Archive for the ‘Ultherapy’ Category
If you have not yet heard of Ultherapy it is a non-invasive procedure that is intended to lift and tighten the skin. It sounds almost to good to be true, right. So, the question is, does it really work?
The short answer is, yes it does work, but before you make any decisions, you need to know what kind of results can be expected. First, non-surgical treatments will always give a non-surgical result. If you are hoping for a cheeper alternative to a facelift, mini-facelift or even lifestyle lift, you will be disappointed with Ultherapy or ANY non-surgical treatment. During a traditional facelift the surgeon address lax facial muscle, fat and repositions the skin. Ultherapy is not a facelift and a facelift is not a skin treatment. One procedure does not replace the need for the other.
As we age collagen production progressively declines, which leads to wrinkles and thinning skin. Not to confuse facial volume (fat) loss, with skin (dermal/ epidermal) thinning, they are different concerns requiring different procedures. Like many of the treatments used in the world of medical aesthetic, Ultherapy is used to stimulate collagen. What makes Ulthera so unique is the way it stimulates collagen, where it stimulates collagen, the amount of increased collagen and the duration that collagen production is up regulated. Initially the targeted tissue will contract causing a tightening effect. As the renewal process continues collagen production is up regulated, improving skin density and giving a modest lift. The increased collagen is seen at multiple levels of the dermis, most prominent in the deeper dermal tissue. This up regulation of collagen continues, on average of a year.
An average of 69.5% improvement in dermal thickness is seen after Ultherapy
Although, Ultherapy is currently the only non-invasive treatment that can claim to lift skin, there are other treatments that can tighten the skin. Skin tightening is generally seen when aesthetic treatments target the dermal layer of the skin and stimulate collagen production. Ulthera works by targeting deep into the dermal tissue and also to the top of the facial muscle, leaving the surface intact. This is important because other non-surgical treatments, like RadioFrequency (RF) and laser do not treat at the same depth. Although, RF treatments can target fairly deep into the dermal area, the targeted area is only heated to a tempeture that will cause tissue contraction, this helps to tighten the skin. The difference is that RadioFrequency (RF) treatments do not heat the targeted area to the needed tempeture to achieve optimal collagen synthesis. Laser resurfacing and fractional resurfacing treatments, do heat the target area to optimal tempeture and will definitely generate significant collagen synthesis in the upper-mid dermis, which is ideal for treating lines, scars and skin texture. The difference is that we can not treat as deeply into the dermis with laser resurfacing as we do with Ultherapy. Most importantly, RadioFrequency (RF) and laser do not target the top of facial muscle, where Ultherapy does. Ultherapy does work, very well actually. Ultherapy is most appreciated when it is part of a comprehensive approach to anti-aging.
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Décolletage is what we call the neckline, or more specifically the area made up of the neck, chest and cleavage. If we neglect this area between our face and breasts, it is sure to age us. Although we can cover up our décolletage, we would certainly be limiting our style and where is the fun in that.
The décolletage is a special concern, because it tends to suffer more sun damage than other areas and women also tend to develop lines between the breast while sleeping on their side. Luckily, there are plenty of options to improve this area, but we have to be patient as correction for non-facial skin is much slower than it is when treating the face. When we treat the décolletage or any non-facial area, we need to treat more conservatively and thus, more often. The skin cell turn over for non-facial skin tends to be slower, so this means the recovery process will take longer, which will require more time spaced between treatments. When treating the décolletage you should treat early and often. Slow and steady wins the race.
When it comes to skin care and anti-aging, the best approach is a comprehensive one. One treatment does not necessarily replace the other. Your skincare provider should work to help you understand which treatments are best for you and the time line that treatments may be done. When budget is a concern, you will need to decide which concerns are a priority for you.
Topical Skin Care
The first step is to use effective skin care products on your neck and chest, every morning and every night, just as you would your face. Most of the skin care products that are used on the face, can also be used on the chest. Some topicals, such as hydroquinone and retinoids need to be used less frequently on non-facial skin to avoid irritation. Some products should be used daily, such as topical antioxidants and an SPF 30 or higher. There are some great products formulated specifically for the neck and chest. Revision skin care formulated Nectifirm for firming the neck and décolletage. NIA 24 Sun Damage Repair for Décolletage and Hands, is formulated with patented Pro-Niacin to repair damaged skin. Consult with your Esthetician, to determine the appropriate protocol for you.
