SAN DIEGO (FRONTLINE MEDICAL NEWS)Ultrasound treatments are an alternative for patients looking to avoid the pain and prolonged recovery associated with surgical body contouring or skin tightening procedures, according to Dr. Elizabeth L. Tanzi. Currently, several types of ultrasound devices are available for such procedures, she said at the annual meeting of the American Society for Dermatologic Surgery.

High-intensity, focused ultrasound and pulsed focused ultrasound devices are used for body contouring, and the micro-focused high-intensity ultrasound device is used for skin tightening, Dr. Tanzi explained. Body contouring has rapidly gained popularity in the United States and elsewhere, but surgical contouring procedures can be painful and can require prolonged recovery times, she noted.

Ultrasound for body contouring works via two noninvasive mechanisms, both of which cause selective damage of adipose tissue, said Dr. Tanzi , codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery.

First, adipose tissue directly absorbs ultrasonic energy during treatment, leading to immediate thermal coagulation and necrosis of fat cells, she said. Mechanical processes also break down tissue, such as when shear forces are created at high levels of pressure during treatment. Circulating macrophages then absorb the damaged adipocytes and the triglycerides they release, leading to a gradual reduction of the fat layer at the treatment site, she added.

When using ultrasound for body contouring, “patient selection is paramount,” Dr. Tanzi emphasized. Although the procedure carries no risk of infection or scarring, ultrasound yields subtler cosmetic results than would liposuction, and patients should understand that difference up front, she said. “This is body contouring, not weight loss,” she added. Patients can typically expect to see a slow reduction in adipose tissue at the treatment area about 1-4 months after treatment, and they also should understand that they might need multiple treatments to achieve their cosmetic goals, Dr. Tanzi said.

“Discuss side effects with patients,” Dr. Tanzi added. When used for body contouring, ultrasound can cause temporary erythema, bruising at the treatment site, soreness, and contour defects, although the latter are rare, she noted. Dr. Tanzi said she now treats patients with lower levels of ultrasonic energy to improve their comfort. “We are much more aggressive now with the overall number of lines we place on the body,” she added. “Go over the areas again and again.”

For example, in one clinical study, high-intensity focused ultrasound yielded statistically significant decreases in waist circumference at 12 weeks with treatment of 150-180 Joules per square centimeter, she noted. However, six passes at just 30 J/cm2 was more comfortable and gave similar results, she said ( Dermatol. Surg. 2014;40:641-51 ).

Micro-focused high-intensity ultrasound can be used for skin tightening, particularly on the face. The procedure targets precise areas of adipose tissue within the skin to create small foci of thermal necrosis, and also stimulates localized collagen production for about 3-6 months afterward, Dr. Tanzi said. As with body contouring, patients should expect subtler results than would be expected from a surgical procedure, but the absence of scarring and the opportunity to immediately return to regular activities can bolster their satisfaction, she said.

Dr. Tanzi is a consultant for Ulthera, Solta, Cynosure/Palomar, Syneron & Candela, and Cutera, and has received financial support from Zeltiq, miraDry, and Clarisonic.


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