Due to the high intensity of the ultrasound waves there is an induction of vibration amongst the molecules in the targeted tissue and the resulting molecular friction causes production of heat in the tissue. Generally, this heat generated reaches a temperature of 60 C -75 C at the ISPC. Collagen is a present within the skin dermal, deep dermal and SMAS layers. Studies have indicated that collagen fibrils, when heated to a specific temperature over a period of time, willcontract because the intra-molecular covalent hydrogen bonds in the collagen structure are broken down at a temperature of approximately 68 C. The figure No.2 on previous page show the breaking of the covalent bonds between the helices.
Reaching these threshold temperatures during an HIFU treatment is importment in order to optimize the effect on collagen denaturation, which ultimately leads to collagen synthesis.Following the initial thermal-induced collagen contraction and denaturation, the next phase being neocollagen and Collagen remodeling. The ISCP’s created by HIFU are recognized by the human body as scared-tissue/injury,thereby initiating the wound healing response. This Response involves tissue repair and synthesis of new collagen which undergoes organization and cross-linking, enabling it to have better mechanical properties in terms of stress bearing capabilities. Over time , this leads to tissue lifting and tightening. This lifting basically occurs over three stages 1) Inflammation, 2)Proliferation & 3)Maturation & Re-modeling
During the treatment two varieties (4.5mm & 3.0mm) of ultrasound transducers (the hand piece which delivers the ultrasound energy) are used. Each transducer treats different tissue depths, from deep to shallow. The deep transducer (4.4mm | 4 Mhz) is usually applied first and you will feel more sensation than the lesser penetration (3.0mm | 7Mhz) transducer. The sensation can be likened to a Diwali “spark” touching the surface of your skin – fine sparks of heat that dissipates immediately. Most patients find the sensation tolerable. There are many power adjustments that can be made through the treatment if the patient is uncomfortable.
Some patients experience a toothache type discomfort for several minutes after an area has been treated with 4.5mm transducer. Thus we recommend the take two Paracetamol (acetaminophen) tablets (500 mg each) approximately 45 minutes prior to treatment. Immediately after the procedure the treated area may look slightly pink like you have had a facial. Rarely, some spots of bruising may be already visible, but typically bruising is not evident until 1-2 days after the session. To minimize risk of bruising it is advisable for the patient to apply an ice pack for approximately 10 minutes after the procedure. The main advantage of the HIFU system is that there is no downtime for the patient after the procedure has been performed.
The patient should avoid the rotine use of anti-inflammatory medications for 45 days. The inflammatory response in the tissue from HIFU works in a positive way to stimulate collagen fiber formation and remodeling. Topical prescription skin products can help to stimulate collagen fiber formation through direct action with growth factors and through exfoliation to resurface skin. Medical skin care combined with HIFU can maximize the results obtained and help to maintain the results. Schedule a follow-up medical assessment to review clinical results and discuss the option of additional treatments to achieve desired outcome for this treatment site and other treatment sites. Small and affordable follow up sessions in targeted areas that need the most work can be very powerful to obtain the best result depending upon the degree of laxity prior to treatment.
The new collagen fibers that are formed as a result of HIFU have a life span of 4+ years, however an optional interval for retreatment will be sooner than that. Depending upon the severity of tissue laxity and the patients age, follow up treatment intervals will vary but there are two ways to approach maintenance – more frequent small touch ups and less frequent full treatments. More frequent small touch up treatments is the best approach for achieving continued, ongoing collagen stimulus as well as cost affordability. Frequency of touch ups will again vary but may be every 12 months depending upon the individual’s particular needs. Less frequent full treatment are an alternative. Recommendations for this approach would be every 1.5 to 2 years depending upon need.
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