Treatments that use Intense Pulsed Light work to treat brown spots and redness. There is also research to suggest that ongoing treatments will positively effected gene expression in the skin to mimic that of a younger person. Generally a series of 3-5 treatments are recommended, scheduled 3-4 weeks apart. For enhanced results Levulan may be applied prior, this is known as PhotoDynamic Therapy.
Medium depth chemical peels that reach the papillary dermis or upper reticular dermis, such as the Obagi Blue Peel or ZO controlled depth peel will improve skin discolorations, improve texture, laxity, lines and stretchable wrinkles. A medium depth peel on the chest, may take up to 14 days for peeling to be complete. On the up side, peels on the face generally do not look bad during the peeling phase and are easy to tolerate. These peels can be done as often as 4 times a year, however I find that once a year is optimal when combined with other treatments.
Ultherapy is the treatment of choice for the lines that develop between the breasts. Ultherapy works at a deeper level than any other non-surgical treatment, to lift and tighten skin. Ultherapy uses focused ultrasound to target deep into the dermis and even the top of the muscle. Like many other aesthetic treatments, Ultherapy works by creating a wound healing response, but because the targeted areas are at a deeper level we see more tightening and lifting. The increased collagen production in the treated area, can be seen a year post treatment. Most people should plan on repeating this treatment once a year, although younger patients may be able to stretch it out to every two years. Those with advanced photo damage, or who desire more improvement may choose to repeat the treatment in six months. Pain medication may be prescribed, in which case you will need to arrange for someone to bring you in to your appointment and take you home.
Non facial skin does not respond well to “full coverage” ablative laser resurfacing. Non-ablative or sublative fractional resurfacing treatments, such as E-Matrix or Fraxel are more appropriate for treating non-facial skin. These treatments reduce lines, wrinkles and smooth skin texture. Like many other aesthetic treatments, fractional lasers work by creating a wound healing response in the skin, that stimulates the fibroblast in the skin to up regulate the production of collagen. Because laser treatments create heat, we appreciate a different type of wound healing response than we do with other treatments such as chemical peels, micro needling, which is why we see the up regulation of collagen for longer periods of time post treatment.
Fractional lasers generally work in the deeper layers of the skins dermis, an area which is not effected by chemical peels or IPL treatments. The frequency and number of treatments will depend on the level of treatment performed, level of correction desired and condition of skin.
Micro-Needling Collagen Induction Therapy
Aesthetic professionals use micro-needling pens such as the Eclipse or Dermapen, to deliver tiny needles into the epidermal and dermal layers of the skin creating micro-injuries. This begins a natural wound healing or renewal process that will stimulate collagen production in the treated area. There is little to no down-time, and it is surprisingly comfortable. Although, micro needling treatments do not deliver the same level of correction to skin texture as fractional lasers, they are the treatment of choice for scars and stretch marks. Micro-needling is also a good option for early intervention or in between other aesthetic treatments.
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Ultherapy has become a popular anti-aging treatment for those looking to tighten, lift and avoid the thin skin associated with aging. The common question with any aesthetic treatment is “how long the effects will last” and with Ultherapy, the answer is a long time.
How Does Ultherapy Work?
Ultherapy is the only device that is cleared for skin tightening and lifting. It uses focused ultrasound to precisely target and treat tissue at three levels, the Superficial Dermis, Deep Dermis and most importantly the SMAS which is at the top of the muscle, all while leaving the surrounding tissue intact. We are not able to treat all these areas with chemical peels, micro-needling or even other devices such as lasers or Radio Frequency. So basically…. this is as good as it gets with the exception of surgery.
As we age the processes within the skin begin to slow, our skins fibroblast are more sluggish and we produce less hylauronic acid, elastin fibers become weak, we produce less collagen and our collagen becomes un-organized. This all results in lax skin that is less firm and thinning.
