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Sagging improvement and slimming effect by HIFU treatment and risk avoidance method




理絵 山下
Dr. 理絵 山下

Shonan Fujisawa Plastic Surgery Clinic R

Japanese Society of Plastic and Reconstructive Surgery Specialist, Area Instructor, Pediatric Surgery Instructor, Skin Tumor Surgery Instructor Japanese Society of Laser Medical Specialists / Instructors Japanese Society of Cosmetic Surgeons Specialist Japan Association of Aesthetics and Medical Care Beauty Laser Specialist Japanese Society of Anti-Aging Medicine Specialist Specialist of the Japanese Society of Burns Japanese Society of Wound Surgery Specialist Certified by the Japanese Society of Regenerative Medicine Japan Society of Cosmetic Dermatology (Councilor) Japan Oncoplastic Society (Director) T / E Implant Responsible Doctor, Practical Doctor Japanese Society of Wound Healing Japanese Society of Craniomaxillofacial Surgery Japanese Society of Clinical Hair Japanese Dermatological Association International Society of Cosmetic Surgery International Burn Society American Society of Cosmetic Surgery


Medical institution with Dr. Rie Yamashita

Shonan Fujisawa Plastic Surgery Clinic R Shonan Fujisawa Plastic Surgery Clinic R
Contact: 0466-54-4374

Hyphen treatment consists of three layers: the "dermis layer" that is involved in the firmness of the facial skin, the "SMAS layer (superficial fascia group)" that exists underneath, and the "subcutaneous tissue" that is mainly the fat layer. It is a beauty treatment that can be expected to improve skin firmness and elasticity, improve skin sagging, and slimming effects by irradiating ultrasonic waves on the skin.

In addition to hyphen treatment, aesthetic medicine that can be expected to be effective in improving sagging includes laser treatment, radio frequency (RF) treatment, thread lift (thread lift), and face lift surgery. Hyphen treatment is the only treatment that can approach the SMAS layer other than the facelift surgery that raises the SMAS layer.

However, while the treatment effect can be expected, there are many people who are concerned about the degree of pain, side effects and risks. Before undergoing treatment, you can receive hyphen treatment with peace of mind by knowing the effects of hyphen treatment, pain, side effects, risks, and effective treatment frequency .

Sagging improvement and slimming effect by HIFU treatment and risk avoidance method Principle of hyphen treatment that can locally target the treatment area

HIFU is an abbreviation of English "High lntensity Focused Ultrasound", which is a method of collecting and irradiating ultrasonic waves with a high frequency that cannot be heard by the human ear. .

In the same way that black paper burns when sunlight is focused on one point with a magnifying glass, the focused irradiation of ultrasonic waves on the target area causes a high temperature and heat is generated .

Principle of hyphen that can aim at one point_explanatory image of hyphen

The effects that can be expected from hyphen treatment include a small face effect by lifting (tightening) that lifts sagging by the action of the heat generated, improvement of skin firmness, tightening of pores, and slimming effect by destroying fat cells. over.

Compare hyphen treatment with other irradiation treatments

Differences between hyphen treatment and other irradiation treatments

In aesthetic medicine, in addition to hyphens, energy sources such as lasers, light, and high frequencies are used, but there are differences in the depth to which the energy reaches and the range of influence.
In hyphen treatment, the energy of strong heat gathered at one point reaches the fascia called SMAS layer under the skin .

In laser therapy and phototherapy, the wavelengths contained in lasers and light are absorbed by melanin pigments, red hemoglobin in blood, and water, and the heat generated is used to improve spots, redness, and wrinkles. Therefore, depending on the color of the skin, it may react with the melanin pigment and cause burns, making the treatment difficult.

On the other hand, high-frequency and hyphen treatments can be performed regardless of skin color. However, it may be recommended to postpone the treatment because the skin becomes hot immediately after excessive sunburn, making it easier to feel pain and heat.

Machine for hyphen treatment

  • Ultraformer Ⅲ
  • Ulthera
  • Doublo
  • Ultracell Q Plus
  • Lipocell
  • Liposonic
  • sono queen

Areas that can be treated with hyphen

  • Areas of the face that can be treated with hyphen

However, for neck treatments, avoid the area where the thyroid gland is located.

