Coming & Going

Ultherapy for Décolletage

The décoletté is an area that can show aging and photodamage even in patients with less aged facial and neck appearance. Most common complaints are wrinkled skin, but the chest can also show signs of sagging and loss of tone, texture, and tightness. Many techniques and technologies are used, but Ultherapy with micro-focused ultrasound technology has applied for FDA approval for this indication.

In 2009, Ulthera became the first energy-based aesthetic technology to receive FDA approval for non-invasive browlift. In October 2012, Ulthera received its second non-invasive lift indication— for the neck and submental region.

As with many technologies, most of the early problems with Ultherapy surrounded patient comfort. The company has since addressed this and improved the technology with an “AMPLIFY” system upgrade to lower energy settings and increase patient comfort without sacrificing efficacy. In addition, the company also introduced an improved user interface with a faster treatment delivery system.

Two Pilot studies (both level two) have been done using Ultherapy for the décolletage. A single center prospective study and a multicenter prospective study both used single treatment, multiple depth micro-focused ultrasound. In the first study, blinded assessment and patient satisfaction were both high, and physician-rated GAIS improvement scores of greater than 85 percent were maintained at 90 days and 180 days. The most common improvement was seen in wrinkles. The second study, with 130 subjects, again with single, multi-depth treatment parameters, also showed significant improvement in chest wrinkles. This study has been accepted for publication in a peer-reviewed journal.

While newer Ultherapy treatment regimens continue to evolve, it appears that Ulthera for the décolleté is effective and may soon have an official indication.

Cheek Implants

With the advent of facial fillers and fat grafting, knowledge regarding midface anatomy, as well as the effects of facial aging with soft tissue and bone loss and skin changes, has increased dramatically. This, coupled with the anatomic demonstration of facial fat compartments, has changed the way we “re-volumize “ the face. We now use higher G' fillers, such as Radiesse (Calcium Hydroxylapatite) or Juvederm Voluma (HA), or collagen-stimulating agents such as Sculptra (PLLA), or fat grafting in multiple planes to augment the mid-face. Surgical placement of cheek implants is rarely used or indicated because of the improvements in injectable cheek augmentation.

Surgical cheek implants have the disadvantages of surgical placement, post-operative swelling and bruising (often prolonged), malposition, dis-insertion, and subsequent dyskinesis of facial muscles. Additionally, there can be sharp implant edges, especially in thin, sallow faces. These implants often look unnatural and “fake.” Many patients with cheek implants have accentuated disharmony between the mid-face and the upper and lower face. With all of these disadvantages considered, as well as the ease and much more natural results using “liquid” implants, the question is: Why should we consider this at all?