Many of the treatments we use in aesthetics, benefit from the skins wound healing ability. By creating a wound healing response in the skin we stimulate the fibroblast to produce more collagen. The type and length of the wound healing benefits can vary, depending on how and where the “wound” was created. For example a scratch or something like microdermabrasion may only be 14 days of increased collagen production, an IPL / BBL treatment is about 3 weeks, and RF treatments around 6 months. Ultherapy leads to an inflammatory wound healing response which stimulates long-term tissue remodeling and leads to further lifting and tightening. Increases collagen production is seen in skin biopsies 12 months after treatment.
Clinical tightening and lifting can be seen as early as 3-6 weeks,but the most appreciable results are seen at 3 months. The duration of response after a single treatment can be up to 2 years.
Anti-Aging Benefits of Ultherapy Observed in Study
– Increased dermal collagen by over 23.7%, new collagen is organized
– Increased over all dermal thickness
– Increased New collagen Type I (21%-30%) and collagen Type III (48%-68%)
– Increased amount of elastin, elastin fibers are more parallel and straighter
Repeating Ultherapy Treatments
The aging process is continues and regardless of which procedure you choose, maintenance is always necessary. The exact longevity of results with any treatment depends on your body’s ability to produce, maintain and breakdown collagen. The frequency of treatments will depend on age, health, lifestyle, condition of skin, other anti-aging measures taken and desired results. Although one year between treatments is most common, many opt for a second treatment as early as 6 months to boost results.Those who are younger may go as long as 2-3 years between treatments. Ultherapy works best as part of a comprehensive approach to aging, your skin care professional can work to customize a plan for your specific needs.
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Pay attention! I am about to share the ultimate beauty secret, the secret to anti-aging.
The desire to stay young and beautiful is a natural part of the human psyche and we are apparently willing to pay big bucks to achieve it. Americans spend billions of dollars each year on anti-aging products and services in a desperate search of the fountain of youth. Each new product we try offers a new opportunity to look younger, but they often prove to be nothing more than disappointment in a bottle. So… how can we avoid disappointment and achieve real results? The answer lies with a comprehensive approach. To understand the benefits of a comprehensive approach you should first try to grasp some of the basics of the aging face. After all, if we do not understand the aging process how can we know how to prevent or correct it?
What is a comprehensive approach to aesthetics in relation to the aging face?
Comprehensive Aesthetics uses a variety of treatments and products to cover a large scope of issues associated with the aging face. Aging occurs on many levels of the face, including the bone structure, muscular level, fat or volume distribution and finally the dermal and epidermal levels of the skin. To achieve the most ideal results it is necessary to address the affects of aging at each level, in order to do this a variety of treatments are needed. We also can not ignore the effects of lifestyle and general health, as both play a major factor in aging.
Aesthetic Professionals and Interdisciplinary Collaboration
Aesthetics is a branch of philosophy or science pertaining to the nature of art and beauty. Aesthetic professionals are those whom are specially trained in the art of beauty. Utilizing a full team of medical aesthetic professionals, including a Plastic Surgeon, Dermatologist, Nurse Injector, Estheticians and Certified Laser Technicians, we are able to take advantage of an interdisciplinary collaboration. Each professional possess a special set of skills that contributes to a truly comprehensive approach toward an attractive, youthful face.
Bone adds to the volume of the face and provides structural support to the other layers of facial tissue and skin. As we age there is a significant loss of facial bone which contributes to biometric volume loss. The bones that define your nose, and upper jaw and brow bone recede and the bones of the eye socket gradually widen. The jawbone also recedes and becomes less defined, reducing the angle of the lower jaw. Even the skull shrinks with age, further adding to excess facial skin. The loss of structural support creates noticeable changes in the other layers of tissue, simply put – when the bones that define your face recede your skin begins to droop.
Bad news ladies, we begin to see bone loss as early as our 40’s, where men may not notice bone loss until their mid 60’s. Hormones can play a factor in bone density. As we age bone density can decrease, leading to diseases such as osteoporosis. Your doctor can help you monitor and address issues of bone density loss. Maintaining a healthy diet with enough calcium vitamin D and magnesium can also help prevent bone density loss.
