Thank you for your question.
You submitted a question without a photo. And you’re asking what’s the difference
between high intensity focused ultrasound versus Pelleve and do they both essentially
lift the face. Well, I can certainly help you understand this type of confusion which
is very common.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I have integrated in my practice many non-surgical modalities to help
my patients look their best. From the beginning of the first CO2 lasers back in the mid-90s
to the more modern non-invasive methods including laser assisted thermal tightening and radiofrequency
thermal tightening. So I can certainly give you an idea of what the principles are and
how to distinguish the outcomes that most people are really looking for.
You see, one of the challenges in our profession once the proliferation of devices and other
modalities to help people improve their appearance became multiplied in our field that the strategy
of device manufacturers is very similar to the strategy of pharmaceutical companies.
What they would do is essentially market directly to patients and then trying to create essentially
demand for their product before doctors, clinicians, not the doctors who do the studies but the
clinicians get a sense of whether or not these devices work as proposed or whether or not
there’s a lot of hot air behind them.
Well essentially, the flavor of the past couple of years was high intensity focused ultrasound
and one particular product created so much buzz and was featured in multiple media outlets.
And almost as quickly as it came into the scene within the past couple of years as what
I initially predicted, the results have become challenged and disappointing because even
though the manufacturers often don’t claim to provide results that are the same as surgery
and surgical facelifts, there’s no shortage of the insinuations and implications of a
non-surgical facelift.
So before you decide whether or not one particular device is better than another for your needs,
I think it’s very important to understand facial aging. Generally speaking, these devices,
these name brands are sought after by people who are seeing their facial aging process
transpire but they want to avoid surgery. When you think about facial aging, what are
two things that matter that are the results of facial aging: volume loss that means bone
loss, muscle, fat and soft tissue then sagging, soft tissue descent, weakening of the tissue
as well as the connections of the underlying tissue.
Now the idea is that if you heat up the skin to a certain temperature, what you are doing
scientifically speaking is you are inducing a collagen remodeling response. Although there
can be some potential tightening effect, there isn’t really a predictable consistent lifting
effect and in no way does any radiofrequency technology or heating technology whether it’s
radiofrequency, high intensity focused ultrasound or long pulse width laser devices that induce
heating, it’s still about shrinking and remodeling. So you can get improvement in
skin tone. You can get improvement in quality but you don’t necessarily get a vertical
lifting.
Now, one of the things that I would present in this discussion in my patients who have
asked similar questions is what I’ll do is I will take their photos and I’ll place
them up in the screen, front view, three quarters, side views and I’ll show them that essentially
what they want often is to pull upward. They do mirror lift, a very common action that
people do at home to see how much better they would look. Well, at a certain stage and this
often is in the 40s and 50s and even later 30s and even as late as the early 60s, the
volume loss is what dominates the issue. And so, it’s the structure underneath that has
shrunk and people believe that the skin has sagged.
An alternative to these devices also is a procedure we perform in our practice called
Structural Volumizing. With Structural Volumizing, what we’re doing is we’re placing long
acting fillers such as Juvederm Ultra Plus and Juvederm Voluma at bone level. And by
placing it at the bone level, we’re restoring volume in a way that actually creates the
effect of a lift. Why? Because when you restore volume in the cheeks, the jaw angle, the jawline,
the chin, you’re actually creating a re-inflation of lost volume that often really looks like
you had a facelift.
A strategy then could be to combine Structural Volumizing with some skin soft tissue remodeling
using thermal energy device. I think that it’s very important to ask critical questions
about this. When you get down to it, the principle behind every device whether it’s Pelleve,
high intense focused ultrasound is about heating the skin to a critical temperature and having
the skin respond with remodeling of the skin. So in that respect, essentially you’re looking
at basically similar outcomes even though it’s different styles of delivery.
So I think it’s important to have a consultation by an unbiased doctor. What’s an unbiased
doctor? Someone who can do pretty much everything, may or may not have these devices in their
practice. But what I find is when people get convinced to getting a very expensive device
in their practice, they end up having to use those devices. A lot of times, doctors will
lease the device and the device will be in their office and the hype pushes the sale
of the device or the lease of the device. And when the hype dies away, they’re stuck
with the device. So you have to take things with a grain of salt. Be specific about what
kind of outcome you want to see happen.
And I would predict as an experienced practitioner with 20 years of practice that once someone
lifts vertically like this and improves their neck and jawline, that’s not going to happen
with a thermal energy device. It just doesn’t work that way. When the face is lifted when
we do surgery, we are lifting not just skin, we are also repositioning soft tissue and
muscle related tissue. That’s a lot of work to move and remove excess skin. Even the most
conservative facelift, there’s a fair amount of skin that actually ends up being redundant.
So you’re not going to get those kinds of results with a thermal energy device.
One of the things to close the whole loop about the strategies for facial aging, when
we do surgery, we do it under local anesthesia with LITE™ sedation. And that has been a
real big step for helping people overcome their hesitation about having face lifting
surgery because we do these procedures under local LITE™ sedation and avoid general anesthesia.
But even if you choose never to have a facelift, you have to then decide what really matters
most for your appearance and understand that there’s always room to achieve a certain
goal that meets a desired range of expectations. You can’t get surgical results with non-surgical
solutions. But in the modern world, when we have opportunities to improve volume and do
other things to improve skin quality, we can certainly do a lot of things that are non-surgical
and can’t be done with surgery. So, there really is a potential opportunity for synergy
when you put the right modalities together.
So I hope that was helpful, I wish you the best of luck and thank you for your question.