Microfocused Ultrasound With Visualization Research Articles

Hi5 Protocol for the Use of Microfocused Ultrasound with Visualization.

Microfocused ultrasound with visualization (MFU-V) is used for lifting and tightening of facial tissues. Standard protocols are completed in a single session. Despite excellent outcomes, we identified several barriers of entry for a significant number of patients. Therefore, we devised an individualized pan-facial protocol that is delivered as a series of short, intense treatments to address these issues. We enrolled 12 participants with mild-to-moderate skin and fibromuscular laxity to receive one superficial and one deep pass per visit (average 280 lines). Qualitative improvements were rated by both patients and physicians at 6 or 10 months due to COVID-19 delays. Changes in the submentum and eyebrow heights were quantified. Ten patients (age range: 31-61 years) underwent an average of four MFU-V treatments. Two patients were excluded after massive weight gain. Skin and fibromuscular ptosis and overall soft tissue laxity improved in all patients. Mean brow height increased by 1.7 mm, whereas the mean submental lift was 78.7 mm2. All patients and treating physicians rated an improvement in appearance, whereas independent physicians rated improvements in 87% of cases. Four patients self-rated as "markedly improved." Pain was rated at up to 6.2 (out of 10). Although mask-wearing was mandatory, loss of elasticity, wrinkles, and skin roughness all improved. Superficial welts (n = 5), erythema (n = 3), tenderness (n = 3), and mild bruising (n = 2) occurred, but all resolved within a few days and no severe or permanent adverse events occurred. The Hi5 protocol was noninferior to standard single-session protocols and improved brow heights and submental lifting.

Other hyaluronic acid fillers and combination fillers

AbstractThe use of hyaluronic acid (HA) fillers has become increasingly popular in the cosmetic industry due to their efficacy and versatility. Common types of HA fillers include Restylane, Juvéderm, and Bolotero. Other various options available for HA fillers include the resilient HA fillers (RHA) collection, Revanesse versa, and Prevelle silk. The fillers can be used singularly or in combination to achieve a desired cosmetic outcome. The RHA collection line is the first FDA approved filler used to treat dynamic facial lines using a less rigid formula than earlier HA fillers and by uniquely adapting to facial movement, stretching, and repeated facial compression. Revanesse versa filler is designed to effectively address moderate to severe facial wrinkles, including nasolabial folds, with a focus on providing lasting results even after the HA filler has been absorbed. Other HA fillers such as Prevelle silk, Hydrelle, and Puragen contain 0.3% lidocaine for more tolerable treatment for moderate to severe facial lines. Examples of combination fillers include HA/botulinum toxin, HA/calcium hydroxyapatite (CaHA), and HA/poly‐ l‐lactic acid. To facilitate the administration of injections, HA fillers can also be mixed with agents such as lidocaine, lidocaine and epinephrine, normal saline, and sterile water to decrease viscosity. Furthermore, the use of CaHA in conjunction with microfocused ultrasound with visualization (MFU‐V) has shown to enhance skin tightness and neocollagenesis. Other applications of HA include utilization of its bacteriostatic effects to coat biomedical devices, as a material for bioink and tissue‐engineering, and to create novel formulations to further personalize cosmetic goals.

Patient satisfaction of microfocused ultrasound treatments on the face and neck laxity: A narrative review.

Microfocused ultrasound with visualization (MFU-V) delivers focused ultrasound energy to heat tissue and has emerged as a fast and effective noninvasive method for treating skin laxity. After obtaining approval in 2009 by the Food and Drug Administration, satisfactory feedback was recorded using several scoring systems for MFU-V treatment for facial and neck laxity. To evaluate the efficacy and satisfaction rates of MFU-V for facial and neck laxity treatment by providing a basis for developing a validated scoring system for MFU-V treatment. A constrictive survey was carried out by selecting relevant publications on MFU-V treatment of facial and neck laxity using PubMed, Medline, and Embase electronic databases from January 2017 to March 2022. Of the 11 original articles used in this review, the majority of the scoring methods used were the subjective global aesthetic improvement scale and the 5-point scale rating global aesthetic improvement in appearance. Around half of the patients were described as much improved or very much improved on days 30 and 90, while most returned to baseline on Day 360. Most of the adverse events reported were mild bruising, redness, and pain. None of the patients reported serious adverse events. A burn occurred in one case because of improper application of the probe. The MFU-V provides excellent and promising responses for treating facial and neck laxity. A few mild events were observed, such as erythema, pain, edema, and injection-site induration, all of which resolved within approximately 2-3 days.

