International Journal of Advanced Computer Research, Vol 6(26)

ISSN (Print): 2249-7277 ISSN (Online): 2277-7970

Research Article
http://dx.doi.org/10.19101/IJACR.2016.625013

Patient satisfaction and efficacy of accent high-intensity focused ultrasound

for face lifting
Hamid Zandvakili1* , Ramin Rafiei Hamid1 and Reza Chabok2
Department of Biomechanics Engineering, College of Biomedical Engineering, Science and Research Branch,
Islamic Azad University, Tehran, Iran1
NIH Resource Center for Medical Ultrasonic, Transducer Technology, Department of Biomedical Engineering,
University of Southern California, Los Angeles, United States2

Received: 6-June-2016; Revised: 13-August-2016; Accepted: 16-August-2016

©2016 ACCENTS

Abstract
High-intensity focused ultrasound (HIFU) method treatment has recently erosed in response to the increasing demand
for skin lifting and tightening. This study was aimed at evaluating the patient’s satisfaction with HIFU treatment for
lifting in different areas of the face. Twenty five Iranian women patients with facial wrinkle and laxity were analyzed
after a single session of HIFU treatment. Two independent, blinded clinicians and patients evaluated the clinical
improvement in seven areas of the face by comparison of standardized photographs obtained before, and at two months
after treatment. Assessment of satisfaction and adverse effects of treatment were done by using questionnaires. Results
showed that significant differences (p<0.05) between the physician and patients’ satisfaction about lifting. HIFU could be
an effective and non-invasive procedure that can be used to improve facial lifting in Iranian skin. If more sessions to be
used in the patients more likely it will be effective.

Keywords
High-intensity focused ultrasound, Face lifting, Patient’s satisfaction, Iran.

1.Introduction However, collagen remodelling on deep dermis

With increased life expectancy as a result of public slightly helps to regain some degree of skin elasticity
and personal hygiene, prevention and treatment of but it is difficult to improve its own fundamental face
skin aging are necessary for some people. As human contour [1].
gets older, skin and it’s under structural tissues
constantly get ageing process. Typically, number of About history of face lifting & tightening the Latin
fibroblast on the skin decreases and collagen word ‘Rejuvenation‘is the compound word of 'Re'
synthesis also decreases and functions and numbers and 'Juvenile' which can be interpreted ‘as a kid
of many skin appendages are also dropped. For under again’ or ‘be young again’. Rejuvenation has
the tissues of the skin that maintain the face contours historically always been a concern for the human.
also form laxity due to the aging process. Face and The development of laser and other medical
scalp are composed of several layers and these can be equipment for rejuvenation can be classified in many
specifically composed into five standard layers: Skin, different ways but can be largely categorized in five:
Subcutaneous layer, Musculoaponeurotic layer 1-Ablative resurfacing with lasers, 2-Photo
(SMAS: Superficial MusculoAponeurotic System), rejuvenation with intense pulsed light (IPL), 3-
Loose areolar tissue (spaces and retaining ligaments), Rejuvenation with electrical current radiofrequency
fixed periosteum and deep fascia. So far in the laser (RF), 4-Rejuvenation with fractional laser, 5- New
treatment area of dermatology, the epidermis and generation rejuvenation with HIFU [1].
dermis were the main interested therapeutic areas for
the skin treatment. When the laser technology was not developed in old
days, ablative laser or chemical peeling was used for
face lifting [1]. Recently, HIFU was explored as a
new treatment modality for skin tightening and
*Author for correspondence rejuvenation [2,3]. High intensity focused ultrasound
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can produce small, micro-thermal lesions at precise method. The results in the study [19] showed that
depths in the dermis up to the fibromuscular layer, macroscopically, UVB-induced hyperpigmentation
causing thermally induced contraction of collagen was significantly reduced two weeks after HIFU with
and tissue coagulation with subsequent collagenesis, 0.2 J/cm2, and three weeks after HIFU with 0.1 J/cm2.
while sparing the epidermis [4,5]. Many different Histopathologically, the heavy deposition of melanin
laser and other light-based systems have been in the epidermis induced by UVB exposure was
developed and evaluated for their capability to reduced three weeks after HIFU irradiation [19].
reverse photo damage and age-associated rhytides, a
process referred to as photo rejuvenation[6,7]. The aim was to compare neocollagenesis and
Although ablative lasers remain the gold standard for neoelastogenesis in each layer of the dermis after
photodamaged skin rejuvenation, their use is each session of HIFU and monopolar RF in [3]. They
associated with side effects as well as a prolonged analyzed the area fraction of collagen and elastic
and unpleasant posttreatment downtime [1,8]. Thus, fibers using the Masson’s Trichrome and Victoria
in recent years, non-invasive and non-ablative blue special stain, respectively, before and after two
procedures have attracted attention with the hope of months of treatments. Histometricanalyses were
achieving skin tightening effects close to those of performed in each layer of the dermis, including the
ablative lasers while avoiding long recovery times papillary dermis, and upper, mid, and deep reticular
and potential complications [9-11]. Nonablative dermis. Results showed that Monopolar RF led to
rejuvenation (NAR) devices have been designed to neocollagenesis in the papillary dermis, and upper,
induce thermal injury within the dermis without mid, and deep reticular dermis, and
epidermal damage [12-14]. However, laser energy neoelastogenesisin the papillary dermis, and upper
can be diffracted, absorbed, or scattered, resulting in and mid reticular dermis. Among these treatment
suboptimal energy penetration [15,16]. methods, HIFU showed the highest level of
neocollagenesis and neoelastogenesis in the deep
One of the recent advances in non-invasive skin reticular dermis [3,20].
tightening is the use of HIFU. This can produce
small, micro-thermal lesions at precise depths in the Given that very few studies have been done
mid to deep reticular dermis up to the fibromuscular HIFUmethod for face lifting purpose of this study
layer, causing thermally-induced contraction of was Patients’ satisfactions and efficacy of accent
collagen and tissue coagulation with subsequent HIFU for face lifting.
collagenesis, while sparing the epidermis[17,18].
Recently a lot of concern about facial wrinkles has 2.Materials and methods
been created in the community. About this problem, This research is a cross-sectional study and was
various treatments, including ,microdermabrasion, conducted in two laser center with HIFU in Tehran.
fractional laser, and radiofrequency, have been Patients who have recently had a history of skin
proposed for the treatment of facial wrinkles and rejuvenation excluded. In our study there were 25
laxity; however, the ideal treatment option has yet to patients women 35-50 years (Mean ± SD = 42.56 ±
be identified [4,15,19, 20]. Recently, ultrasound was 4.02). All patients were consented for the procedure.
introduced as a new treatment for therapeutic and The major complaint of patients was that they all tend
cosmetic purposes [2,4]. HIFU may be the best to lift sagging facial skin in the cheeks and eyebrows.
example of this technique. White et al reported the All patients were banned for 72 hours from ingestion
first dermatologic, aesthetic use of HIFU in 2008, of drugs such as NSID, aspirin, corticosteroids,
and HIFU was approved by the food and drug heparin, vitamin K and vitamin E. In this study, all
administration in 2009 for use in brow lifting [18]. of them didn’t any attempt to face lifting with HIFU
Currently, it is being used for facial rejuvenation, or similar technology in last year. Of the 25
lifting, tightening, and body contouring, which are participants in the study there were only 6 people
considered ‘off-label’ use [10]. The principle of unbearable pains. In no case was found bruises. They
HIFU is to induce cellular damage and volume were treated with a HIFU face lifting device (Doublo
reduction of the target area selectively by means of from Hironiccompany made by South Korea) to the
coagulation by generating instant microthermal entire face, except for the nose and eyes, by using the
lesions through the accumulation of high-frequency following probes: Power is in the range of 0.8 to 1.2
ultrasound beams at the specific tissue site without MHz according to diagnosis and patient needs set in
any damage to the epidermis and adjacent issue [21]. all patients. Pitch was considered 2-mm in all
But so far, few studies have confirmed the use of this patients.
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From 400 to 450 shots were delivered according to SPSSGraphic18.0 (SPSS INC., Chicago, IL) software
the size of the face. Standardized photographs of and Chi-square test analyzed in p≤ 0.05.
frontal and 450 angle views, along with profiles from
each side, were obtained before, and 2 months after 3.Results
the treatment. For comparison and record comments Patient and physician’s satisfaction for face lifting are
pre- and post-treatment photographs were printed out given in Figure 1.
and organized side by side to be reviewed by
physician and patients. Information collected through

