Mayumi Nomoto, M.D1.2. Miyu Narita, RN2.
1 Mayumi Nomoto Skin Care Clinic, Niigata, Japan, 2 Mayumi Nomoto Ginza Clinic, Tokyo, Japan
1. Overview
ULTRAcel Q+ is one of the latest medical devices for skin lifting treatment that use high intensity focused ultrasound (HIFU) technology. This device works by delivering HIFU deep down into the superficial musculoaponeurotic system (SMAS) layer, which is inaccessible to conventional lasers and radio frequency (RF) treatments. Thanks to its powerful thermal energy, the device has been shown to induce the wound healing process and tighten the facial line; however, the facial brightening effect of ULTRAcel Q+ is less well known. In my clinic, the following treatment protocol has been established based on my clinical experience to date: ULTRAcel Q+ is combined with intense pulsed light (IPL) to holistically improve symptoms from the perspective of three skin factors: shape (tightening), quality, and color tone to achieve healthy and beautiful skin. This article presents typical cases we treated with ULTRAcel Q+ as well as a case treated with a combination of ULTRAcel Q+ and IPL and discusses the characteristics of its therapeutic effects and its possible synergistic effects.
2. Introduction
Cartridges with different target depths can be mounted on the ULTRAcel Q+ : 1.5 mm, 2.0 mm, 3.0 mm, and 4.5 mm. Designed primarily for facial tightening, this device focuses the acoustic energy of ultrasound on the SMAS layer, which is inaccessible to conventional lasers and RF treatments, resulting in an immediate tightening effect through thermal disruption. Moreover, the device can induce the wound healing process, facilitating accelerated collagen production and sustained tightening and lifting effects for several months (Figure 1).
(Figure 1) ULTRAcel Q+ (Jeisys Inc.): optional cartridges for different target depths induce thermal damage to any tissue and accelerate the wound-healing process.
While the skin tightening and lifting effects of the ULTRAcel Q+ are well known to clinicians, the skin brightening effects by selecting cartridges for different target depths are not. In my clinic, the following treatment method has been recommended: a combination of ULTRAcel Q+ and cellec V that emits IPL for addressing the three skin factors of shape (tightening), quality (texture), and color (tone) to further enhance the skin brightening, lifting, and brightening effects of ULTRAcel Q+.
As a dermatologist, I have treated inflammatory skin conditions including severe atopic dermatitis and acne vulgaris, as well as severe rosacea. Based on my clinical experience to date, I believe that in order to achieve beautiful skin, the healthy state of the skin should be restored from the perspective that “skin beauty” is synonymous with “healthy skin”. The next section describes typical cases that we have treated with either ULTRAcel Q+ alone or with ULTRAcel Q+ plus cellecV that improved skin quality and color tone with facial tightening.
3. Methods
The post-procedure tightening and lifting effects were quantitatively evaluated using a 3D image analysis system. The effects of improving skin texture and color tone were quantitatively evaluated using an image analysis system.
4. Cases
<Tightening and lifting effect of ULTRAcel Q+>図2
Subject: 48-year-old female
Skin type: Fitzpatrick skin type III
Parameters: dot 2.0 mm / 3.0 mm / 4.5 mm
Shot Count: 600
Treatment duration: 60 min.
Evaluation: Four weeks after a single procedure, changes in fixed points on the skin surface were evaluated by a 3D image analysis system.
Results: As shown in the image below, the fixed points (arrows) of the entire face line ascended with an upward vector (Fig. 2). The more the color of each arrow changes from yellow to red, the more significant the change.
(Figure 2) Tightening and lifting approx. 1 month after ULTRAcel Q+ irradiation alone.
<Cheek pore tightening effect of ULTRAcel Q+> Figure 3.
Subject: 53-year-old female
Skin type: Fitzpatrick skin type Ⅱ
Parameters: dot 2.0 mm / 3.0 mm / 4.5 mm
Shot Count: 600
Treatment duration: 60 min. Irradiation was performed in such a way that the cheek was lifted to the center.
