Is it possible
that the same benign technology we use to view fetuses in the
womb will tighten redundant facial skin? And does it make sense
that a non-invasive, painless and inexpensive topical treatment
can provide the same facial rejuvenating benefits credited to
laser technology? Within the last few years there has been a consumer
explosion in the demand for no downtime, non-invasive methods
of non-ablative facial resurfacing. Many companies are spending
an overabundance of dollars educating you and the consumer that
their laser is ideal for reducing wrinkles, decreasing pore size,
evening out pigmentation and reducing skin laxity. Although the
research is very promising we are still in the process of determining
which laser is best and what the optimal parameters are in order
to achieve the maximum outcome. In the meantime laser technology
is expensive and can be dangerous if misused by inexperienced
personnel. Additionally, state and local agencies highly regulate
who can use the laser and to what degree. Therefore access to
such treatments is limited and most states restrict paramedical
professionals from performing such treatments. Effort and research
has been expended in order to identify alternative methods of
facial rejuvenation, beyond the recognized capabilities of superficial
peel and microdermabrasion yet short of lasers.
Ultrasound
technology is well accepted and ubiquitously used in physical
therapy and geriatric circles for treating musculoskeletal ailments.
Additionally it has reach wide spread acceptance as a method for
stimulating wound repair in patients with poorly healing skin
wounds. Research with ultrasound has demonstrated its ability
to stimulate fibroblast activity, increase local circulation and
increase the wound rate repair. (1)
How
does ultrasound work?
Ultrasound is a method by which sound waves are created by a rapidly
oscillating hand piece probe. By altering the frequency of the
oscillations we can limit the depth of penetration, the higher
the frequency the less penetrating the waves. Wavelengths in the
1 MHz range can extend deeply to muscle and bones and are at greater
risk for causing local tissue damage if not properly used. However,
in the 3 MHz range ultrasound waves should stay more superficial.
The waves are conducted to the epidermal tissues via a coupling
water base gel placed between the ultrasound's hand piece and
the skin's surface. Physiological benefits are categorized as
thermal and non-thermal.
Thermally, ultrasound waves may cause local tissues to heat up
to 40-45 degree Celsius. In turn increasing blood flow and perhaps
directly stimulating fibroblast activity resulting in collagen
production.
Physiological
benefits are categorized as thermal and non thermal.
Ultrasounds
non-thermal modalities include cavitation, acoustic streaming
and phonophoresis. By creating micron- sized bubbles of blood,
lymphatic and tissue fluids, ultrasound induced cavitation may
influence cellular membrane permeability, ionic gradients and
cellular calcium uptake. Increased intracellular calcium can act
as a signal inducing fibroblast cells into wound repair and a
collagen production response.
An additional
and wildly potential benefit of ultrasound is the capability to
deliver medicinal products through the skin via a process known
as phonophoresis. Animal model studies have clearly shown the
ability of ultrasound to deliver significant levels of hydrocortisone,
certain viricidal agents and even salicylic acid (2). Many of
you already know that salicylic acid is a Beta hydroxy acid with
proven age reducing benefits to the skin.
Over the last
year I have become very interested in this possibility, as have
many others. At the University of Illinois, we have just completed
a 3 -month study in the laboratory evaluating the ability of ultrasound
assisted technology to extend the delivery of glycolic and salicylic
acids deeper into the dermis. Concomitantly, clinically we have
treated thirty patients with a combination salicylic acid and
ultrasound treatment. Preliminary results have been very encouraging
and promising. Long-term outcomes and conclusions are pending.
However, treated patients have reported improved skin texture,
reduction in skin laxity and a youthful plumping out of the skin.
The procedure takes minutes, is painless, and there is no associated
downtime. Following treatment, patients may immediately reapply
their make-up and return to their social or work activities. Additionally,
unlike visible light lasers and pulsed light systems patients
of all skin types may achieve benefits.
Time will
tell if this modality is the answer for non-invasive facial rejuvenation.
But if it is, expect it to "catch-on" quickly as it
is an easily transportable and relatively inexpensive technology
that has been safely used for many years by a multitude of paramedical
professional. In the continuing search for better and more convenient
methods of facial rejuvenation, ultrasound may be poised to become
a breakthrough modality.