  • Parts of the body that can be treated with hyphen

Those who are suitable for hyphen treatment

  • Wrinkles due to slack such as nasolabial folds, marionette lines, and golgo lines are conspicuous
  • Worried about double chin and sagging face line (fat)
  • i want to be small
  • Those who want to obtain skin rejuvenation effects such as firmness of the skin and reduction of pores
  • Want to improve wrinkles around the eyes, forehead, and around the mouth
  • I want to reduce wrinkles on my neck
  • want to lose weight

If the sagging is not severe to begin with, even if you receive hyphen treatment, there may be no change and you may have the impression that it is "ineffective." Depending on the degree of sagging, treatments other than hyphen treatment may be suitable, so please consult your doctor during counseling or examination before treatment.

Improving skin firmness, improving sagging, and slimming effect that can be expected from hyphen treatment

Hyphen cartridge description image

By changing the tip part (cartridge) equipped in the machine, the hyph machine can change the "ultrasound focal depth", which is the depth that the ultrasonic waves aim at, to 1.5mm, 2.0mm, 3.0mm, and 4.5mm. I can do it. However, depending on the machine, 2.0mm cartridges may not exist, and the most common pattern is 1.5mm, 3.0mm, and 4.5mm.

By changing the cartridge, you can perform treatments according to your wishes, such as "I want to improve firmness and texture", "I want to tighten the sagging of the face", and "I want to lose some weight".

depth of focus layer that can be irradiated
1.5mm/2.0mm Epidermal layer prone to superficial fine wrinkles
3.0mm The dermis layer where collagen decreases and firmness and elasticity decrease
4.5mm SMAS layer involved in aging (sagging) of facial muscles

Some hyphen machines are equipped with 6.0mm, 9.0mm, and 13.0mm cartridges for the body other than the above.

Also, the layer that can be irradiated with the above cartridge is a guideline. In the actual treatment, the doctor selects the cartridge based on the skin thickness and skin condition of each individual.

Recovery of firmness and texture by promoting collagen production with hyphen treatment

The skin is layered from the outside into the epidermis layer and the dermis layer, but the dermis layer is the majority of the skin tissue and can be said to be the main body of the skin.

Explanatory image of the dermis layer

About 70% of the dermis is made up of fibrous protein "collagen". Collagen is bound by a fibrous protein called "elastin", and "hyaluronic acid" fills the gaps while holding moisture, giving the skin firmness and elasticity.
These cells that produce collagen, elastin, and hyaluronic acid are "fibroblasts," which are also called factories that make collagen.

When hyphen treatment is performed with a cartridge that reaches the dermis layer where fibroblasts are located, the wound healing power that tries to repair the heat-damaged part and its surroundings works, and the fibroblasts are activated . Therefore, collagen and hyaluronic acid, which keep the skin firm and fresh, are replaced with new ones, and you can expect skin firmness, pore reduction, and skin tightening effects .

Improves fine wrinkles on the skin surface

By performing hyphen treatment with a cartridge that reaches the shallow part of the dermis layer just below the epidermis layer, it can be expected to improve fine wrinkles on the skin surface.

Hyf shower® that tightens pores and tightens skin

Ultraformer III, one of the hyf machines, is capable of continuous irradiation with weak heat called "Hyf Shower®". Because the speed of continuous irradiation is fast, even weak heat can be expected to improve skin firmness and tighten pores .

Also, Hyf Shower® is done with 1.5mm or 2.0mm cartridges. Compared to other hyphen treatments, it is said that the downtime until the skin at the treatment site returns to its original state is shorter.

(*"Hyf Shower®", "Hyf Eye Shower®", and "Hyf Deep Shower®" are registered trademarks and can only be used with the Ultraformer III machine.)

Improve sagging by raising the SMAS layer with hyphen treatment

The difference between hyphen treatment and other sagging treatments such as thread lift and high frequency is that it reaches the "SMAS layer" under the skin that thinly covers facial muscles.

The SMAS layer is an abbreviation for "superficial musculo-aponeurotic system", and is a thin superficial fascia that is formed over a wide area of the face while continuing from the head to the forehead, temples, neck, etc. The SMAS layer lies under the dermis layer and subcutaneous tissue (fat) and covers the muscles of facial expression.