Once bone loss has occurred you can take action with aesthetic treatments. Injectable fillers such as Sculptra can add volume and support for a more youthful and defined face. Sculptra is injected below the skin to correct the effects of fat loss and natural age-related bone loss. A plastic surgeon can also strategically place fat into the face or use facial implants to make up for bone loss.
Below the facial skin and fat, is muscle. The muscle and connective tissue add support to the overlying fat and skin of the face. As our face ages the ligaments stretch and the supporting system begins to elongate causing the face to droop or sag. When the face is sagging due to muscle, this is usually the time for surgical intervention. During a facelift the underlining muscles and tissues are lifted. If you are not ready for surgery, you may consider Ultherapy which does work at the top of the muscle (SMAS) and gives a modest non surgical lift. Keeping in mind that a non-surgical treatment will always provide a non-surgical result. Ultherapy will not remove excess skin or reposition fat pads, but it will tighten skin and provide a modest lift. Ultherapy is perfect for early intervention and probably as good as it gets without surgery.
Muscle contraction can also cause lines and wrinkles. The muscles we use to make expressions become etched in our face over time, this is most noticeable with the vertical lines between our brows commonly referred to as frown lines, as well as crows feet around the eyes and the lines across our forehead. At first these lines are only noticeable with facial movement, but with out preventative action they are constantly visible even without movement (this is referred to as wrinkles at rest). Botox or Dysport injections are used to treat the lines and wrinkles caused by muscle contraction. It is a good idea to consider these types of treatments early on to prevent the lines from becoming “permanent”. Once the lines and wrinkles have become permanently etched into the skin, fillers may be used to lift the area along with laser resurfacing to smooth the skin or in some more severe cases surgery may be recommended.
Fat and Volume Distribution
A youthful face has the right amount of fat in the right places. As we age some areas of the face loose fat while others gain fat. The areas of fat also become farther apart and the fat pads appear as separate structures rather than a smooth continuous layer.
Fat provides support and volume in the face, as we age this valuable fat begins to decrees. Fat loss creates overall volume loss which contributes to folds, lines and wrinkles. The signs of volume loss can be noticed as early as our 30’s and becomes more significant in our 50’s. As we lose fat in our mid face, we begin to notice things like sunken or flat cheeks, heavy lines and folds around the mouth. Volume loss can also be seen around the temples, near the brow bone and under the eyes. When volume is lost under the eyes, it creates a hollow look and dark circles. Injectables such as Sculptra, Juvederm and Restylane can be used to replace volume to the face. Fat injections can also be used as a more long term approach to replace or add volume. Fat transfer or fat injections is a process in which a plastic surgeon removes fat from one area of the body and places it in another. ( How wonderful is that?! )
Fat accumulation is often seen under the chin and along the jawline creating an undefined jawline and the dreaded jowls. Bags under the eyes are also the result of fat accumulating in the wrong area. A plastic surgeon can perform a blepharoplasty to remove the fat bags under the eyes. The jowls and fat along the jawline can be corrected with a facelift as fat pads are repositioned, but if you are not ready for surgery fillers can be strategically injected to help contour the jawline. If you opt for fillers over surgery you may consider adding Ultherapy prior for a modest lift. Again…. a non-surgical treatment will never give a surgical result.
During a facelift the underlining muscles and tissues are lifted, fat pads are repositioned, fat bags may be removed from under the eyes and volume may be added with fat injections as needed and excess skin is removed.
The surface layer of the skin is generally the first place we begin to notice the effects of aging, most of us begin to notice the effects of aging on our skin in our 30’s. As we age our skin has a reduction in collagen production, elastin, hyaluronic acid and skin cell turnover begins to slow. Uneven melanin production and distribution causes dark spots and skin discolorations. We begin to notice more broken capillaries, changes in skin texture, thickness, elasticity and moisture. When we are treating these issues in the skin we must first consider what skin functions are involve and what layer of the skin the problem begins.
The skin can be divided up into three basic layers Epidermis, Dermis and the Subcutaneous Layer (fat). When we talk about skin we are generally referring to the Epidermis and Dermis. The Epidermis is the top layer of the skin and the Dermis is the deeper layer.