Figure 1 Patient and physician’s satisfaction about face lifting

16 patients were assessed their face lifting as 4.Discussion

moderate and normal, 4 people good, 3 people Both intrinsic and extrinsic aging processes
excellent and only 2 people assessed that weak. contribute to aesthetic changes. Advances in the
Physician were evaluated 15 patients good in face understanding of skin biology have led to the
lifting, 7 people normal, 2 people excellent and only development of a number of technologies for
for one person assessed weak. Chi-square test method rejuvenating the skin. Current treatment modalities
is shown in the Table 1 and compares patient and include ablative and non-ablative lasers,
physician satisfaction about face lifting with HIFU. radiofrequency devices, and ultrasound devices [2,
22, 23].
Table 1 Chi-square test
Value Df Sig Recently, HIFU treatment has received proper
Pearson 10.423 3 0.015* medical attention as a ‘high-tech’ way to improve
Chi-square face lifting [3,4,10]. To date, few articles have
*p ≤ 0.05 demonstrated the efficacy of HIFU face lifting and
devices. HIFU was a safe and effective modality for
The results showed that patient and physicians’ facial skin tightening [4]. Another recent study
perspectives about face lifting with HIFU are showed that HIFU could also be used safely and
statistically meaningful differences (p ≤ 0.05). effectively to improve the skin texture and contour of

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in the superficial musculoaponeurotic system using Kerman in 2005, and received M.S.
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J, et at. High intensity focused ultrasound as a Research Branch, Islamic Azad University, Tehran, Iran in
potential new modality for the treatment of 2014, and He finally Studies his Ph.D. degree in
pigmentary skin disorder. Skin Research and biomedical engineering at Department of Bioelectric
Technology. 2015;22(2):131-6. Engineering, College of Biomedical Engineering, Tehran
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HH. Safety study of transcutaneous focused Tehran, Iran now His interests include high frequency
ultrasound for non‐invasive skin tightening in Asians. ultrasonic transducers and arrays, and digital methods for
Lasers in Surgery and Medicine. 2011; 43(5):366-75. fabrication of piezoelectric materials and composites for
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