As the SMAS layer loosens with age, it can no longer support the skin, and signs of aging such as wrinkles and sagging begin to appear. The skin tightening effect can be expected by stimulating the dermis layer to restore the firmness of the skin. It is said to have the effect of pulling up from

In addition to hyphen, there are light (IPL), laser, and high-frequency energy for aesthetic medicine that stimulates the dermis layer, but hyphen treatment is the only treatment that can approach the SMAS layer below the dermis layer without surgery. I'm here.

Slimming effect by reducing fat cells with hyphen treatment

When the subcutaneous tissue, which is mostly composed of fat, is irradiated with hyphen heat energy, the heat destroys or shrinks the fat cells . Destroyed fat cells can be expected to have a slimming effect by gradually being discharged out of the body by "macrophages", which are a type of white blood cell and play a role in releasing dead cells and their debris from the body.

In addition, it is said that the more hyphen irradiation, the more fat cells can be damaged.

Progress after hyphen treatment and required number of times and frequency of treatment

Lift-up effect of sagging treatment with HIFU and risk avoidance method

Immediate effect can be expected depending on the content of hyphen treatment

In the sagging treatment that uses hyphen to act on the SMAS layer , the SMAS layer is tightened immediately after irradiation, so immediate effects can be expected in improving sagging .

On the other hand, in the firmness improvement treatment that acts on the dermis layer, the effect begins to appear by activating fibroblasts and increasing collagen, elastin, and hyaluronic acid. Since these wound healing actions progress gradually, the effect may be felt about a month after the treatment, but it is said that the effect often appears over 2 to 6 months.

In addition, it is said that it takes 4 to 12 weeks for the destroyed fat cells to be discharged when acting on subcutaneous fat, so it is said that the effect can be felt gradually.

It is said that the treatment effect will appear even once, but if you want a higher treatment effect or depending on the condition of the skin and fat, it is more effective to receive the treatment multiple times on a regular basis.

Treatment frequency of hyphen treatment

Hyphen treatment is, so to speak, a treatment that intentionally causes injury. Immediately after the treatment, the treatment site is in a state of being injured by heat, and immediately after the treatment, the SMAS layer and fat layer are in a scab state, or the scab is about to come off.

If you receive hyphen treatment again before the wound is completely healed, it will be an act of creating a scar on the wound, which will damage the skin cells and lead to aging of the skin.

Therefore, the next treatment is 1 to 2 months after the treatment on the dermis layer, which aims to improve the firmness and elasticity of the skin, and 3 to 6 months, if it is a treatment that aims to improve skin sagging and slimming effects. Once a day is a guideline. However, the frequency of treatment varies depending on the condition of the skin and subcutaneous fat, so please follow the doctor's instructions.

There are two types of pain during hyphen treatment

It is said that there are two types of pain in hyphen treatment. One is "pain that reverberates through the bones" and the other is "pricking, stabbing pain under the skin."

Pain that resonates in the bones is pain that occurs when the forehead or near the chin is irradiated, and is said to be caused by a thermal response due to the absorption of ultrasonic waves by the cortical bone.

There are individual differences in how pain is felt. It is said that people with thin skin or thin skin are more likely to feel pain, but the pain is considered to be tolerable without anesthesia.

Hyphen treatment flow and precautions/downtime

(1) Examination (counseling)

Since there are individual differences in bone structure, flesh, and fat thickness, we will determine a treatment policy that suits the individual.

(2) Cleansing, washing face and changing clothes

For facial treatments, cleanse to remove makeup and wash your face to keep your skin clean. In addition, in the case of treatment on the body, change into special treatment clothes.

(3) Treatment

Gel or oil is applied to the area determined by the counseling so that the energy can be easily transmitted, and the depth of irradiation, the intensity of the energy, and the number of times of irradiation are adjusted while irradiating.

(4) Termination

The treatment is completed by wiping off the gel and oil. The treatment time is about 30 to 45 minutes for hyphen treatment on the cheeks and face line. If the face is irradiated, makeup can be applied as usual immediately after the treatment.

Precautions and downtime for hyphen treatment

Although there are individual differences, it is recommended that the skin be well moisturized for 2 to 3 days after the treatment, as the skin may be dry .

In addition, you can expect a tightening effect by causing heat contraction of the protein, but due to this action, inflammation (redness), swelling, and swelling may occur in rare cases, but even if they appear, they will subside in about a week.

