HIFU – Just an Aesthetic Fad? By Nancy Abdou Nina Nedelkovski

HIFU - what is it? How does it work? And does it really reduce facial volume that causes premature aging? HIFU (High Intensity Focused Ultrasound) fractionally and specifically traumatises tissue, whilst maintaining dermal integrity around each traumatised thermal zone, thereby expediting wound healing, increasing skin tightening and enhancing dermal remodelling results.

Fractional trauma is fast becoming the preferred method of controlled trauma, as it leads to consistent and predictable results. Keeping surrounding tissue intact and healthy, also enables higher cytokine activity, reduces downtime and risks of adverse events, such as PIHP. Further, there is zero incidence of infection, unlike fully ablative treatment options.

What is HIFU & How Does it Work?

HIFU was first used as an early stage cancer treatment in medicine, from there HIFU is now utilised in the aesthetic industry and has a wide array of treatment applications for both face and body. Treatment is extremely safe, has virtually no down time and provides comparable results to invasive surgery.

The inflammatory response that HIFU triggers, leads on to the other two stages of wound healing: proliferation and maturation or remodelling, causing fibroblast synthesis and jumpstarting neocollagenesis, followed by remodelling of the collagen fibres. The secondary effect HIFU is set in motion by heat - when tissue is exposed to substantial heat, noticeable skin tightening and contraction can be seen. HIFU waves bypass the epidermis and converge at specific depths, which then induce cellular vibrations within molecules, triggering friction leasing to thermal damage and denaturation of the proteins in collagen, at approximately 6070 degrees. Because HIFU can bypass certain depths, HIFU can reach depths that lasers and light based devices can’t and can do so safely on most Fitzpatrick types. By using very specific depths of penetration HIFU targets and address epidermal-dermal junction, the dermis, SMAS or the subcutaneous layer of the skin. Beams of intersecting ultrasound energy are delivered, which is focused by an ‘acoustic lens’ to bypass the epidermis and travel directly to the targeted depth. Below is a simple example of how some of the most common HIFU depths produce very different end points.

1.5mm targets superficial dermis, (similar to needling), but without epidermal damage or disruption

3.0mm targets connective tissue of deeper dermis (collagen zone)

4.5mm targets SMAS layer – this deeper collagen structure; tightening and regeneration of this layer results in skin lifting and contouring of the jowls.

What is SMAS anyway?

Playing an important role, the superficial musculoaponeurotic system (SMAS) is a layer of connective tissue that helps to support and shape the face. The SMAS is located between the skin and the underlying facial muscles, starting at the bottom of the facial bones and extending up to the dermis.

This system plays an important role in facial expressions, as it attaches to the muscles of the face. In addition, the SMAS helps to hold facial fat in place and provides support and foundation for skin. As we age, the SMAS begins to deteriorate and loosen, leading to wrinkles and sagging skin.

When the SMAS is lifted, it can help smooth out wrinkles and give the face a more youthful look, which is why the SMAS is often referred to as the “facelift layer” because it can be surgically lifted or repositioned to change the contours of the face or on the other hand, it can be treated less invasively, with aesthetic devices such as HIFU, to help lift and define the face.

Do we really need to prep for HIFU?

Yes, it’s true that HIFU is extremely safe and has a very low risk of adverse events, however, like any aesthetic treatment, if we want to obtain the absolute best results for our clients, prepping is simply non negotiable. line up of cosmeceuticals. SPF, Tyrosinase Inhibitors and Vitamin A. Of course we recommend Lumen-C, Activate, Vita-Boost & Zinc Armour from Skindividual Functional Skincare, for optimal results.

In addition to skin care, we strongly recommend that red LED and/or infrared is also utilised for prepping the skin. As we know, red LED stimulates a photochemical reaction at a cellular level, accelerating natural healing process and activates ATP (adenosine triphosphate) in mitochondria. NASA found that LED improves healing by 50% and fibroblast activity by 155%! Clients prepping for HIFU treatments should complete a series sessions of 2-4 weeks, every 2-3 days. LED can be used to decrease healing time post treatment after 24 hours

Are the Myths true?

Does HIFU really “melt fat”? It can, if that is what the aim of the treatment is. We hear so often that therapists and clinicians are scared to perform HIFU, because they have heard horror stories of clients actually losing volume in the face, resulting in premature ageing.

So let’s talk a little bit about Dermal Density & Fat Compartments

Depending on the age of the face, we all have superficial fat compartments. These compartments vary in thickness and composition. With age, people often lose facial volume, so we need to be careful when treating the fat pads that sag and pull on the SMAS due to their interconnecting structures.

Understanding what is happening to the skin and fat compartments is key to treating your client. When we see sagging in the tissue that is often evident in the jowls, chin and lower mouth areas this is often caused by a separation of the connective tissue and the cell size increase, we therefore aim to rebuild the layers, starting at the SMAS, then the fat pads and finally the dermis.

When HIFU treatments are delivered properly, with the correct cartridge depth - HIFU does NOT destroy facial fat cells (apoptosis). It is only when the 3mm cartridge is utilised on a degraded or thinning dermis, that HIFU can cause unwanted apoptosis, this is where HIFU has earned its negative reputation.

It is imperative to prepare the skin and thicken dermal thickness by other means or forego the use of 3mm cartridge altogether if in doubt. This is why good training, delivered by experienced and knowledgeable trainers is vital - we teach you how to push the boundaries, safely.

How should you perform HIFU and setting client expectations.

Treatments should be performed every 3-6 months with a maximum of 3 treatments per year. (A HIFU Glow treatment can be performed monthly.) Results can last over a year, depending on age, diet, medical history and lifestyle. HIFU can safely be combined with other treatments to further results.

The HIFU Glow Facial is becoming increasingly popular, deservedly so, the epidermis and upper dermis are targeted at 1.5mm, resulting collagen regeneration and a radiant, more youthful appearance.

HIFU treatments are excellent for: • Skin refining (removes fine lines, including lip lines and forehead) • Skin plumping, toning & smoothing (reduces pore size) • Reduction in Scarring (including acne scarring and stretch marks, but NOT keloid) • Skin tightening, lifting and facial contouring • Selective and wanted fat reduction for the body • Cellulite reduction

If you want to learn more about HIFU or discuss devices, get in touch at info@dermalandlaser.com.au Our recent Advanced HIFU Workshop is an excellent starting point if you’re curious about the treatment or if you have been performing HIFU and aren’t getting those amazing results!