Skin cell turnover in the Epidermis
The skin is constantly in a cycle of growth. The cycle of a skin cell is about six weeks, this is the time it takes for a new skin cell to rise to the surface of the skin and naturally slough off. As we age this process slows down and the dead skin cells begin to accumulate at the surface. When this happens the skin will have a dull appearance, rough texture, dark spots will become more dense and appear darker, and lines and wrinkles become more prominent. In addition to all of this, accumulation of skin cells can clog pores causing them to appear larger and lead to acne blemishes. The slowing of skin cell turnover begins in our 30’s, which is a good time to consider a medical based skin care regimen. Tretinoin (Retin-A), Laser and Chemical peels can stimulate skin cell turn over.
As the skin cell turn over rate slows so does wound healing. After an injury the skin takes longer to reepithelialize, meaning the top most layer of skin (Stratum Corneum) is not quickly replaced. This is why many Doctors and Estheticians recommend preconditioning your skin before surgery or skin treatments.
Collagen is important to youthful skin, but as we age collagen production slows down. Loss of collagen causes the dermal layer of skin to thin and reduces the skins ability to retain elasticity (from elastin) and moisture (from hyaluronic acid). This leads to the domino effect, as loss of elastin causes laxity in the skin and reduced hyaluronic acid which cause skin to be dryer, less supple and thinner.
Professional chemical peels, laser and IPL treatments can help to stimulate collagen production. some treatments offer short term improvement in increased collagen production, treatments such as laser resurfacing and Ultherapy offer longer lasting effects. Beyond professional treatments, a skin care program that includes continuous use of Tretinoin (Retin-A), topical vitamin -C and full spectrum sunscreen will help with collagen production. Tretinoin (Retin-A) is an effective way to stimulate collagen synthesis. Vitamin C is nessacerry to produce collagen and it protects skin from both UVA and UVB, by neutralizing the UV rays. Sun exposure degrades collagen so it is essential to use a good sunblock daily. Another tip to prevent collagen loss add a topical Resveratrol to your night time skin regimen.
A melanocyte is the cell that produces melanin (pigment), the melanin dispersed to keratinocytes, giving skin it’s color. As we age the cycle of melanin production and distribution becomes irregular.
As we age there is a reduction in the number of melanocytes. After age 30 the number of melanocytes decline about 6-8% every ten years. As the number of melanocytes decrease skin will become lighter, less even and white spots or patches (hypopigmentation) can be seen.
Browns spots and patches such as melasma, sunspots, age spots and freckles are known as hyperpigmentation. When a melanocyte produces more than normal amounts of melanin the result is hyperpigmentation. Furthermore the melanocyte doesn’t disperse the melanin evenly, so it is presented as dark spots or patches. Hormones and sun exposure are factors in even skin color.
There are many professional skin treatments that address hyperpigmentation, including chemical peels and Photofacial (IPL) treatments, however daily skin care is most important. Daily sun protection is necessary, this is not optional! Products containing hydroquinone suppresses tyrosinase, the enzyme involved in creating melanin. Botanical (plant based) lighteners can also help to suppresses tyrosinase, however alone are less effective than hydroquinone. Tretinoin (Retin-A) is also important, as it will help with even distribution of melanin.
As we age the structural wall of the capillaries (tiny blood vessels) break down which results in broken capillaries. Flushing, redness and broken capillaries are treated with Photofacial (IPL / BBL) and laser treatments. Vitamin C can also help to strengthen capillary walls, I recommend a healthy diet with enough vitamin-C and a daily topical vitamin -C serum. A sunblock with Zinc oxide can further help by blocking some of the heat that causes blood vessels to dilate.
Lifestyle and Health
Our skin is a direct reflection of our health. All the skin care products and treatments in the world can only do so much, it is up to you to be proactive in maintaining your health.
– Work with your physician to maintain your health.
– Maintain a healthy diet with plenty of fruits and vegetables.
– Exercise contributes to a healthy body and hormone levels.
– Sun protection will go a long way to save your skin.
– If you smoke, quit!
