Ultherapy – a conversation with the renowned Dr Sabrina Fabi

Ultherapy is the first approved device for tightening and lifting sagging skin on the face, neck and décolletage.

In October 2016, leading US dermatologist Dr Sabrina Fabi hosted an Advanced Ultherapy Masterclass in Sydney, sharing her extensive experience using the breakthrough device.

Ultherapy is a non-surgical treatment that uses microfocused ultrasound energy to primarily target the Superficial Muscular Aponeurotic System (SMAS) and platysma layers, the same muscles of the face and upper neck that are affected in a surgical facelift, without harming the overlying skin. The system has been shown to non-invasively lift the eyebrow, face, neck and sub-mental areas, as well as improve lines and wrinkles on the décolletage.

Distributed by Merz Australia, the Ultherapy system is the first ultrasound device cleared for skin ‘lifting’ in a facial aesthetic medical application by the FDA in the US and is listed in the ARTG (ARTG225194) in Australia.

One of the most impressive features of Ultherapy is its ultrasound imaging technology, which enables visualisation of tissue planes to a depth of 8mm and allows the user to see where the energy will be applied. This real-time subcutaneous imaging allows clinicians unprecedented control during treatment by visualising the relative thickness of the dermis and subcutaneous fat layer and allowing avoidance of bone and vessels – Ultherapy is the only treatment to deliver this level of visualisation.

“We have more than 50 non-surgical devices in our clinic. With most of these devices, you can’t effectively get to deeper tissue depths of 4.5mm consistently and you certainly can’t visualise that depth,” says Dr Fabi.

Studies have shown that treating the face at 4.5mm contracts the SMAS and platysma layers, resulting in non-invasive lifting without affecting the skin’s surface.

“Ultherapy is the only FDA-approved device in the US to allow access to those depths and visualise the deeper layers, and the only device that has indication for a lift,” she continues.

“This is more than just superficial skin tightening; with Ultherapy we can actually lift tissue. In order to do this, we need to target the very tissue planes affected in a facelift and this device allows just that.”

How Ultherapy works

The different transducers of Ultherapy can target the deep and superficial dermis, causing thermal coagulation and stimulating the activity of fibroblasts at the treatment site.

Ultherapy delivers energy to specific layers in the skin. Unlike traditional energy-based systems, where greater energy delivery is achieved by increasing the intensity on the skin’s surface, Ultherapy uses cross beams of ultrasound energy to precisely heat tissue at three discrete depths (1.5mm, 3.0mm and 4.5mm) using two ultrasound beams. At the meeting point of these beams (the coagulation point), the optimum temperature to denature collagen is reached.

A clinical study has shown that collagen contraction and denaturation are optimised at temperatures between 60 and 70˚C, resulting in neocollagenesis. “When Ultherapy’s two ultrasound waves meet, it creates the thermal coagulation point, delivering heat at 65˚C which is the optimal temperature to denature collagen,” Dr Fabi explains.

The epidermis and melanocytes are avoided, making the treatment suitable for all pigmented skin types. The discrete spacing between the thermal coagulation points also helps to promote healing post-treatment.

Dual-depth treatment enhances results Dr Fabi uses dual-depth treatment passes (at 4.5mm and 3.0mm) for greater tightening and lifting of cheek tissue, improving jawline definition, and reducing submental skin laxity.

“When you create a controlled wound, this triggers an inflammatory cascade and if you have injury at multiple different tissue planes then you can theoretically create a synergistic effect where the sum is greater than each part,” says Dr Fabi. “That’s the reason we have seen greater results when performing a dual-depth treatment (4.5mm and 3.0mm) with Ultherapy than a single depth treatment.”

Patient comfort & satisfaction

The treatment is well tolerated and most patients report a hot prickling feeling during treatment. Some parts, especially around the bony areas like the cheekbones and temples, can feel more sensitive.

It is recommended to use the lower energy settings. The reduction in energy levels means the procedure is much more comfortable, with only a few spots of heat experienced by most patients. In essence, it offers greater patient comfort with the same result.

“We have found that the lower energy settings don’t have any bearing on results (you’re still delivering energy at 65˚C and at the same depth) but discomfort is reduced by up to 40%,” says Dr Fabi.

An appealing aspect of Ultherapy is that the effect will build gradually.

Results appear over two to three months (improvement can continue for up to six months) as new collagen begins to lift and tighten the skin on the face, neck and brow, as well as smoothing the skin on the chest.

Typically, results will be seen with one Ultherapy treatment, making it a valuable standalone treatment, but treatment can be repeated and maintained to offer improved results.

Ultherapy is ideal for both men and women of all skin types with mild to moderate wrinkles and skin laxity who desire a natural degree of firmness and minimisation of wrinkles and lines.

“Patient selection is key but age is no barrier,” adds Dr Fabi. “We are achieving the same level of results in our over-60s as we are in our 20-somethings – it just comes down to patient selection.”

Changing the face of anti-ageing treatments

Ultherapy is an essential device in the modern cosmetic clinic, working side by side with injectables and laser/IPL.

“Fillers and neuromodulators are key tools in any cosmetic practitioner’s toolbox, but they can only do so much,” says Dr Fabi. “With Ultherapy, collagen is stimulated so we achieve improvement in not only superficial skin quality but also lifting. While CO₂ devices also target collagen production, not every patient is amenable to downtime so you have to offer something that fits their lifestyle. This is a reason Ultherapy fits so well into our practice and is our third-highest revenue- producing procedure after fillers and neuromodulators.”

Another key benefit of Ultherapy is that it can treat the difficult décolletage. “Prior to Ultherapy, we were limited with the energy devices we could use in that area,” says Dr Fabi.

“In a single Ultherapy treatment we can now achieve significant results in the décolletage area. Indeed, in the pilot trial for FDA approval for this indication, 90% of patients saw significant improvement in just one treatment.”

The non-invasive industry is only set to grow as more companies invest even more into R&D and refine their modalities. “Non-surgical procedures have increased 980% since 1997,” says Dr Fabi. “If there’s demand, you need to give your patients what they want.”

For enquiries or product information contact Merz Australia on 02 8076 8120 or visit www.ultherapy.com.au

BEFORE and AFTER one Ultherapy treatment at 180 days

BEFORE and AFTER one Ultherapy treatment at 120 days

About Dr Sabrina Fabi

International speaker, trainer and author, Dr Sabrina Fabi is an internationally recognised leader in cosmetic dermatology. She is a double board-certified dermatologist and dermatologic cosmetic surgeon, who is an assistant clinical professor at the University of California, San Diego. As the associate research director at the practice, she is actively involved in multiple injectable, laser and sclerotherapy clinical studies, including Phase III FDA clinical trials. She is considered a leading authority on Ultherapy and has pioneered many of its current applications, including its combination with other injectables and laser treatments to achieve a natural 3D rejuvenation on the both the face and body.