Ultherapy

by

Innovations
By John D. McCann, MD, PhD

Ultherapy™: Using sound to improve appearances

There are many medical devices that have been invented to tighten the deeper layers of the skin but they have all suffered from one of two problems: too much recovery, or too little result. A new technology called Ultherapy™ has recently been introduced which overcomes these problems.

Too Much Recovery
In the too much recovery category, we have nearly all forms of using a laser to vaporize the outer layer of the skin so that when the skin heals it will be smoother. Examples are ablative CO2 skin resurfacing and erbium laser skin resurfacing. These procedures have often been successful in smoothing and tightening the skin but suffer from long recovery periods when new skin is growing over the area of vaporized skin. With all of these procedures it was noted that with greater degrees of vaporization of the skin deeper wrinkles could be smoothed but at the cost of having a very red face for months and sometimes years later developing loss of skin pigmentation. There is also risk that the skin will be vaporized too deeply causing scarring or that the skin will become infected as immediately after vaporization the protective outer layer of skin is gone. The best compromise in the category has been fractional laser resurfacing which leaves most of the skin intact. Vaporizing a small percentage of the skin area has resulted in much faster recovery but has markedly diminished the amount of improvement one can achieve in deeply wrinkled skin.

Too Little Result
In the too little result category, we have all of the forms of using radiofrequency energy (RF) to heat the deeper layers of the skin to the point that it would tighten without causing any damage to the skin surface. An example of this technology is Thermage™. The RF procedures have been safer than ablative skin resurfacing but have suffered from not creating as much tightening of the skin and in many cases causing no measurable result. When the technology has been pushed by delivering higher levels of energy in hopes of achieving a result, it has at times resulted in an intolerably painful procedure or, worse yet, scarring.

Ultherapy™
A new break through technology called Ultherapy™ has been introduced. Ultherapy™ is the only FDA cleared technology for lifting facial skin. It can be used to tighten the skin resulting in a non-surgical non-invasive brow lift, face-lift, or neck lift. It cannot replace the corresponding surgical procedure as the magnitude of lift is not as great as what can be achieved with surgery. For a younger patient with mild to moderate skin laxity it can achieve excellent results. It also works well for patients who have had surgery and are developing some mild to moderate laxity as the aging process marches on. It can be combined with other surgical modalities to reduce the amount of surgery done such as when the face is lifted with a miniature lift while the neck is tightened with Ultherapy™.

It is completely different than laser or RF as the energy that is used in Ultherapy™ is sound energy. Sound energy (ultrasound) is able to penetrate to great depths. For instance, eye doctors use ultrasound to measure the length of the eyeball and cardiologists use ultrasound to measure the movements of the heart deep inside the chest. So getting sound to penetrate a few millimeters beneath the skin is easy, where as with laser energy this can only happen if the superficial layers of skin are first vaporized. The Ultherapy™ device focuses the sound energy at specific depths beneath the skin, which heats the tissue to temperatures high enough to make tiny cautery marks beneath the skin. When the body heals itself over a period of several months after the procedure, the collagen remodels and the skin is tightened. Ultherapy™ does not impact the superficial and visible portion of the skin so there is no visible sign of having treatment until months later when the skin tightens. Ultherapy™ has been found to be much more effective than radiofrequency procedures and is much different than laser procedures which require substantial times to recover.

Ultherapy™ Experience To Date
To date I have gotten a lot of experience with the Ultherapy™ technology which creates cautery marks 3 mm and 4.5 mm beneath the skin and have found it effective for lifting and tightening the forehead, face, and neck. It causes about one- fourth the tightening and lifting one can achieve with surgery, and costs about one- fourth as much as surgery; and unlike surgery it does not require a trip to the operating room or weeks off for recovery. The 3 mm and 4.5 mm deep cautery marks do not alter the pigment or texture of the skin, but just in the last few days a technology that makes cautery marks more superficially only 1.5 mm beneath the skin has been introduced. I have already found this to improve skin texture in the d├ęcolletage area (chest) and will likely be used to improve skin texture (wrinkles) on the face.

Other Effective Treatment for Fine Lines and Skin Pigmentation
Some other procedures that also improve fine lines, brown spots, and red spots of the skin include medium depth TCA peels and Intense Pulse Light Therapy (IPL).

Medium depth TCA chemical peels are typically used at the time of a surgical procedure such as blepharoplasty or face-lift. It takes about 2 weeks to recover from the TCA peel and a similar amount of time to recover from surgery so the TCA peel is not rate limiting for recovery. With a TCA peel the skin does not slough off until days after the procedure such that new skin is already growing underneath before the old skin sloughs off. Because the patient is never without skin, they do not have as much risk of infection and the skin does not weep and ooze as it does after being vaporized by a laser. TCA causes the skin to slough off at the dermal epidermal junction so it can improve skin texture and remove blotchy brown skin pigment but will not tighten or lift the deeper layers of skin. TCA peels tend to work synergistically with surgery as surgery can tighten and lift skin but is not effective at improving skin texture or altering skin pigmentation.

If the patient is not undergoing surgery, then I prefer Intense Pulse Light Therapy (IPL) as this requires no recovery and is effective at getting rid of brown spots like the TCA peel. IPL can also treat redness of the skin such as the skin changes which occur in Acne Rosacea. IPL does not improve skin texture like a chemical peel, but it requires no recovery.

Summary
In my practice the TCA peel is used to improve fine lines and brown spots synergistically with surgery. IPL is used to improve brown and red pigmentary changes and requires no recovery. Prior to Ultherapy™ we have had no non-invasive method to lift and tighten skin as this required surgery. We also had no way to improve deep wrinkles that did not require months of recovery. Ultherapy™ is being used to non-invasively lift and tighten the forehead, face, and neck. Ultherapy™ is also being used to improve skin texture in the chest and will likely be used to improve both deep and superficial wrinkles on the face. Ultherapy™ is the only way to non-invasively lift and tighten the face, and it may prove to be the best way to non-invasively improve skin texture. Ultherapy™ is a break through technology that will remain an important part of the armamentarium of procedures used at the Center For Facial Appearances as we continue to push the envelope in facial rejuvenation.

Article by
Sandy Oculoplastic Surgeon