A Novel Technical Approach to Non-Surgical Facial Rejuvenation with Intense Focused Ultrasound and Poly-L-lactic Acid Injections

Traditional rhytidectomy addresses skin laxity of the aging face without managing facial volume loss. Frequently permanent and semi-permanent filler materials are injected to replace missing volume. A common barrier to rhytidectomy acceptance for patients is the amount of post-operative recovery time. A new combination of non-invasive techniques can achieve the goals of rhytidectomy and semi-permanent fillers. We propose a technique of injectable poly-L-lactic acid to increase facial volume and the use of intense focused ultrasound light for skin tightening as non-invasive rehabilitation of the aging face with minimal recovery time. 

Poly-L-lactic acid was injected into areas of clinically significant volume loss including temporal, zygomatic, maxillary, and lateral brow regions. Each patient returned for additional treatments every 6 weeks until adequate volume gain was achieved. A focused intense ultrasound probe was used to tighten regions of significant skin laxity on the face and neck.

Patient satisfaction was measured subjectively surveying patients at 30 days and 90 days post-treatment. Patient satisfaction with treatment was 100% despite reported rare adverse effects of erythema and palpable subcutaneous nodules. Pre and post-treatment photos display the subjective improvement in both increasing facial volume and skin tightening. 

Facial skin laxity and volume loss are the fundamental issues of managing the aging face. Enhancing volume and skin tightening can be improved with the used of poly-L-lactic acid injections and the use of non-ablative focused intense ultrasound energy. Patient acceptance and post-operative recovery supersedes that of traditional rhytidectomy with this combination technique. Although the efficacy of this non-invasive technique cannot achieve the results of traditional rhytidectomy, the utility is significant. 

Bartus C, William Hanke C, Daro-Kaftan E. A Decade of Experience with Injectable Poly-L-Lactic Acid: A Focus on Safety. Dermatol Surg. 2013 Feb 4. doi: 10.1111/dsu.12128.

Lee HS, Jang WS, Cha YJ, Choi YH, Tak Y, Hwang E, Kim BJ, Kim MN. Multiple pass ultrasound tightening of skin laxity of the lower face and neck. Dermatol Surg. 2012 Jan;38(1):20-7. doi: 10.1111/j.1524-4725.2011.02158.x. Epub 2011 Sep 14.