Combined Treatment with Micro-Focused Ultrasound with Visualization and Intradermal Incobotulinumtoxin-A for Enlarged Facial Pores: A Retrospective Study in Asians.

Despite the increasing need for the improvement of enlarged facial pores, the treatment remains challenging. A few previous studies have reported the effects of micro-focused ultrasound with visualization (MFU-V) or intradermal incobotulinumtoxin-A (INCO) on enlarged facial pores. To evaluate the efficacy and safety of combined treatment with superficial MFU-V and intradermal INCO for enlarged facial pores. This single-center retrospective study included 20 patients treated with MFU-V and intradermal INCO to improve enlarged facial pores. Outcomes were evaluated 1, 4, 12, and 24 weeks after a single session of the combined procedure. Pore count and density were objectively quantitated using a three-dimensional scanner, and improvement was assessed using the physician and patient Global Aesthetic Improvement Scale (GAIS). The mean pore count and density decreased after one week and decreased by up to 62% until 24 weeks. After one week, almost all patients (100% in physician GAIS and 95% in patient GAIS) showed improvement with a grade 3 (much improved) or higher. All adverse events were transient. Combined treatment with MFU-V and intradermal INCO could be effective and safe for reducing enlarged facial pores; the improvements can be sustained for up to 24 weeks.

Safety and efficacy of superficial micro-focused ultrasound with visualization for melasma in Asians: An uncontrolled pilot study.

The pathophysiology of melasma is multifactorial, resulting in treatment resistance and a high recurrence rate. Recent research suggests that focused ultrasound might treat melasma effectively. To investigate the efficacy and safety of superficial micro-focused ultrasound with visualization (MFU-V) for melasma in Asians. Patients (n=20) with mixed melasma on both cheeks received 2 MFU-V treatments spaced 1 month apart. At monthly visits over 5months, treatment efficacy and safety were evaluated. Standardized photographs were clinically assessed using the modified Melasma Area and Severity Index (mMASI), and 6-point grading scales for melasma lightening and area of involvement. Patients provided pain, global aesthetic improvement scale (GAIS), and satisfaction assessments. In 40 cheeks, the mean mMASI score was significantly reduced from 13.2 at baseline to 2.4 at month 4, and 2.8 at month 5. Twenty-nine cheeks (72.5%) showed lightening of melasma at month 4 that persisted until month 5, with improvements up to 75% compared to baseline. Melasma area decreased overall, with sites containing >30% melasma involvement decreasing from 55% to 20% by month 5, and none with 70%-89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as 1 month after index MFU-V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient GAIS and satisfaction scores. Procedure was well tolerated with only mild-to-moderate pain reported in 92.5% of treatments. Superficial MFU-V is a safe and effective treatment for melasma.

The role of topical capsaicin gel in pain management during microfocused ultrasound treatment for neck laxity.

The transient receptor potential vanilloid 1 (TRPV1) provides a heat and pain sensation (nociception). Capsaicin, a TRPV1 agonist, has been shown to induce a refractory period in the nerve terminal expressing TRPV1 and create long-term nerve terminal defunctionalization. To evaluate the efficacy of capsaicin for pain reduction during microfocused ultrasound with visualization (MFU-V) treatment. A randomized, split-side study including 24 subjects was conducted. A combined 0.025% capsaicin gel and topical anesthetic were randomly applied on one side of the neck, and a topical anesthetic monotherapy was applied on the contralateral side for 30 min before MFU-V treatment. Pain score (visual analog scale, 0-10) was evaluated at T1 (before MFU-V), T2a (after the 4.5-mm transducer treatment), T2b (after the 3.0-mm transducer treatment), and T3 (after the entire treatment). Side effects were recorded. Mean pain scores at T2a for combined and single regimens were 5.19 (±2.26) and 6.91 (±1.72), respectively (p<0.001). The capsaicin-treated side had a lower pain score at T2b and T3 (p<0.001). Redness was longer on the capsaicin-treated side (112.67vs. 10.68 min, p<0.001). No other adverse events including contact dermatitis were reported. A single application of a combined 0.025% capsaicin gel with topical anesthesia produces a significantly lesser pain score during the MFU-V treatment. Defunctionalization of TRPV1 may explain the alleviation of painful sensations caused by heat from MFU-V.

