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

April 2020 | Volume 19 | Issue 4 | Original Article | 405 | Copyright © April 2020


Published online March 6, 2020

doi:10.36849/JDD.2020.4625

Yana Alexandrovna Yutskovskaya MD,a Anna Daniilovna Sergeeva MD,b Evgeniya Altarovna Kogan MDc

aDermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia bClinic of Professor Yutskovskaya, Moscow, Russia cDepartment of Anatomic Pathology, Sechenov University, Moscow, Russia

Abstract
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): doi:10.36849/JDD.2020.4625

INTRODUCTION

Correction of age-related changes using calcium hydroxylapatite (CaHA; Radiesse®, Merz North America) dermal filler and non-surgical SMAS-lifting microfocused ultrasound with visualization (MFU-V, Ultherapy®, Merz North America) is becoming increasingly popular.1 Currently, CaHA is the only biodegradable filler that immediately restores lost volume and simultaneously stimulates the production of natural skin collagen to achieve long-term results.2 According to the Consensus Recommendations for the Use of Hyperdiluted CaHA as a Biostimulatory Agent, it acts as a collagen and elastin biostimulator when used undiluted or diluted up to 1:6.3 The mode of action of MFU-V lies in the ability of an unscattered ultrasonic wave to heat tissue selectively at a given depth. Tissue exposure leads to the formation of thermal coagulation points, the regeneration of which promotes the synthesis of new collagen fibers that create support in the tissues. Both of these methods have a favorable and well-characterized safety profile and are FDA cleared; their effectiveness has been demonstrated in a number of studies.4-10 The possibility of their combined use to potentiate the lifting effect stirs interest, but at present, there are only few reports of studies of this combination in the treatment of cellulite, atrophic acne scars, skin laxity and wrinkles on the neck and décolleté, lax skin of the inner thighs.11-14

The primary aims of this study were to evaluate the clinical efficacy and tolerability of the combination of MFU-V and injectable CaHA diluted with normal saline (1:2), for the correction of age-related changes in the face, neck and décolleté, as evidenced by the lifting effect, and to assess patients’ satisfaction with this combination therapy.

The secondary aims of the study were to assess the clinical efficacy of the combination of MFU-V (a single treatment session) and injectable CaHA diluted with normal saline (1:2) and evaluate pathohistomorphological features of compatibility of the combination of MFU-V and CaHA.

METHODS

Study Design
This was a randomized, split-face, comparative clinical study and
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