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Ultherapy – Is It a Facelift?

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    "I want to spend a few minutes today to talk about a new technology, Ulthera. Ulthera is an ultra-sound device that has been cleared by the FDA for actually doing lifting, using a non-invasive technology. It's the first and only device in the United States that's got a clearance from the FDA for lifting, and you will see actually some photographs that we'll post here on blog and also some demonstrations if you view my website at, some very good examples of actual lifting improvement that is achieved by using ultrasound.

    Now I want to talk a little bit about how the technology works and then contrast it against some of the other technologies that have made some claims about lifting but are really devices cleared for med skin tightening.

    So these technologies, I wanted to describe graphically how they work and I'll focus in on Ulthera in just a second, but if you can imagine this has being the skin surface and subcutaneous tissues, here's the surface here, the epidermal layer, the sub-dermal ,or the dermal layer here and the sub-dermal layer immediately below that you can see the little fat globules here and the fibers tissue bands that are part of the fascia that belong down below here which is the brow line and the fascial layers they're the most areas of the face.

    So again it goes skin surface, epidermis, that dermal layer which is very important, that's where collagen, elastin and hyrolic acid reside, sort of the ground substance of the skin. The sub-dermal layer which includes fat, fascial bands and then a very thick connective tissue layer the fascial area like the SMAS in the face, the so-called subcutaneous musculo aponeurotic system.

    When we do laser skin re-surfacing as can be described here in the fractional layer, what we're doing is creating little thermal injuries that go through the epidermal layer and into the second layer of the dermis and depending on heating, that can go all the way through, that is why we're very careful. It's a selective injury and lasers work on the skin surface only. They do smoothing, a great job at fine lines and wrinkles, contour and texture, so that's where that category of energy delivery device for the skin, is.

    The next category of skin injury device, and actually you could include in this area chemical peels, or even full laser resurfacing or dermabrasion, in which case you wouldn't see little lines of thermal injury like you see represented by this little triangles, you'd actually see the full layer here of skin being gone, and how that rehabilitates itself or recovers, is by migration of new skin cells from the adnexal tissues below the skin, with are the oil and sweat glands and hair follicles etc and re-epithelialization of new skin over the surface. Fractional lasers are different in that it heals much faster, and we've talked about that in other of our sessions.

    The next type of technology which is most interesting and, I really believe in and has a good application in many of the things we do is radio frequency or electrical energy, basically that's being delivered to the skin and tissues below the skin surface.

    There are many devices, one which we have the Velashape 3, which is the newest of them from Syneron. There's a handful of devices, one of which is Thermage. When Thermage first came out, of course it's improved a lot now, it's grounded distally with a little grounding pad and there's a surface treatment handle that's placed on the skin surface, and with that electricity is passed through the skin, and the skin acts as a resistor with the fat and skin cells creating impedance and whenever there's a resistor impedance to electrical energy flow there's heat built up, and you can see its built up near the skin surface the yellow where it's hottest, the green less heat, and then down lower, the least amount of heat.

    So what we're seeing with velashape and thermage and the radio frequency devices is gentile heating, and this is all control based on the energy level set in the operator using it, down to and including maybe the top, maybe through the dermis and in some cases we think we can get sub-dermal.

    There's a lot of energy delivery that is done this way. I think we can see general skin tightening and some contour improvement is seen also, particularly with these new devices but there is really need for further research in terms of how much contour we can actually get. Sort of excited about what we'll be able to see with the new velashape 3 device getting the tissues up to 42, 43c with thermage, they're actually getting up into the 50 some degree range here and causing skin tissue tightening. Now, "How much contouring it gets?" That's another question and I'll leave that for further discussion at another point.

    The last of this technology, Ulthera, uses ultrasound energy and those are literally sound waves, high frequency sound waves that are delivered through the skin surface and based on the tip that's being used or the transducer on the end you can lay the ultrasound energy really at the fascial layer 4 to 5 millimeters below the skin surface at the junction between the subcutaneous tissue and the dermis at about 3 or 4 millimeters and then much nearer the skin surface if we want to do fine lines at about 1 1/2 millimeters.

    There's a small hand piece that's applied to the skin surface. Typically patients get very small amounts of anesthesia with this and those energy delivery depending on the hand piece would lay little rows or dots and contour along the lower face, neck and even brow area. This showing what it would be if it was a 4.5 millimeter transducer, this little dots were representing it 3 millimeter transducer if you were targeting those areas. But, for general contour and we're primarily using this 4.5 millimeter transducer to get improvement in contour.

    So Ultherapy, I think represents a significant technological advance in the area of facial contouring. This is a procedure that's often offered in the office with no downtime. There's no injury whatsoever to the skin surface when it's properly performed.

    It has minimal discomfort, and we have a whole protocol for people who are a little sensitive, with doing very light skin blocks so they feel absolutely nothing. The company actually just recommends Ibuprofen, but we want to make sure it's a totally comfortable procedure. If you're reading about it and you've seen some uncomfortable reviews with patients, they have likely not been offered a blocking alternative, I think doing a small local anesthesia block is so simple and easy that for anybody that is little sensitive, that is easy to do.

    We're seeing really good results, it's certainly not a facelift and I don't ever think it should ever marketed as a replacement for facelift, but for people who are younger in their 40′s, they're late 30′s, or even with sun damage, or people who have already had a lift and just need a little tightening, Ulthera may very well be the best option for them.

    If you have any questions about Ulthera again, we encourage you to visit our website at There are before and after pictures there, as well as a detailed explanation of how the technology works. Or, visit our blog at, I'm open to any question you have. You can visit the blog site, send me photos, videos or written questions and we're happy to talk about it. I'm Dr. Corey Mass on Looking Your Best."