Prospective, Single-arm, Split-face Pain Management Evaluation of Nitrous Oxide System During Micro-Focused Ultrasound With Visualization.

Although micro-focused ultrasound with visualization (MFU-V) has great cosmetic results, patients can be hesitant or decline the treatment due to the pain experienced during the treatment. The primary objective is to assess the efficacy of pain management of the nitrous oxide system during MFU-V treatment. The secondary objectives include patient satisfaction and efficacy on reducing facial laxity and improving aesthetic appearance. A prospective, single-arm, split-face, open-label study. Ten patients were treated with MFU-V without use of a self-administered nitrous oxide system on the right side of the face, followed by use of the nitrous oxide system on the left. A patient-reported Visual Analog Pain Intensity Scale was used to assess pain on the right and left sides at 3 different treatment time points. Patient satisfaction was measured using a 5-point Likert scale and efficacy was measured using the Investigator GAIS and the Facial Laxity Score. Clinically significant differences were seen between pain ratings for the treated and untreated sides at 2 of the 3 time points. 100.0% of patients (n=9) who had completed the study were very satisfied (55.6%) or somewhat satisfied (44.4%). Five patients (55.6%) were scored as Improved on the GAIS and 4 patients (44.4%) were scored as Much Improved. 90.00% (n=9) of patients had moderate lower face and neck laxity prior to treatment, compared with 11.11% (n=1) and 22.22% (n=2) with moderate laxity at follow-up. The nitrous oxide system provides clinically significant pain reduction, increases patient satisfaction, and improves cosmetic results of MFU-V treatment. J Drugs Dermatol. 2022;21(11):1228-1234. doi:10.36849/JDD.7030.

Combined Calcium Hydroxylapatite Plus Microfocused Ultrasound for Treating Skin Laxity of the Chest and Buttocks.

Microfocused ultrasound with visualization (MFU-V) and a calcium hydroxylapatite dermal filler (CaHA) were both developed to meet the patient demand for a noninvasive but effective means for lifting and tightening of lax skin. Recently, there has been growing interest in the use of dilute (1:1) and hyperdilute (1:&ge;2) CaHA to achieve skin tightening and stimulating neocollagenesis, and the combined use of difference techniques to obtain optimum aesthetic outcomes. Here, two patients with Grade 3 chest laxity on the D&eacute;collet&eacute; Wrinkling Assessment scale improved by 2 grade points after two treatment sessions because increasing the tissue layers treated with MFU-V and adding an additional syringe of CaHA per 100 cm2. Similarly, two addition patients with Grade 3 scores on the Gluteus Laxity Scale improved by 2 grade points after two or three treatment sessions. Customizing the number and depth of MFU-V treatment lines and the amount of CaHA should be considered when making a treatment plan for patients with severe skin laxity. Similarly, it is important to consider body mass index (BMI) when treating body areas such as the gluteus and the potential need for volume correction. J Drugs Dermatol. 2022;21(1):27-30. doi:10.36849/JDD.6368.

Combined Calcium Hydroxylapatite Plus Microfocused Ultrasound for Treating Skin Laxity of the Chest and Buttocks

Microfocused ultrasound with visualization (MFU-V) and a calcium hydroxylapatite dermal filler (CaHA) were both developed to meet the patient demand for a noninvasive but effective means for lifting and tightening of lax skin. Recently, there has been growing interest in the use of dilute (1:1) and hyperdilute (1:≥2) CaHA to achieve skin tightening and stimulating neocollagenesis, and the combined use of difference techniques to obtain optimum aesthetic outcomes. Here, two patients with Grade 3 chest laxity on the Décolleté Wrinkling Assessment scale improved by 2 grade points after two treatment sessions because increasing the tissue layers treated with MFU-V and adding an additional syringe of CaHA per 100 cm2. Similarly, two addition patients with Grade 3 scores on the Gluteus Laxity Scale improved by 2 grade points after two or three treatment sessions. Customizing the number and depth of MFU-V treatment lines and the amount of CaHA should be considered when making a treatment plan for patients with severe skin laxity. Similarly, it is important to consider body mass index (BMI) when treating body areas such as the gluteus and the potential need for volume correction. J Drugs Dermatol. 2022;21(1):27-30. doi:10.36849/JDD.6368

Effectiveness of combined microfocused ultrasound with visualization and subdermal calcium hydroxyapatite injections for the management of brachial skin laxity.