Evaluation: Four weeks after a single procedure, changes in fixed points on the skin surface were evaluated using a 3D image analysis system.
Results: As shown in Fig 3 (right), the arrows are directed toward the center of the cheek.
(Figure 3) The cheek pore tightening effect was observed approx. 1 month after ULTRAcel Q+ procedure
<Brightening effect of ULTRAcel Q+ and cellec V with irradiation by both modalities on the same day> Figure 4.
Subjects: 51-year-old female
Skin type: Fitzpatrick skin type III
Parameters: ULTRAcel Q+ => 1st procedure: dot 2mm/3mm/4.5 mm、2nd-4th procedures: dot 2.0 mm
Cellec V => 560/700 filter, 230 shots
Evaluation: The effect was evaluated using an image analysis system after a total of five procedures over seven months.
Results: After seven months of treatment, the brown and redness scores were reduced, and brightening (skin color) effect and skin quality were improved. This subject may have had naturally good skin quality so that the pore score did not change.
(Figure 4) The skin brightening effect of ULTRAcel Q+ and cellec V
5. Discussion
My clinic has shown through daily treatment that ULTRAcel Q+ can provide a significant tightening effect, and that the combination of ULTRAcel Q + and IPL improves skin texture and color tone, resulting in healthy and beautiful skin. The skin brightening effect of HIFU even after just a single procedure has been demonstrated in some studies that investigated the effects of ULTRAcel Q+. For instance, a Korean research group has reported the brightening effect of the HIFU 1.5 mm cartridge on the skin of guinea pigs previously irradiated with UVB.1) In this study, the group performed a histopathological evaluation three weeks after HIFU irradiation. It showed that the epidermal melanin deposition was greater in the HIFU irradiation group than in the control group. Also, a research group in Thailand has reported that UVB irradiation of the forearms of 20 patients, followed by 1.5 mm HIFU treatment, had a brightening effect on skin types with a high melanin content.2) It has been suggested that the mechanism by which HIFU has a brightening effect may be different from that of conventional laser and IPL. This may be because that HIFU treatment removes pigmented areas of the epidermis and dermis by mechanical destruction through thermal coagulation caused by ultrasonic vibration and friction, or that HIFU affects the deposition of melanin on top of the thermocoagulated layer through the thermal stimuli due to vibration and friction.
Based on these findings, my clinic uses ULTRAcel Q+ not only to tighten the skin, but also to improve its texture and color tone. For the purpose of skin tightening, the target area of ULTRAcel Q+ is centered on the deep skin layer; therefore, the minimum treatment interval is 3 months, typically once or twice per year.
As a basic treatment for skin tightening, my clinic has recommended a treatment method that “addresses all layers of the skin” by performing multiple irradiations with ULTRAcel Q+ (2.0 mm) and cellec V on the same day, targeting the superficial skin areas (Fig. 5).
(Figure 5) Target skin areas for tightening and for improving quality/color by ULTRAcel Q +
On the basis of my clinical experience to date, I believe that the visual appearance of the skin is healthier and more natural when the combination of ULTRAcel Q+ and cellec V is used. Long-term repeated IPL or laser treatment alone results in highly shiny skin; however, combined treatment with ULTRAcel Q+ and cellec V can lead to foggy skin whose pores are more invisible. In fact, an image analysis system shows that the pore score is increased.
In summary, due to its high tightening effect, I believe that ULTRAcel Q+ can improve skin quality and color tone leading to healthier skin. The combination of ULTRAcel Q+ and cellec V is also highly effective as a skin quality treatment method that can be used between HIFU tightening treatments of once or twice per year. Therefore, this combined method can also be used as a next step for patients who are already being routinely treated with laser or IPL.
References
1） S. Y. Choi, et al: Skin Research and Technology, 22: 131‒136, 2016.
2） Vasanos Vachiramon, et al: Lasers in Medical Science, 33:361‒367, 2018.