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

Abstract

Background: There is no publication to date on the combined use of microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite (CaHA) for brachial skin laxity.

Aim: To assess the effectiveness of combining MFU-V with diluted/hyperdiluted CaHA in a single session for treating brachial skin laxity.

Subjects/methods: Female 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.

Results: Twelve 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.

Conclusions: Combined use of MFU-V with diluted/hyperdiluted CaHA demonstrates significant improvements in both objective and subjective measures of brachial skin laxity.

Keywords: arm laxity; calcium hydroxylapatite; combination therapy; microfocused ultrasound with visualization.

Conflict of interest statement

This study was supported by a research grant from Merz Aesthetics. Sylvia Ramirez and Ivan Puah report no additional conflicts of interest in this work.

© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

Figures

FIGURE 1

Treatment administration. (A) MFU‐V treatment: The brachial regions were treated in a standardized pattern at two depths using the 4.0 MHz‐4.5 mm depth transducer and 7.0 MHz‐3.0 mm depth transducer. A total of 180–240 treatment lines (20 lines per 2.5 × 2.5 cm square) were administered using each transducer. (B) CaHA treatment: subjects received subdermal injections of diluted or hyperdiluted CaHA with a 25‐gauge cannula using a retrograde fanning technique. The crosses in Figure 1A denote the three standardized points where cutometer readings were taken

FIGURE 2

Objective biophysical parameters of the brachial skin over time. (A) Mean (SD) R0 readings, a measure of skin firmness, and (B) mean (SD) R2 readings, a measure of skin elasticity, before treatment and at 4, 12, and 24 weeks after treatment

FIGURE 3

Mean (SD) arm VAS scores before treatment and at 4, 12, and 24 weeks after treatment

FIGURE 4

Photographs of upper arms of a subject before treatment (left) and at 24 weeks after combined treatment with microfocused ultrasound with visualization and diluted calcium hydroxylapatite (right)

FIGURE 5

Investigators global aesthetic improvement scale (GAIS) ratings over time

FIGURE 6

Subject satisfaction over time