BackgroundThere is no publication to date on the combined use of microfocused ultrasound with visualization (MFU‐V) and calcium hydroxylapatite (CaHA) for brachial skin laxity.AimTo assess the effectiveness of combining MFU‐V with diluted/hyperdiluted CaHA in a single session for treating brachial skin laxity.Subjects/MethodsFemale subjects who had skin laxity in the brachial regions and who desired non‐surgical intervention were enrolled into this prospective, single‐arm pilot study. MFU‐V (Ultherapy®, Merz North America, Inc. Raleigh, N.C.) was applied using the 4.0 MHz‐4.5 mm and 7.0 MHz‐3.0 mm depth transducers, followed by subdermal injections of diluted (1:1)/hyperdiluted (1:2) CaHA (Radiesse®, Merz North America, Inc). Subjects were followed for six months after treatment. Objective biophysical skin assessments were conducted using a cutometer (Cutometer® Dual 580 MPA; Courage & Khazaka, Cologne, Germany). Subjective assessments included the arm visual analogue scale (VAS), global aesthetic improvement scale (GAIS), and subject global satisfaction scale.ResultsTwelve subjects participated in the study. The mean R0 reading (measure of skin firmness) progressively improved from 0.515 mm at baseline to 0.433 mm at 24 weeks (p < 0.05 for 12 and 24 weeks). The mean R2 reading (measure of skin elasticity) and mean arm VAS improved significantly from baseline at all visits (p < 0.05 for all). The majority of subjects at each visit showed improved arm appearance and were satisfied with their treatment. Both procedures were well‐tolerated.ConclusionsCombined use of MFU‐V with diluted/hyperdiluted CaHA demonstrates significant improvements in both objective and subjective measures of brachial skin laxity.

A study of combined microfocused ultrasound and hyaluronic acid dermal filler in the treatment of enlarged facial pores in Asians.

Enlarged facial pores are a common cosmetic complaint in practice. Microfocused ultrasound with visualization (MFU-V) and low-degree crosslinked hyaluronic acid filler (L-HA) injection has recently become a popular procedure for skin rejuvenation. The effectiveness of the combined MFU-V and L-HA injection in the treatment of enlarged pores has not been evaluated. To compare the efficacy of MFU-V monotherapy (single technique) and MFU-V combined with L-HA injection (combined technique) for the treatment of enlarged facial pores in Asians. We conducted a randomized, single-blinded, split-face study on participants with enlarged facial pores. Each side of the face was randomly assigned to treatment with one session of single technique or combined technique. Pore volume was objectively measured by an Antera 3D® system. Subjective assessment was evaluated by one-blinded physician using a pore grading score (0-4). Patients rated the improvement in terms of satisfaction using the visual analog scale (VAS, 0-10). Forty-six participants completed the study. The mean pore volume of both sides declined with statistical significance at every visit compared to baseline, with the lowest mean at 4months post-treatment. The combined technique showed a lower mean pore volume than single technique throughout the follow-ups. Physician's subjective evaluation showed no statistically significant difference between the two techniques. The patient satisfaction score showed a similar trend to the mean pore volume, with a statistically significant difference at 4 and 6months post-treatment. Both techniques are effectively minimize enlarged facial pores. The combined technique resulted in more patient satisfaction.

Treating Striae Distensae Albae in Asians: Efficacy and Safety of Combined MFU-V and CaHA.

