HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)

Dr Padmavathi Surapaneni has completed her MBBS at Rangaraya Medical College and PG in Dermatology at Andhra Medical College, Visakhapatnam. She is fellow and certified by the American Academy of Aesthetic Medicine. She has also been a faculty and trainer in various national conferences and has conducted training workshops on injectable and body contouring.

Who is a good candidate for HIFU?

Know more from Dr Surapaneni about HIFU: HIFU is a recent and versatile introduction for antiageing treatments.The acoustic energy is similar to that used in medical imaging. However, it is highly convergent and uses different frequencies.Young patients – 30-40-year-olds – with mild to moderate skin laxity, and good skin elasticity and healing tendency are good candidates.This plus, BMI should be less than 30. I advise this treatment to patients who do not want to opt for a surgery, but want a good jawline definition, improvement in nasolabial fold (NLF), cheek lift, and brow lift.

How can best results be derived from this treatment and tell us about the technique?

HIFU delivers precise acoustic energy in high frequencies. Different cartridges are used to target various depths at varied frequencies.

 •1.5 mm cartridges, 10 MHz targets mid reticular dermis 

•3.0 mm cartridges, 7 MHz targets deep reticular dermis 

•4.5 mm cartridges, 4.0 MHz targets SMAS (superficial musculoaponeurotic layer) just above the muscle.

Tightening of this layer lifts the tissues.

The HIFU energy heats the tissues up to 60 degree centigrade causing denaturation of collagen, remodelling and neo collagen synthesis.This causes tightening and lifting of the tissue.To ensure good outcome, the cartridges are selected to target different depths on different facial areas and the number of lines delivered and energy selection depend on the tissue mass. For cheeks, 4.5 mm and 3 mm are used one after the other. For forehead, brow and lower lid rejuvenation, 3 mm and 1.5 mm are used. Neck and décolleté can be treated with 4.5 mm and 3 mm cartridges. Ideally, 600-800 lines are delivered to cover the face and neck. With an immediate improvement of 20 per cent, maximum results are achieved within three months, and these sustain for six months. Maintenance sessions are scheduled every year.

What is the recovery time for a patient? What does the post-treatment care involve?

Usually, a patient may experience mild pain, erythema, tingling and numbness for a couple days. In the jawline and submental area, slight tenderness may persist for a week. Other serious complications such as nerve weakness can be avoided by proper techniques.A soothing moisturizer and sunscreen are enough for a post procedure care.The patient should be instructed to avoid steam and sauna for a week and strenuous exercise for a couple of days.

Any contraindications involved that one should be aware off?

HIFU should be avoided in patients with severe sagging and elastosis; infection or open wounds in the treatment area; and implants in the treatment area. Also, a thin patient with volume loss may show volume deficits post treatment as well, and hence should not opt for it.

One challenging case study that you have dealt with for this treatment.

HIFU is the best energy based device (EBD) for lower face rejuvenation. We can achieve a good lift, firmness and facial contouring. My challenging case was treating a 50-year-old woman with jowls, NLF and double chin. She wanted a contoured face with a defined jawline along with reduction in NLF. She did not want to opt for surgery, injectable and threads, due to budget constraints. I suggested HIFU: We used 4.5 mm and 3 mm for the cheek and neck; 3 mm and 1.5 mm for the forehead, periorbital area.A total of 800 lines were delivered. After three months, her NLF showed good improvement, jowls reduced considerably with a reasonably contoured face.