Complications from microfocused transcutaneous ultrasound: Case series and review of the literature

Abstract

Background and Objective Microfocused ultrasound (MFUS) technology has been utilized since 2009 for improvement in mild to moderate skin and soft tissue laxity of the face and neck. Few complications have been previously reported, the majority of which include mild and transient erythema, edema, ecchymosis, and nerve paralysis. Rare yet serious potential complications of MFUS for noninvasive skin tightening of the face and neck are, however, possible. Methods & Materials Retrospective multicenter case series of five patients from the authors’ practice who developed serious adverse events directly related to MFUS with a commercially available device (Ultherapy; Merz North America, Inc., Raleigh, NC). Results Five patients developed blistering, erosion/ulceration, cutaneous, or subcutaneous tissue edema with resulting atrophy, and/or cutaneous necrosis following single sessions of MFUS. Conclusion Despite their rarity, serious adverse events secondary to MFUS are nevertheless possible and may be underreported. Early management of complications includes local wound care, patient reassurance, and topical corticosteroids and/or pulsed‐dye laser to mitigate inflammatory sequelae. Other cosmetic and surgical therapies should be utilized when conservative measures have failed. Lasers Surg. Med. 50:13–19, 2018. © 2017 Wiley Periodicals, Inc.

Correction of involutional skin changes using microfocused ultrasound combined with PRP-therapy

“…The objective of all equipment for non-invasive skin lifting, the microfocused ultrasound one included, consists in heating the specific target tissue by means of a source of energy (focused ultrasound), which at the same time allows avoiding the accompanying damage of the surrounding tissues (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). The target tissue is a network of collagencontaining tissues, including the reticular stratum of derma, fibrous septa in subcutaneous fat, and fascial strata.…”

“…Transcutaneous microfocused ultrasound energy pulses of a short duration of 25-50 msec within the MHz frequency range (to level out any cavitation processes emerging) create precise areas of spatially-focused, chromophoreindependent thermal (60-70 °C) coagulative damage, sized less than 1.0 mm 3 . As a result of this quick spot heating, collagen fibers degrade, and this destroyed collagen stimulates neocollagenesis by the "feedback" principle, increasing the thickness of derma and the collagen content in its reticular stratum further on, (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

“…Hardware methods in aesthetic medicine are represented by a broad range of physical factors used (1)(2)(3)(4)(5). State-ofthe-art technologies allow conducting procedures at the minimum injury rate, no need for rehabilitation, and a good tolerability (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). As new technologies are used, there arises the necessity to differentiate their administration and to combine them with other methods for enhancing clinical efficiency of the procedures (3,(14)(15)(16)(17).…”

“…In particular, when microfocused ultrasound is used, precise areas of spatially-focused chromophore-independent thermal (60-70 °C) coagulative damage are created. As a result of the action, collagen fibers degrade, and this destroyed collagen stimulates neocollagenesis by the "feedback" principle, increasing the thickness of derma and the collagen content in its reticular stratum further on, without affecting intermediate tissues or underlying skin meanwhile (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Microfocused ultrasound suits best for patients having a light and moderate extent of laxity of skin and soft tissues, because the clinical response to microfocused ultrasound correction partially depends on the synthesis of collagen and the extent of so-called wound healing response (1,15).…”

Introduction special dermatology plastic surgery issue January 2018

“…It is important that the clinician be aware of the risks of any procedure that he/she performs and the knowledge to minimize such risks. Friedmann et al have reported on complications from microfocused transcutaneous ultrasound including blistering, erosion, atrophy and cutaneous necrosis. The authors speculate as to why these complications occurred and make suggestions for minimizing risks.…”