Background:This study evaluated the efficacy and safety of a single treatment combining microfocused ultrasound with visualization (MFU-V) and subdermal diluted calcium hydroxylapatite with lidocaine (CaHA+) for Striae Distensae Albae (SDA).Methods:Ten prospectively enrolled women with abdominal, back or thigh SDA were treated with MFU-V at 3 focal depths (4.5, 3.0, and 1.5 mm), followed by 3–6 mL of diluted CaHA+ (1:1 ratio) in the same session. Outcomes were assessed at 1 month, 3 months, and 5 months postprocedure using a 5-point quartile grading scale, an SDA scoring scale, a 10-point visual analog score, and a global aesthetic improvement scale.Results:All patients exhibited improvement in SDA at 3 months, with further improvement at 6 months. Physicians’ assessment with the quartile grading scale showed that 8 patients improved moderately, whereas 2 had good improvement at 6 months. The mean overall SDA score was 11.6 at baseline, 11.1 (not significant) at 1 month, 7.9 (P = 0.005) at 3 months, and 6.2 (P = 0.005) at 6 months. All patients had improved global aesthetic improvement scale at 3 and 6 months, with 4 patients being much improved, and 3 patients being very much improved at 6 months. At the end of the study, all patients were less bothered with their SDA compared with baseline with a mean reduction of 2.7 in visual analog score, and all patients were satisfied or very satisfied with the treatment. No adverse events occurred.Conclusion:A single combination treatment of MFU-V and diluted CaHA+ improves SDA without side effects and may be considered for patients seeking to minimize SDA.

Comparison of microfocused ultrasound with visualization for skin laxity among vegan and omnivore patients.

The aging of facial structures depends on genetic, anatomic, chronologic, and environmental factors that affect the skin and underlying tissues. Microfocused ultrasound with visualization (MFU-V) has emerged as a safe and effective treatment for skin laxity. As the nutritional status may contribute to skin aging, it would be interesting to evaluate whether different dietary patterns can also influence the response to MFU-V treatment for skin laxity. The aim of this study is to compare the outcome of MFU-V therapy between omnivore and vegan patients. Twenty-seven vegan and twenty-seven omnivorous women who underwent MFU-V treatment for laxity of lower face and neck were enrolled. The clinical outcome was evaluated using the FLR (Facial Laxity Rating) scale after 3 and 6months from treatment. At baseline, no significant differences were found in terms of FLR scale in both treated sites. After 3months, reduction in FLR scale was significantly lower for vegans both on face (P=.04) and neck (P=.004). At 6months, vegan patients had a worse clinical outcome on lower face (P=.001) and neck (P<.001). The present study suggests that a vegan diet may negatively influence the outcome of a MFU-V treatment.

Single-Plane Versus Dual-Plane Microfocused Ultrasound With Visualization in the Treatment of Upper Arm Skin Laxity: A Randomized, Single-Blinded, Controlled Trial.

Non-invasive skin tightening devices have become a safe and non-invasive treatment for patients with skin laxity of the upper arm. The efficacy of microfocused ultrasound with visualization (MFU-V) in skin tightening had been demonstrated in several studies. This study aimed to evaluate the efficacy and safety of MFU-V in treating skin laxity of the upper arm using different treatment protocols. Thirty patients with upper arm laxity were enrolled. Patients were randomly assigned to receive single-plane MFU-V treatment (4 MHz/4.5 mm transducer) on one arm and dual-plane treatment (4 MHz/4.5 mm and 7 MHz/3.0 mm transducer) on the contralateral arm, totaling 200 lines in each arm. Investigator Assessment Skin Laxity Scoring System (IASLSS) and improvement scores were evaluated at 1, 3, and 6 months after the treatment. Adverse events were recorded. A modest reduction of mean arm circumference was observed on both sides. Mean physician-rated improvement scores, single-plane treatment received 2.22 (±1.05), 2.70 (±1.32), and 1.61 (±0.79), respectively. Dual-plane treatment received 2.00 (±1.00), 2.56 (±1.05), and 1.39 (±0.54), respectively. Single-plane treatment was superior from physician's ratings (P < 0.05). IASLSS followed the same trend as the improvement scores. Mean patient-rated improvement scores in single-plane treatment were 3.63 (±2.63), 3.69 (±2.83), 1.90(±2.51) for 1, 3, and 6 months, respectively. Dual-plane treatment received 3.5 (±2.57), 3.22 (±2.59), 1.78 (±2.48), respectively. The median pain scores were 2.6 (0-8) for single-plane treatment and 1.9 (0-8) for dual-plane treatment (P = 0.136). No other significant side effects were observed. Both single-plane and dual-plane treatment provide a modest skin tightening effect in the upper arm for at least 3 months. Physicians should assess skin thickness in every patient using the visualization screen to select the appropriate transducer for each individual patient. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Nonsurgical Treatment of Postpartum Lower Abdominal Skin and Soft-Tissue Laxity Using Microfocused Ultrasound With Visualization.

