In today’s fast paced life, patients have been more inclined towards skin tightening and rejuvenation procedures with little or no downtime. The current trend is to opt for noninvasive procedures which offer superior and long lasting results comparable to surgical treatments but without the risk or downtime associated with surgery.There are several treatmentoptions available ranging from non-invasive, minimally – invasive to surgical options. Earlier treatment options ranged from light based or energy based devices like lasers & Radiofrequency which had their own limitations as they delivered heat more superficially. These procedures provide a variable amount of skin tightening but most of them require multiple sessions.

With the advent of High Intensity Focused Ultrasound (HIFU) we are now able to treat deeper layers of the skin in a way that only surgery could treat before. HIFU provides an instant uplift to the skin & more longlasting results.

What is HIFU

HIFU is currently the only non-invasive medical device that uses focused ultrasound energy to selectively heat the superficial and deep dermis as well as the SMAS layer. The SMAS is a subcutaneous, fan – shaped structure that covers the face & connects the facial muscles with the dermis. It has a more durable holding property & less delayed relaxation after lifting procedures than the skin alone thus making it a desirable target for noninvasive skin tightening procedures.HIFU utilises ultrasound energy which is an oscillating pressure wave and can be focused like a beam with a high degree of precision. It is able to reach a deeper depth than the other devices.

Mechanism of Action

The ultrasound waves penetrate into tissue, leading to vibration in molecules at the site of beam focus. The friction between molecules produce heat and thermal injury at the focal site of the beam. Penetration depth is determined by frequency in which higher frequency waves produce a shallow focal injury zone or point and lower frequency waves have a greater depth of penetration to produce focal thermal injury zones (TIZ’s) at deeper layers.At frequency of 1-7 MHZ it can increase the temperature to more than 60 degrees C within the focal zone causing tissue proteins to coagulate followed by neocollagenesis which results in tightening & lifting of the skin. An important aspect of HIFU is that the tissue above & below the focal zone will remain unaffected.

HIFU System Variables

1.Frequency

Higher the frequency more is the absorption of energy & lesser the penetration. Lower the frequency lower is absorption in the tissue and deeper the penetration.

7 Mhz frequency is more superficial & is used for thinner tissue

(e.g. forehead and periorbital areas).

It reaches a depth of 1.5 & 3 mm. It targets the superficial and deep dermis.

4 Mhz frequency reaches deeper layers and is used for thicker tissue (e.g.cheeks & jawline).

It reaches a depth of 4.5 mm.It targets the SMAS layer.

2.Pitch

Pitch implies the distance between the 2 focal thermal coagulative zones or points. When you decrease the pitch the treatment becomes more intense or aggressive. If the spacing between 2 focal points is narrow the chances of side effects could also increase.

3.Energy

Energy indicates the intensity of HIFU. The energy is delivered in a straight line of 5 to 30 mm length. The energy needs to be adjusted according to the thickness of the skin & area to be treated.

Indications:

• Forehead lines
• Crows feet
• Lifting of eyebrows
• Jowls
• Neck lines
• Double Chin
• Facial Contouring

Contraindications:

• Pregnancy
• Bleeding disorders
• Autoimmune disease
• Epilepsy
• Metal implants in the area to be treated
• Active infection at the sight of treatment

Procedure 

• Cleanse the skin
• Take photographs & consent before the treatment
• Apply topical anaesthesia 30-40 mins prior to the treatment (optional)
• Mark the preoperative treatment areas with a marker pencil if required.
• According to the skin thickness select the appropriated cartridge.
• Set suitable intensity (energy),focal length and pitch.
• Apply a generous amount of gel on the preoperative area.
• Maintain complete contact of the cartridge on the skin at all times and do not lift the hand piece during the procedure while the shots are being delivered.
• Avoid treatment over the temporal branch of trigeminal nerve, marginal mandibular nerve and centre of neck ( thyroid gland).
• Post procedure sight redness or swelling might be visible which usually subsides within a few hours. Apply moisturizer and sunscreen post procedure.
• Treatment lines of the ultrasound pulses should be adjacent and parallel to one another with minimal spacing. Vertical and horizontal passes are given in the areas concerned. The total number of lines depends upon size of the treatment area. Approximately 600-800 lines are required for the full face.
• 5 mm cartridge can be used for areas like cheeks and jawline.This can be followed by a 2nd pass with 3mm cartridge.
• The 3mm superficial cartridge can be used for areas like neck, double chin and lower face.
• Additional pass with 1.5mm could be given if required in clients who have fine lines and wrinkles. For eg. Periorbital area, eyebrow and forehead.

Prevention of complications

Post treatment erythema is a common occurrence. It usually subsides within the first few hours.

Pain & tenderness is usually experienced around the bony areas like the jawline & the forehead. Application of numbing cream & anxiolytics or pain killers could be opted for in case of clients with a low pain threshold.

Nerve injury can be avoided by not treating the areas where the course of the  nerves becomes relatively superficial.

Geometric wheals or striations generally occur with superficial transducer. Apply ice & topical steroid cream post treatment for fast resolution.

Results

The results are visible immediately as a result of tissue contraction which keep on gradually improving over the next few months. Maximum results are appreciated after 6 to 8 weeks.

The best part about the technology is that it does not require multiple sessions. Depending on the age group & the indication one may require 1 to 2 sessions only.

HIFU has become the most sought after treatment as it offers a significant instant uplift to the skin with no downtime & long lasting results. As it is a safe, effective & non-invasive procedure which offers superior quality of result it also ensures high patient satisfaction range.