Depending on the person, symptoms such as "heat sensation", "dull pain deep in the skin", and "muscle pain" may occur, but it is said to subside in 2 to 3 days.

There are no restrictions on exercise or lifestyle, so you can lead a normal life immediately after the treatment.

Those who cannot receive hyphen treatment

If you have little subcutaneous fat to begin with, the effect may not appear. Also, you may not be able to receive it depending on your chronic illness or physical condition.

  • have heart disease
  • have liver or kidney disease
  • Blood vessel problems such as phlebitis and thrombosis
  • have skin disease
  • After skin surgery or hospitalization
  • use a pacemaker
  • Have epilepsy (including those who have had it in the past)
  • There is a foreign substance such as silicon or precious metal (gold thread) in the area to be treated

For those who have undergone hyaluronic acid injection, botulinum injection, or thread lift treatment with dissolving thread in the area to be treated, the swelling caused by hyphen treatment may shorten the duration of the injection treatment or thread lift effect .

Therefore, it is recommended that those who are undergoing these treatments receive hyphen treatment after about a month.

Risks and side effects of hyphen treatment and how to avoid them

Risks and side effects of hyphen treatment

  • Inflammation (redness) and swelling/swelling
  • Burn
  • nerve palsy

Inflammation, swelling, and edema may occur due to the thermal effect of the irradiation site becoming hot, but it will subside in about a week. In addition, post-inflammatory pigmentation may occur due to inflammation, but it will disappear over time in about 3 to 6 months.

Burns and nerve paralysis can be avoided by an experienced doctor .

In hyphen treatment, if the energy (strength) to be irradiated is incorrect, partial burns may occur. In addition, if the nerve is irradiated, symptoms such as neuralgia such as dull pain and headache, and facial paralysis may occur. Nerves are concentrated in the center of the face, so it is not possible to irradiate anywhere.

Since there are many nerves running in the face other than the center, hyphen treatment requires knowledge and experience to avoid the nerves and irradiate.

Hyphen treatment is at a medical institution with an experienced doctor

Hyphenation can also be performed at beauty salons, but the output of the hyphenation machines at beauty salons and the hyphenation machines at medical institutions are different . Esthetic hyf machines have a limiter so that the temperature does not rise to the extent that cells are destroyed, and it is said that the output is about 1/3 compared to hyf machines at medical institutions.

Destroying cells and tissues violates the Medical Practitioners Act, so if a treatment to destroy fat cells is performed at a facility where there is no doctor, it will be "illegal", and placing a medical hyph machine outside a medical institution is illegal. Not sanctioned by the Medical Practitioners Act.

In addition, when using a hyf machine for esthetics with low output, the effect and duration often differ from the expected results, and even though the output is low, there are reports of burns during the treatment [*1] ] has also been

[*1] Information announced by the National Consumer Affairs Center of Japan

In order to obtain satisfactory results with hyphenation, it is necessary to undergo hyphenation treatment at a medical institution, and to receive treatment under the supervision of a doctor who is familiar with the anatomy of the face, has many treatments using hyphenation machines, and has a proven track record. is important.

Hyphen treatment Q&A with Dr. Rie Yamashita

Rie Yamashita, who supervised the article, taught me about hyphen treatment.