Microfocused ultrasound with visualization (MFU-V) is a well-established treatment modality for skin tightening. There is a paucity of evidence for its use in body treatments, such as the lower abdomen. To investigate the effectiveness and safety of MFU-V in treating lower abdominal skin and soft-tissue laxity in postpartum women. The lower abdomen of 20 female patients between 6 and 24 months postpartum are treated with MFU-V using 1.5-, 3.0-, and 4.5-mm transducers. Data are prospectively collected and analyzed at 3 and 6 months using subject-reported and investigator-reported outcome measures. One additional patient underwent planned abdominoplasty 6 weeks after MFU-V treatment with tissue assessed intraoperatively and histologically. There was a mean improvement of 1.0 and 1.3 grades at 6 months using the investigator-reported and patient-reported skin laxity scale, respectively (p < .001). Patient-reported outcomes and satisfaction survey showed consistent improvement at 6 months. Histological examination of pretreated tissue showed increased total collagen, increased number and thickness of fibrous septae, and no change in fat cells within pretreated tissue compared with the control. No significant adverse events were recorded. MFU-V is an effective and safe treatment modality for lower abdominal skin laxity in postpartum patients.

Combination of Calcium Hydroxylapatite Diluted With Normal Saline and Microfocused Ultrasound With Visualization for Skin Tightening.

Background/Objectives: Treatment options for the correction of age-related changes in skin include the use of energy-based devices and dermal fillers. In this study, we evaluate the clinical efficacy and tolerability of microfocused ultrasound with visualization (MFU-V) and injectable calcium hydroxylapatite (CaHA) filler diluted with normal saline, for the correction of age-related changes and to assess patients' satisfaction with this combination therapy. Methods: This was a randomized, split-face, comparative clinical study and immunohistochemical analysis in 20 subjects with indications for lower face, neck and décolleté lifting. Over five visits, CaHA diluted with normal saline (1:2) was injected subdermally in the lower third of the face, neck and décolleté, and lower abdominal quadrant. MFU-V was performed on the lower third of the face, neck, and décolleté, and the right lower abdominal quadrant. Results: Upon baseline examination, the age-related changes were quantified as follows: marionette lines score 2.47 ± 0.8, jawline contour score 2.2 ± 0.7 and neck score 2.1 ± 0.7 points; and after 15 months, they changed to 1.8 ± 0.7 (P≤0.00003), 1.89 ± 0.56 (P≤0.005), and 1.7 ± 0.6 (P≤0.005) points, respectively. The procedures were well tolerated, and subject satisfaction was high. Conclusions: The injections of CaHA in combination with MFU-V treatment stimulated neoangiogenesis, led to the increased synthetic activity of cells, a marked increase in collagen and elastin fibers, and remodeling of both the superficial and deep layers of the dermis. An improvement in the severity of age-related changes was observed in all areas studied. J Drugs Dermatol. 2020;19(4):405-411. doi:10.36849/JDD.2020.4625.

Using the BODY-Q to Evaluate Appearance and Quality of Life Following Treatment of Skin Laxity of the Outer Thigh with Microfocused Ultrasound and Calcium Hydroxylapatite.

Two procedures that have demonstrated collagen-stimulating properties and improvements in skin laxity in a variety of aesthetic indications are microfocused ultrasound with visualization (MFU-V) and injection with calcium hydroxylapatite (CaHA). By treating skin laxity with a combination of these therapies, it was hypothesized that our patients would experience improved appearance and quality of life as measured by the BODY-Q. A total of 60 consecutive female patients aged 30 to 60 years with body mass index less than 28 kg/m2 who expressed interest in treatment for skin laxity affecting the outer thighs completed selected scales (Body Image, Appraisal of Excess Skin, Satisfaction with Hips and Outer Thighs, and Appearance-Related Psychosocial Distress) from the BODY-Q within 1 week of treatment. At the time of treatment, MFU-V was directed to the outer thighs (150 lines at focal depths of 3.0 and 4.5 mm per outer thigh). Immediately following MFU-V, patients received treatment with CaHA injected into the subdermis (1.5 mL diluted 1:1 with 1.5 mL of 2% lidocaine solution per outer thigh). At 90 days posttreatment, these patients repeated the BODY-Q. At 90 days posttreatment, with 100% follow-up among the 60 consecutive female patients treated, scores from the BODY-Q scales showed statistically significant improvement (P < 0.01). Following treatment of skin laxity on the outer thighs with a combination of MFU-V and CaHA, our patients reported a statistically significant improvement in appearance and quality of life at 90 days posttreatment. This protocol may be applicable to other areas of the body.

