moderate ageing who are willing to repeat the treatment regularly over several years or decades to slow the ageing process. They should be willing to accept that in about one third of patients results after the initial treatment might be unnoticeable. Similarly patients who want to prolong the effects of cosmetic surgery could benefit from these treatment on a long term. Being minimally to moderately effective HIFU treatment is on the other hand, fast, safe and non-invasive associated with very low risks and almost no downtime. Patients with pronounced signs of ageing, sagging skin, and platysmal bands or patient looking for immediate and obvious results are likely to be better served by surgical treatment. Being highly effective and commonly turning the hands of time for more than a decade face and neck lift surgery leaves a scar and is associated with risk and lengthy recovery times and one time higher cost.