There’s no denying that as aesthetic medicine has advanced into the mainstream by opening new markets and broadening the realistic potential base, patients have begun to demand better results, less discomfort, decreased risk and less downtime with the aesthetic procedures they choose to peruse.
Before I describe Ultherapy in detail, one must understand from a historical perspective what modalities are available to treat the aging face. In 1901, patients had only one choice, a “skin-only face-lift,” which only involved the epidermis (the roof of the skin) and the dermis (the foundation of skin). In 1970, the skin and muscle surgical face-lift was introduced. In the 1990s, the short scar surgical face-lift was developed as an outgrowth of the skin and muscle procedure to minimize the scar by using a smaller incision. Short scar face-lift procedures may also be called Mini Lift, Quick Lift, Brow Lift, Fat Transfer Lift or Thread Lift. At the same time as the short scar face-lift was introduced, lasers were also first developed for facial rejuvenation. Many of these lasers were ablative (meaning they removed the tissue) and are directed toward the epidermis and superficial dermis of your skin. There are many types of these ablative lasers, but the best known are the CO2 (carbon dioxide) or Fractional CO2 lasers. Patients who have these procedures take a longer time to recuperate after the laser surgery. In 2002, the radiofrequency procedure was introduced. This procedure utilized radio waves to tighten the dermis in the skin. My patients who have had this procedure told me that it was extremely painful. Although there are a number of radiofrequency procedures available, the best known of these radiofrequency procedure is “Thermage.”
In 2009, the Micro-Focused Ultrasound procedure was first introduced to the medical community. It is called Ultherapy. It was promoted as “the non-surgical face-lift.” This procedure penetrates directly down to the muscle in your skin.
Ultherapy is a novel ultrasound modality for non-invasive, non-surgical skin rejuvenation and lifting. It was developed with those very concepts in mind.
Ultherapy is the first and only energy-based device for facial aesthetics to receive an FDA-approved indication for non-invasive lifting of not only the face but also the brow, submental (under the chin), the neck’s dermal tissue and also the deeper subdermal tissues.
These are the same areas that would be targeted with a “surgical knife” when a patient decides to have a face-, brow- or neck-lift, only in the case of Ultherapy, it would be done with ultrasound.
“The Ulthera System,” which represents a new category of treatment, combines ultrasound visualization of and beneath the skin’s surface with the delivery of microfocused thermal coagulation points via ultrasonic energy to the skin and deeper fibromuscular layers to stimulate collagen, which provides its lasting effect. This affords a level of precision heretofore unheard of given the superficial nature of the treatment.
The limited depth of penetration of treatment energy also improves control and enhances the dermatologist’s or plastic surgeon’s ability to safely and accurately treat the patient while concurrently sparing other tissue layers.
The Ultherapy procedure may be optimal for some surgical candidates who are unwilling or unable to undergo facial surgery. Ultherapy represents an alternative that allows some patients to postpone facial surgery or for the younger person to delay the eventual onset of wrinkles as they progress through the normal aging process.
Ultherapy may also serve a patient well for secondary corrections of previous unsatisfactory surgical scars that may be technically challenging for a surgical revision. It also may represent a simplified somewhat less-effective but more-acceptable non-invasive alternative for a patient that desires not to revisit surgery and present with stubborn, modest post-operative recurrences of a sagging brow, crow’s feet around the eyes and “bags under their eyes,” accentuations of facial lines and a small amount of sagging under their chin.
As with any modality, patient selection and patient understanding is of paramount importance. If you are considering Ultherapy yourself and expect to achieve consistently good results, you must understand the following,
If you have severely sun-damaged skin and have had many precancers; thin/porcelain skin; scarred skin and tissue; severe laxity to your skin, fat and deeper muscles; systemic or local infections or conditions that may compromise wound healing; or a long smoking history, you would not be considered an ideal candidate for Ultherapy.
I expect the best results in my patients that have mild to moderate laxity of their forehead, brow, face and neck skin. I also tell my patients during their consultation that “if the skin under your chin and anterior neck is hanging down like a rooster’s, Ultherapy is not the procedure for you”.
During an office consultation, my patient compared the skin on his face to the skin on his dog’s face, so I asked. “What kind of dog do you have?” He replied, “a basset hound.” I responded “Ultherapy will do nothing for you. You need a face-lift.”
At least eight out of 10 of my patients have been pleased with their results, but I explain that because the way this treatment works on collagen, it will take three to three and a half months to begin to see improvement after the Ultherapy procedure.
• Dr. Eugene Conte is part of Ahwatukee Skin & Laser, 4425 E. Agave Road, Suite 148. Reach him at firstname.lastname@example.org.