– Limit alcohol consumption
– Drink plenty of water
– Get enough sleep
– Try to reduce stress (get a massage, take up yoga, relax)
– Hormones play a role in the aging process. Ask your doctor to monitor your hormone levels and discuss treatment options.
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Ultherapy is a new type of non-surgical, non-invasive procedure for the face that uses ultrasound and the body’s own natural healing process to lift, tone, and tighten loose skin. Ultherapy is the latest buzz in beauty, it has been featured on shows like 20/20 with Barbara Walters, Dr OZ, The Doctors, Today Show, Rachel Ray, Good Morning America and The View.
Whats The Big Deal?
Ultherapy is a very exciting advancement to those of us in the world of aesthetics for several reasons. First, we are talking about LIFTING and TIGHTENING, not just tightening. An Ultherapy treatment tightens the skin and gives the face a vertical lift. Just incase you missed that, I said “LIFT”! Ultherapy uses ultrasound imaging and ultrasound energy. The ultrasound imaging allows us to see exactly where we are treating. We are able to be very specific in where the ultrasound “energy” or Thermal Coagulation Points are delivered in the skin. The most exciting thing is the depth we are able to treat. Ultherapy is the only non-invasive treatment that can specifically target the deep foundation below the skin that is addressed in cosmetic surgery without cutting or disrupting the surface of the skin. I can’t forget to mention that there is NO down time, which is very convient for those who can’t spare the time to recover from surgery.
Where does it go?
To achieve skin tightening you need to target the skin at a fairly deep level, the dermis and superficial muscle. Procedures that treat the epidermis will not tighten or lift the skin. The Ulthera works at three separate levels, the upper dermis, lower dermis and the SMAS/ Platisma. The area where the facial muscles are connected to the dermis is refered to as the (SMAS). This superficial muscle is something that would be addressed by a facial plastic surgeon during a facelift to reduce the appearance of sagging jowls, cheeks and neck skin. With the Ulthera we are able to address this area without surgery.
Why so specific?
With the Ulthera the “energy” is delivered in a very specific way. This is important because in the past if we wanted to tighten the skin we were mostly limited to devices that use Radiofrequency (RF). Radiofrequency works by delivering heat ( volumetric heating ) deep into the skin to stimulate collagen production and tighten skin. The challenge with RF devices is that they are not very specific. Unlike lasers, RF devices do not precisely reach targeted areas and they are not absorbed by a specific chromophore. Simply put, radiofrequency does not know where to go on it’s own, so it is not as precise as Ulthera or laser treatments. Lasers on the other hand are very precise, they use a single wavelength to target specific chromophores at specific depths of the skin (selective heating). Lasers however do not reach the necessary depth in the skin to achieve skin tightening or lifting. Lasers are not used specifically for tightening, they are more appropriate for treating skin discoloration, vascular lesions, unwanted hair, tattoo removal, acne treatments, peeling and resurfacing treatments to treat scars, lines and wrinkles. Ulthera is in a class all it’s own, it uses (focused ultrasound heating) to precisely target the deep structural support layers of the skin.
Radiofrequenc / Volumetric heating / No Precision
Lasers/ Selective heating / No depth
Ulthera / Focused Ultrasound Heating / Precision & Depth
Tightens and tones the deepest tissues of the skin
Stimulates new collagen production for lasting skin tightening effects
Lifts and brightens the brows and eyes; achieving a non-surgical brow-lift
Defines and contours the neck and jowls
Adds volume to the surface of the skin; reducing the appearance of fine lines and wrinkles
What to expect
Ultherapy will addresses mild to moderate loose or sagging skin, by tightening and gradually lifting the skin. After your treatment there are not any special post treatment instructions or down time. The results will unfold over the course of 2-3 months and some patients have reported continued improvement for up to 6 months. As impressive as the results are, you should always have realistic expectations. You will not achieve surgical results with a non-surgical treatment .
If you are interested in learning more about Ultherapy call Shapiro Aesthetic Plastic Surgery and Skin Klinic to schedule a consultation.
Shapiro Aesthetic Plastic Surgery and Skin Klinic
5410 N. Scottsdale Rd., Ste F-100
Paradise Valley, AZ 85253
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