The Use of Ultrasound in Cosmetic Surgery

James J. Romano, MD

There are numerous exciting new applications of ultrasound therapy in cosmetic surgery. Ultrasound has been used for cosmetic purposes since around the early 1980s. Widespread therapeutic usage, safety, precise control and excellent, predictable results have made ultrasound an important addition to cosmetic surgery practices such as mine. New and current uses of ultrasound include facial and body skin-rejuvenating treatments, reduction of stretch marks, treatment of contracture and scar tissue such as around breast implants, and the pre- and post-operative treatment of plastic-surgery patients to accelerate healing and recovery after procedures such as face lifts, tummy tucks, and liposuction. Ultrasound applied over certain creams contributes to greater effectiveness through deeper and more thorough penetration of the products.

The mechanisms of action of ultrasound should be considered in terms of four categories. First is the thermal effect, which relates to the heat generated into the deeper tissues, especially the collagen, and the benefits derived from this. Second is the mechanical effect, which relates to the high-speed vibrations that act on the tissue just like a micro-massage. Third is the cavitation effect. This refers to the production of countless microscopic droplets of oxygen from the vibrational process. Fourth are the biological effects, which include blood-vessel dilatation, improved blood flow and circulation, sonophoresis, improved lymph flow, muscle relaxation, reduced inflammation, and pain relief.

Skin treatments are more effective because deep cleansing, exfoliation, and moisturizing are improved. This is achieved by high-frequency ultrasonic vibrations that penetrate deep into pores and hair follicles to break up old, dead cells; secretions; and oily blockages. Also, the skin metabolism is increased, which causes lymph flow to increase, which in turn causes waste products to be removed more rapidly and effectively. The more waste products removed, the better the penetration and absorption of your skincare products. Deep-tissue micro-massage improves skin tone, softness, and texture. All combined, these factors create younger looking skin. Treatment sessions take about 30 to 45 minutes and patients report feeling immediate tightening and softer, smoother skin. The skin looks suppler and friends will comment about your “healthy glow.”

Stretch marks, fine lines, and sun-damaged skin are improved through dermapheresis or sonophoresis. These are the terms that have been applied to the use of ultrasound in stimulating deeper penetration of products into the skin. To achieve this even better, we bring together the positive effects of microdermabrasion, ultrasound technology, and potent creams. Microdermabrasion removes the thickened and sun-damaged outer layer of skin. Next, ultrasound application can deliver special creams deeper into the lower layers of the skin. In this way the ultimate effects of the creams are much more potent. Multiple treatments are usually required, and the treatment is safe for all skin colors and types. The number and frequency of your treatments depends on your skin type and response to therapy. Improvements are usually seen by the fourth treatment.

Scar tissue and contracture is improved tremendously with ultrasound. Most believe this is due in large part to the thermal effects of ultrasound with the loosening, stretching, and re-orientation of collagen tissue. This has demonstrated great effects in speeding the healing and discoloration of firm or bruised areas occasionally seen after facelifts, tummy tucks, or liposuction. Patients with breast implants and some hardening have appreciated softening of the implants and breasts. Treatment sessions last 15 to 30 minutes and involve application of the ultrasound over the firm areas followed by home stretching and massaging exercises and special cream applications. Six to twelve treatments provide the best results with improvements usually seen after four sessions. Home exercises and massage preserve the results.

Fat Reduction. There has been a great deal of interest generated recently about the effects of ultrasound on fat reduction. This has already been well documented in the role of ultrasound in preparing the fat prior to liposuction and during the liposuction process. In these cases external ultrasound assistance (EUA) and ultrasonic assisted liposuction (UAL) are both very successful and well received. Recently, ultrasound has been described in its use as the sole modality for its dissolution of fat. Here saline fluid is injected into the area to be treated, and the ultrasound applied for five to eight minutes without liposuction. In even a few sessions, patients have noted improvement in areas of small fatty accumulations such as the jowls.

Unconsciously, ultrasonic products have become common commodities in our everyday life. Ultrasound has been used to shatter kidney stones, examine the fetus during pregnancy, research dolphins’ language, train dogs, and clean contact lenses. Ultrasonic sound waves are the basis of this technology and are generated at a frequency that is above the level heard by the human ear. The rate of ultrasound means the numbers of vibrations that occur in a second. Hertz is the unit of measurement.

Medical and cosmetic ultrasound units are manufactured to typically deliver ultrasonic waves at frequencies of 1 and 3 MHz with duty cycles ranging from 20 to 100 percent. Duty cycles less than 100 percent are called “pulsed” ultrasound while a 100-percent duty cycle is called “continuous.” For our purposes, most machines are utilized at 1 to 3 MHz with continuous and pulsed modes. Ultrasonic sound waves cannot be transmitted through the air and need some sort of liquid medium though which to pass. For this reason a gel is applied between the treatment head of the machine and your skin.

These patients are before and after liposuction. Note how much contour improvement is achieved. Ultrasound is routinely used in these patients to promote fast resolution of swelling, quicker healing, less bruising, and better skin molding and shrinking down around the reduced fatty framework


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