Facial Skin Tightening With Microfocused Ultrasound and Dermal Fillers: Considerations for Patient Selection and Outcomes

November 2019 | Volume 18 | Issue 11 | Original Article | 1075 | Copyright © November 2019

Gabriela Casabona MD and Kai Kaye PhD

Ocean Clinic, Marbella, Spain 

layers treated to achieve the same endpoint in same vector (horizontal or vertical depending on area). As mentioned before, the recommended protocol of transducers per area needs to be adapted according to SMAS or SFS depth. Therefore, the coverage needed to be adapted to bring the same result once the TCP area of the 4mm/4.5 MHz transducer (1mm3) is much bigger than the 7mm/3.0 MHz (0.3mm3) or 10mm/1.5mm MHz (0.2mm3) transducers. The author developed a table using the ruler provided with some HIFU devices that has an area of 2.5cm x 5cm and is used to mark and distribute the determined number of lines when delivered by a transducer in a certain area of face and body (Table 2). This table might help to convert the number of lines from one transducer to the other if needed. Although, it is important to point out that we do not have data on what is the ideal conversion of one transducer to the other to keep the same clinical result. The authors recommend these corrections when changing transducers: 4/4.5 to 7/3.0–50% more lines of standard protocol, 7/3.0 to 10/1.5–30% more lines of the standard protocol (Figures 7A–C).40

4. Plan
In this step, the most important assessments are the vectors involved in the aging appearance for each patient and each area of complaint. The face, neck, and chest have different ways of aging, and the same layers of skin are disposed differently in these three areas. Also, it is very important to evaluate the patient in dynamic and resting conditions because this will provide a hint about which layer is more important to treat to effectively address the specific patient complaint.

• Face: Only MFU-V can provide correction in a horizontal manner on the face, tightening the skin and SMAS from the corner of the mouth to pre-auricular area (fixed part of the SMAS).39,41
• Neck: Only MFU-V can provide correction in a vertical manner in the neck, recreating the mandible definition by tightening the platysma and skin from its origin (mandible region) and insertion (clavicle).39
• Décolleté: Only MFU-V can provide correction in a vertical manner on the chest as shown in clinical experience.42,43

Other procedures such as biostimulators and fillers can enhance the strength of other vectors such as horizontal or projection on the frame of the face, neck, and chest (Figure 8).44,45 They can be boosters (enhance collagen stimulation same areas) or highlighters (enhancing visual result of MFU-V by restoring the structure of bone and fat creating a stretching effect on the tissue envelope from SFS to epidermis). The more vectors you treat without overtreating one or the other, the more natural results look.