HIGH INTENSITY FOCUSSED ULTRASOUND- NON SURGICAL FACIAL REJUVENATION

1. Dr Lalit B Rajpal

2.  Introduction
 Skin Ageing and its causes
 Procedures - Options
 History of HIFU and its principles
 Mechanism
 Parts of Machine
 Advantages
 Indications
 Contra-indications
 Areas that can be treated - Procedures
 Procedure & Post procedure instructions
 Side Effects, Precautions & Follow-up
 Conclusion
Dr Lalit B Rajpal

3.  Photoaging :
stepwise progression
 Textural and
pigmentary
alterations to the
skin
 Dynamic rhytides to
static rhytides
 Laxity
Dr Lalit B Rajpal

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9.  In 1942, Prof. Lynn suggested the use of
focused ultrasound in surgery.
 In 1954, Prof. Fry discovered that ultrasound
can be focused well in soft tissue.
Dr Lalit B Rajpal

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16.  Depends upon the anatomical area being
treated and the thickness of the skin.
Dr Lalit B Rajpal

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18.  Targets the superficial and deep dermis and the
SMAS
Dr Lalit B Rajpal

19.  Tissue above and below the focal point remain
unaffected.
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 It also has an added advantage of giving real time imaging
to visualize the target tissues below the skin surface.
 This ensures proper coupling of the transducer to the skin
 It confirms appropriate treatment depth
 It helps to avoid non target tissue – bone

21.  Facial Rejuvenation
 Nasolabial fold and
Marionette line
reduction
 Double chin
 Undefined Jawline
 Lax skin - neck
 Laxity of skin –
arms, abdomen,
thighs
Dr Lalit B Rajpal

22.  Pregnant women
 Patients with metallic implants (pacemakers,
defibrillators, dental implants)
 Patients with serious heart disease, diabetes
and hyperthyroidism
 Patients with open wounds or cystic acne
lesions
 Patients on oral Isotretinoin therapy for the last
6 months
 Patients with scleroderma
Dr Lalit B Rajpal

23. AVOID
• Prominentia Laryngea (Adam’s apple)
• Philtrum
• Orbital rim
• Temple
• Perioral region
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24.  Patient selection is important depending on the
laxity of skin (mild to moderate)
 Realistic expectations.
 Consent
Dr Lalit B Rajpal

25.  T. Acetaminophen ( Panadol) 1gm – 1 hr
before procedure
Dr Lalit B Rajpal

26.  Photographs should be taken of the area to be
treated in the patients mobile and hospital
camera.
 The area to be treated is cleaned with antiseptic
and precisely marked using a skin marking
pencil.
Dr Lalit B Rajpal

27.  Select the correct size of cartridge according to
the area to be treated.
 The machine is turned on by switching the ON
button and tapping the screen.
 Cold ultrasound gel is applied on the
treatment area.
Dr Lalit B Rajpal

28.  Appropriate parameters
for the treatment are
selected.
 Start treatment from low
treatment level and
gradually increase the
energy level according to
the tolerance of the
patient.
 Suggested shots are
delivered in each
treatment area.
Dr Lalit B Rajpal

29.  Once the first pass is
complete, the
treatment is done
with a different
cartridge as the
second pass.
 The treated area is
then cleaned with
antiseptic and
Cicaplast cream is
applied.
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31.  Avoid creams and make up for 3 – 4 hours.
 Avoid sauna and massages in the treated area for
3 days.
 Patient may have mild redness on the treated area
which will subside.
 Healthy Skin cream is advised for all patients to
be used at night to improve skin texture.
Dr Lalit B Rajpal

32.  Treatment related side effects are generally mild in
severity and transient
 Common – Redness, Swelling and Bruising
 Uncommon –
Dysesthesia (abnormal sensation)
White linear striations or wheals
Hyper pigmentation
Perioral numbness with partial paralysis
(Neurologic complication associated with intense
focused ultrasound- JEONG et al 2014)
Dr Lalit B Rajpal

33.  The most potential complication is Motor nerve paralysis.
 The areas for greatest risk for injury are :
 Temporal branch of Trigeminal nerve
 Marginal Mandibular Nerve
 This treatment should be avoided directly on the temple,
mandible or facial nerves.
 Orbital rim should be avoided to protect the eyes from
ultrasound energy.
 The Thyroid gland should be marked before treatment to
avoid exposing the area to ultrasound energy
Dr Lalit B Rajpal

34.  Our patients are followed up after 1 month and after 2
months post treatment.
 For patients with severe laxity of the skin a second
session may be advised after 2 months.
 Other treatments like Botox, Fillers, Co2 Lasers can be
advised to enhance results.
Dr Lalit B Rajpal

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38.  The High Intensity
Focused Ultrasound
treatment is a non
invasive, effective and
acceptable alternative
for those patients
seeking an effective
way to avoid surgery.
 Care should be taken to
avoid complications
and deliver maximum
benefit for our patients.
Dr Lalit B Rajpal