Safety and efficacy of superficial micro‐focused ultrasound with visualization for melasma in Asians: An uncontrolled pilot study

Abstract

Background The pathophysiology of melasma is multifactorial, resulting in treatment resistance and a high recurrence rate. Recent research suggests that focused ultrasound might treat melasma effectively. Objectives To investigate the efficacy and safety of superficial micro‐focused ultrasound with visualization (MFU‐V) for melasma in Asians. Methods Patients (n = 20) with mixed melasma on both cheeks received 2 MFU‐V treatments spaced 1 month apart. At monthly visits over 5 months, treatment efficacy and safety were evaluated. Standardized photographs were clinically assessed using the modified Melasma Area and Severity Index (mMASI), and 6‐point grading scales for melasma lightening and area of involvement. Patients provided pain, global aesthetic improvement scale (GAIS), and satisfaction assessments. Results In 40 cheeks, the mean mMASI score was significantly reduced from 13.2 at baseline to 2.4 at month 4, and 2.8 at month 5. Twenty‐nine cheeks (72.5%) showed lightening of melasma at month 4 that persisted until month 5, with improvements up to 75% compared to baseline. Melasma area decreased overall, with sites containing >30% melasma involvement decreasing from 55% to 20% by month 5, and none with 70%–89% involvement. Melasma lightening and area improved visibly in 40% and 20% of cheeks, respectively, as early as 1 month after index MFU‐V treatment. Improvements continued after the second treatment and persisted until study closure, correlating with patient GAIS and satisfaction scores. Procedure was well tolerated with only mild‐to‐moderate pain reported in 92.5% of treatments. Conclusion Superficial MFU‐V is a safe and effective treatment for melasma.

Combined microfocused ultrasound and delicate pulsed light for facial rejuvenation: A prospective, randomized, and split‐face study

“…TEWL can be used to evaluate skin barrier function. TEWL on the combined side decreased from 17 (14,22) to 14 (12,16) (g/m²/h) (p within = 0.018), while on the MFU side, TEWL decreased from 17.1 (14.8, 19.4) to 14.8 (12.4, 19.4) (g/m²/h) (p within = 0.079). This demonstrated that the combined side has a better effect in repairing the skin barrier (p between = 0.028).…”

“…This may be due to the vibrations and friction caused by ultrasound during propagation, which can mechanically disrupt or eliminate melanin and pigment fragments above the TIZs plane. [15][16][17] The pigments and pigment fragments produced during this process may recruit macrophages, triggering a response similar to laser tattoo removal, promoting pigment and epidermal metabolism. 18 Although more gentle and slow than tattoo removal, this process can still enhance skin tone.…”

“…Our study shows that the use of MFU alone can slightly improve MI, EI, TEWL, and skin elasticity. This may be due to the vibrations and friction caused by ultrasound during propagation, which can mechanically disrupt or eliminate melanin and pigment fragments above the TIZs plane 15–17 . The pigments and pigment fragments produced during this process may recruit macrophages, triggering a response similar to laser tattoo removal, promoting pigment and epidermal metabolism 18 .…”