A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening.

Objective: to systematically review the efficacy of microfocused ultrasound (MFU) for facial skin tightening. Methods: A systematic search was performed (Pubmed, Embase) to assess the efficacy of single MFU treatments for facial skin tightening. Eligible studies included randomised controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Objective and subjective outcomes were assessed. Results: A total of 693 studies were identified of which 16 studies were eligible. All the studies involved female patients. MFU is capable of tightening the skin, as observed in studies measuring the results of brow lifts (0.47−1.7 mm) and submental lifts (measured as a 26−45 mm2 reduction in the submental area on lateral photographs). Data from the Global Aesthetic Improvement Scale (GAIS) were pooled, and the day 90 pooled subjective investigator reported scores (IGAIS) (n = 337) showed that 92% of the patients demonstrated an improvement in skin tightening and/or in wrinkle reduction which continued up to one year. Longer-term follow-up data are not available. The patient-reported pooled scores (SGAIS) (n = 81) showed that the skin improvements were mild and continued to increase from 42% (90 days) to 53% (360 days) post-treatment. The MFU treatment was moderately painful and caused transient erythema with or without oedema. Other adverse effects were rare (2%), including dysesthesia (numbness or hypersensitivity), bruising and stinging, mandibular burns, striations and contact dermatitis. Various device settings, treatment protocols and energies were applied. Excessive skin laxity and a BMI > 30 were posed as relative contraindications for MFU treatment because positive results declined with an increase in laxity and BMI. Conclusions: MFU treatment is effective in tightening female patients' mildly to moderately lax facial skin. Future studies should focus on objective treatment outcomes, optimising treatment regimens and male patients.

Traditional versus Laterally Extended Upper Blepharoplasty Skin Excisions: Objective and Patient-Reported Outcomes.

BACKGROUND: Different skin excision shapes may result in different aesthetic outcomes after upper blepharoplasty. METHODS: Two skin-only excision shapes were evaluated objectively and subjectively in 28 matched patients with laterally extended skin excision (group A) or traditional elliptical skin excision (group B). The pretarsal show, lateral eyebrow height, amount of scarring (evaluated with the Patient and Observer Scar Assessment Scale), and patient-reported aesthetic results (evaluated using FACE-Q) were scored and compared at 6 and 12 months postoperatively. RESULTS: In both groups, pretarsal show improved significantly after blepharoplasty. The homogeneity of pretarsal show improved significantly in the lateral extension group (group A) together with slightly more pretarsal show (0.5 to 0.8 mm at central pupil region) at 6 and 12 months of follow-up compared with group B ( P = 0.004). A trend was observed in the exocanthion 45-degree measurement, in which group A had 0.6 mm greater pretarsal show 6 months postoperatively. Homogeneity of the pretarsal show had improved significantly in group A, but not in group B, at 12 months after blepharoplasty. No other significant differences were observed between the groups regarding pretarsal show measurements or FACE-Q scores. Both groups showed descent of the lateral eyebrow, but this was only significant in group B. Group B showed 1.4 to 2.0 mm more descent compared with group A. Scarring and adverse effects scores were low in both groups and did not differ. CONCLUSION: Laterally extended skin excision and traditional elliptical skin excision both result in positive aesthetic results, but the laterally extended skin excision technique is accompanied by a slightly more favorable outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.