Omaha, Neb. – Continued improvements in the Ultherapy (Ulthera) device and how it is used make it an ideal treatment for face and neck rejuvenation, says an expert.
Since the device debuted in 2009, says Joel Schlessinger, MD, it has progressed by adding new treatment heads designed to address different layers of facial and neck tissue for optimal results.
“Just as most energy-based devices become more effective and efficient as time goes on and patterns of success are described, so has Ultherapy,” says Dr. “This contributes to its overall success as a new mode.
Dr. Schlessinger
“One of the initial criticisms of (the treatment) was the inconvenience. As with any new treatment, there was some give-and-take until doctors could determine which type or types of anesthesia worked best with the device.
From this point of view, Dr. Schlessinger gives patients 800 mg of ibuprofen, 1 mg to 2 mg of Ativan (lorazepam, Pfizer) and one to two Vicodin (hydrocodone ditartrate/acetaminophen, Abbott) tablets before the procedure. In addition, patients can apply a hand massager – and an air cooler (Zimmer) – to their skin during treatment to distract them from any discomfort.
However, Dr. Schlessinger does not cover the need for anesthesia. Recently, a doctor who was about to undergo Ultherapy for her face and neck wanted out.
“I insisted she take the pain meds,” she says, and the patient was grateful she did. For similar reasons, he recommends avoiding direct treatment over nerves such as the marginal mandibular nerve or in the supratrochlear region.
Additionally, he says, “We’ve found that higher energy levels don’t always correlate with greater success. However, they clearly create more discomfort. As a result, many of the treatment parameters have dropped from their original higher energy settings.”
A 50-year-old female patient before (far left, second from right) and four months after an Ultherapy session. (Photos: Joel Schlessinger, MD)
Review power settings
In an ongoing prospective, blinded, randomized study, researchers found that reducing the device’s energy setting from level 4 (the highest setting) to either level 1 or 3 improved patient comfort by 18 and 38 percent, respectively (data on file, Ulthera). Level 4 corresponds to 0.45 J to 1.2 J, the initial default setting of the device, depending on the transducer used. Level 3 is 0.35 J to 1.0 J and level 1 is 0.25 J to 0.75 J. Additionally, these reduced energy settings did not affect outcomes 90 days after treatment. Accordingly, Ulthera changed the device’s default setting to level 2 (0.30 J to 0.90 J).
Meanwhile, Dr. Schlessinger says, “The number of repetitions done with the machine has increased.” In this regard, each press of the device’s trigger button provides a “line” of approximately 20 short bursts of ultrasonic energy.
Originally, Ulthera recommended using 300 to 325 such lines in total per treatment session. “But now, we’re seeing up to 700 or 800 lines delivered during a treatment session, including the face and neck.” That number includes about 300 surface and 500 deep passes, he adds. Such a treatment typically takes one to an hour and a half, says Dr. Schlessinger, who has treated 65 patients — including eight men — with the device.
“The main difference between this device and all other energy devices is the fact that Ultherapy delivers the energy to the exact area we want to tighten – the superficial muscular aponeurotic system (SMAS)” through a transducer designed to deliver ultrasound energy at a depth of 4 ,5 mm , in the subcutaneous tissue. Other available transducers target the dermis (1.5 mm) and deep dermis/subcutaneous tissue (3.0 mm).
Competing lasers or energy-based devices generally heat the subcutaneous tissues and the area surrounding the SMAS, which can create downtime and adverse effects such as fat necrosis, says Dr. Schlessinger. Plastic surgeons’ practice of cutting and “gluing” the SMAS during a facelift can also create pain, downtime and risk of infection, he adds.
A 53-year-old female patient before (left) and five months after an Ultherapy treatment. (Photos: Joel Schlessinger, MD)
A 55-year-old female patient before (left) and four months after an Ultherapy session. (Photos: Joel Schlessinger, MD)
Addressed to SMAS
Conversely, he says, “Ultherapy precisely sharpens the SMAS in a non-invasive way. Therefore, it is able to contract the area of tissue that provides dramatic results in the neck and periorbital areas” without causing collateral damage.
Additionally, Dr. Schlessinger says, “Newer treatment areas such as the décolletage respond quite well.” Similarly, he says a new treatment head for the upper lip allows the device to treat most — if not all — problem areas for a typical 40- to 50-year-old patient. As a result, Dr. Schlessinger says he is particularly gratified by his patients’ interest in Ultherapy – and their post-treatment satisfaction levels.
“I had treated patients for years with various lasers ranging from fractional to fully ablative CO2 laser.” However, he says the downtime these treatments required reduced overall patient satisfaction.
In contrast, with Ultherapy, “I’ve seen almost no downtime, other than an hour or two right after the procedure,” during which patients experience mild erythema and, very rarely, bruising. “Side effects are extremely limited” and do not require patients to change their schedule – or take painkillers – after treatment.
As a practical thought, “I try to do Ultherapy treatments along with fillers and neurotoxins because I think it improves the results. We generally do fillers and neurotoxins after Ultherapy,” because it could shorten the life of these products. As for Ultherapy, “I tell patients the results should last between 18 and 24 months,” though Dr. Schlessinger says he hasn’t seen long-term data yet. Patients see some results immediately after treatment, he adds, although long-term collagen remodeling can take up to six months.
Correct patient selection
On patient selection, she says, “Ultherapy is great for someone who has mild to moderate wrinkles and those who have moderate neck laxity. But this is not a shortcut to a facelift or facelift.”
The treatment area that responds best to Ultherapy may vary from patient to patient. “Some patients have impressive results in the periorbital area and moderate results around the neck” and vice versa. Regarding patient expectations, Dr. Schlessinger says, “Some people have a greater ability to stimulate collagen than others.” He and his staff inform patients of this possibility and the possibility that they may need a second session. To date, he says, this has only happened to six of his patients.
Thanks to the high success rate and lack of downtime associated with Ultherapy, he says, “We’ve been very pleasantly surprised with the results and the patients’ acceptance of the treatment.” DT
Disclosures: Dr. Schlessinger reports no relevant financial interests.