Rejuvenation of periocular region in Koreans: A multimodal approach combining botulinum toxin, fillers, and micro-focused ultrasound with visualization for optimal results.

Periorbital aging involves all layers of the skin, fat, and the bony orbit. Therefore, a multimodal approach is necessary. Twenty Korean subjects who required periorbital rejuvenation were enrolled in this study. First, micro-focused ultrasound with visualization (MFU-V) was performed across the supra-brow area, lateral canthus, and the infraorbital area. Next, the filler was injected into the sunken upper eyelid, lateral eyebrow, and the infraorbital area. Lastly, botulinum toxin was administered into the forehead, glabella, crow's feet, and the lateral orbital rim below the brow on the same day. Photographs were taken at baseline; immediately after treatment; and at 1, 4, and 12 weeks of follow-up. The average eyebrow height was increased by 3.5 mm, and the maximum height was elevated by 3.9 mm at week 12. Physician visual analogue scale (VAS) scores regarding the whole periorbital area and eyebrow ptosis were continuously improved throughout the observation period. Physician VAS scores for infraorbital hollow and superior sulcus deformity improved immediately after the procedure and were maintained at week 12. Adverse events were mild and transient. We believe that a multimodal approach combining MFU-V, fillers, and botulinum toxin results in significant periocular rejuvenation.

High-efficiency Combination Treatment of Submental Neck Fullness.

Background:Fat accumulation, skin laxity, and muscle contraction cause aging cervical fullness. Combining botulinum toxin to treat muscle contraction, and technique-oriented microfocused ultrasound for skin laxity, can improve cervical fullness without requiring lipolysis. Gel-assisted depth adjustment (GADA) is a depth-targeting, image-guided approach using an appropriate gel volume to precisely heat tissue layers during real-time visualization.Methods:A 41-year-old woman presented with moderate submental neck fullness and saggy cheeks. An appropriate gel volume was applied as determined by the targeted tissue layer’s distance from the skin. The submental and submandibular areas received 112 lines of 0.9 J/cm2 microfocused ultrasound with visualization (MFU-V) from a 4.5-mm transducer and 0.3 J/cm2 from a 3-mm transducer to treat the SMAS and dermosubcutis, respectively. For concomitant jowling, these transducers delivered 111 MFU-V lines to the lower cheek. Six units of incobotulinumtoxinA was injected in 1 point at the mandible to modulate hyperactive mentalis muscles. The platysma received 10U of incobotulinumtoxinA per cheek, whereas downturned mouth corners received 4U of incobotulinumtoxinA.Results:One-month posttreatment, submentum improvements included changes of the vertical pogonion position, more mandible angularity, and a straighter mandibular line. Anterior chin projection was more pronounced and the pogonion had more inferior displacement, creating a younger appearance in the chin-neck complex. Patients followed-up for 3 months also demonstrated these changes.Conclusions:Delivering MFU-V using the GADA technique effectively tightens submental and submandibular soft tissues. When combined with incobotulinumtoxinA, muscles in the chin and perioral area are relaxed. Thus, GADA yields significant clinical improvement and patient satisfaction.

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.

Over the past decade, 2 major modalities for noninvasive skin tightening have emerged: monopolar capacitive-coupled radiofrequency (MRF) and microfocused ultrasound with visualization (MFU-V). Up to date, no comparative clinical trials have been performed. To compare the efficacy and safety of MRF versus MFU-V for the lifting and tightening of the face and neck. Twenty subjects with mild to moderate skin laxity received MFU-V over one-side of the face and MRF over the other side of the face at the same time. Subjects were followed for 6 months. Both MRF and MFU-V led to a decrease in the Fasil Face and Neck Laxity Grading Scale (FLR). These differences became significant at Day 30 and remained significantly improved through Days 90 and 180 in both groups. There was no statistically significant difference in the FLR Scale between MRF-treated and MFU-V-treated sides. Subjects' Global Aesthetic Improvement Scale showed improvement at Day 30, 90, and 180. Both MRF and MFU-V led to significant improvement in face and neck laxity. There were no statistical differences between MRF and MFU-V in standardized investigator measures of face and neck laxity, patient satisfaction, and adverse events.