Single Treatment, Single Depth Superficial Microfocused Ultrasound with Visualization for Rhytid Improvement

Abstract

Background: Standard lifting and tightening protocols with microfocused ultrasound with visualization (MFU-V, Ultherapy) comprise the use of multiple transducer depths. We developed a shortened, single depth treatment protocol for patients seeking skin rejuvenation.

Methods: Single-center, prospective case series. Subjects with static periorbital wrinkles, perioral wrinkles, or accordion lines had a single MFU-V treatment comprising up to 340 lines (periorbital 120, perioral 100, and accordion 120) with the superficial depth transducer (10.0 MHz/1.5 mm). Efficacy was assessed using established rating scales as well as clinician- and subject-reported Global Aesthetic Improvement Scales at baseline, 90, and 180 days, and each subject served as their own control. Adverse events were documented.

Results: Nine subjects, women aged 38-64, received treatment. At 180 days, post treatment clinicians reported visible improvements in periorbital lines (6/6 cases), accordion lines (5/6 cases), and perioral lines (3/6 cases). Subjects' self-assessments mirrored those of the clinicians, reporting improvements in accordion lines (5/6 cases improved, 1/6 cases much improved), periorbital lines (3/6 cases improved, 3/6 cases much improved) and perioral lines (2/6 cases improved, 2/6 cases much improved). Subject-rated satisfaction was high (accordion lines 6/6 cases, periorbital lines 4/6 cases and perioral lines 4/6 cases). All subjects experienced mild, transient erythema; in one subject, wheals persisted for 24 hours, resolving on application of mild topical corticosteroid.

Conclusions: Shortened protocol, single depth MFU-V treatment was well-tolerated. It provided aesthetic improvements in periorbital and accordion lines, and to a lesser extent in perioral lines. Its utility as a noninvasive therapy for superficial skin rejuvenation warrants further investigation.

Conflict of interest statement

Disclosure: Dr Lowe reports nonfinancial support from Merz Aesthetics Australia Pty Ltd during the conduct of this case series; the company reviewed the proposed protocol, provided the transducers used during the treatment sessions, funded medical writing assistance, and reviewed the final manuscript for accuracy of content prior to submission. Dr Lowe also reports receipt of personal fees and nonfinancial support from Merz Aesthetics Australia Pty Ltd outside the submitted work.

Copyright © 2021 The Author. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

Figures

Fig. 1.

Clinician assessment of accordion lines using the Modified Fitzpatrick Wrinkle Scale (MFWS): (A) Assessor A, (B) Assessor B. MFWS: Scale 0 (no wrinkles) to 3 (deep wrinkle).

Fig. 2.

Case 3: Accordion lines. A, At baseline 0. B, At 90 days. C, At 180 days. This case was rated “much improved” by Assessor A and “exceptionally improved” by Assessor B at day 180, according to PGAIS.

Fig. 3.

Clinician assessment of perioral lines using the Merz Aesthetic Lip Wrinkles Grading Scale: (A) Assessor A, (B) Assessor B. Merz Aesthetic Lip Wrinkles at Rest Grading Scale: 0 (no wrinkles) to 4 (very severe wrinkle).

Fig. 4.

Case 11: Perioral lines. A, At baseline 0. B, At 90 days. C, At 180 days. Assessor B rated this case “much improved” at days 90 and 180, according to PGAIS.

Fig. 5.

Clinician assessment of periorbital lines using the Merz Aesthetic Crow's Feet Grading Scale: (A) Assessor A, (B) Assessor B. Merz Aesthetic Crow’s Feet at Rest Grading Scale: 0 (no wrinkles) to 4 (severe wrinkles).

Fig. 6.

Case 15: Periorbital lines. A, At baseline 0. B, At 90. C, At 180 days. Assessor B rated this case as 'much improved" at day 90 and "exceptionally improved" at day 180.

Fig. 7.

Subject satisfaction ratings for (A) accordion lines, (B) periorbital lines, and (C) perioral lines.