There are several types of hyphen machines. What are the differences between the machines?
Dr. Rie Yamashita
As for hyphen treatment equipment, the Ulthera system (manufactured by Ulthera in the United States) was sold as the original product and spread in Japan. Ulthera has the strongest power among HIFU devices, and you can get high effects. However, the treatment is painful and can cause complications such as facial nerve damage. After that, Korea-made Doublo, Ultracell Q+, Ultraformer III, etc. were sold as generic products. The latter is weaker than Ulthera, but it has the advantage of being able to obtain the same effect depending on how you hit it, less pain, and less cost.
I think that hyphen treatment is often used to improve sagging, but please let me know if there are any symptoms that are compatible with hyphen treatment (problems that can be improved), or if there is a type that is suitable.
Dr. Rie Yamashita
Since hyphen reaches the fascia layer, it has a lifting effect and also has a tightening effect. In addition to treating sagging, it also has the effect of raising the eyebrows by improving the double chin and acting on the forehead (frontal region), making the eyes look crisp. In addition, the 2mm cartridge is effective for tightening the dermis layer, and is also effective for wrinkles around the eyes and neck.
If I am worried about my smile lines and want to lift them up, is there an immediate effect with just one treatment? How long will it last? Is it okay to take it over and over again to keep it going?
Dr. Rie Yamashita
Nasolabial folds are caused by sagging, not wrinkles, so HIFU is indicated. A single treatment will not eliminate the nasolabial folds, but the effect of lifting the cheeks will make the nasolabial folds shallower. The effect can be maintained for about half a year by doing it once every six months. There is no problem no matter how many times you take it, but please consult your doctor for indications. If you are concerned about smile lines, combination treatment with hyaluronic acid is effective.
Is it better to do hyphen treatment as a preventive measure before sagging (for example, is it possible to receive it even in your 20s, or is the sooner the better)?
Dr. Rie Yamashita
There is a lot of cheek fat, double chin, and it also has a small face effect, so it may be suitable even in your 20s. However, hyphen is not a device to be used as a preventive measure before sagging, as the effect is obtained from minute scars that occur under the skin. A preoperative diagnosis is required to determine suitability.
Please tell me how to choose a doctor (medical institution) in order not to fail (obtain satisfaction) in receiving sagging treatment by hyphen.
Dr. Rie Yamashita
I think that it is rare to fail in treatment with hyphen. Because everyone who receives it gets a certain effect. However, since hyphen is a treatment that reaches the muscles, treatment by a doctor is a principle. It is also important that the doctor who explained and the doctor who performed the procedure are the same.
If you are concerned about sagging smile lines and marionette lines, which one should you choose if you are unsure about hyphenation, hyaluronic acid injection, or thread lift?
Dr. Rie Yamashita
Different patients have different indications as to which is best. If you need volume or want to rejuvenate your contours, inject hyaluronic acid. Hyphens and threads are pulled up. When choosing by downtime, it goes up in order of hyphen, hyaluronic acid, and thread. I recommend hyaluronic acid injection first, and then I often perform hyphen treatment in combination.
How painful is the procedure? Do you use anesthesia? Also, what kind of pain?
Dr. Rie Yamashita
Blemish treatments, lasers, and photofacials react to melanin in the epidermis, so it feels like a rubber band hitting the skin surface. The hyphen penetrates deeper than that, so it is a pain that resonates deep with a feeling of heat in the skin. It is "tolerable" even without anesthesia. Since the irradiation is divided into three layers, the deep part is irradiated first, and if you work hard only here, the pain will gradually decrease. Many people say that it is less painful than a photofacial.
Thank you very much, Mr. Yamashita.

Introduction of supervising doctor

Board member of the Japan Aesthetic Medical Association, board certified beauty laser doctor, board member of the Japan Society of Aesthetic Surgery (JSAPS), specialist doctor, educational instructor, board member of the Japan Society of Laser Medicine, laser instructor, specialist, and general manager of Shonan Fujisawa Plastic Surgery Clinic R. Dr. Rie Yamashita, the director. He has an established reputation not only in the treatment of trauma, reconstruction, tumors, and other plastic surgery, but also in the laser treatment of pediatric bruises, age spots, wrinkles, and sagging, and has given many lectures and guidance. His motto is, "If you are interested, try it yourself first."

Medical institution with Dr. Rie Yamashita

Shonan Fujisawa Plastic Surgery Clinic R Shonan Fujisawa Plastic Surgery Clinic R
Contact: 0466-54-4374

[Limited to medical professionals] Hyphen treatment Q&A with Dr. Rie Yamashita

Rie Yamashita taught me about HIFU treatment.

  • Tips for effectively irradiating HIFU on sagging
  • Information and knowledge necessary to achieve high treatment effect with HIFU treatment
  • To avoid the risk of facial paralysis
  • Does the result of HIFU treatment vary greatly depending on the practitioner?
  • How do you assemble a combination treatment to improve sagging? …and so on
In some cases, it is said that there is a possibility of causing risks such as facial paralysis, but are there any areas where these symptoms are likely to appear, and are there any points to be aware of when irradiating?
Dr. Rie Yamashita

Nerve focal and burning causes paralysis. Be especially careful when using 3mm or 4.5mm cartridges (transducers). Basically, it is important to firmly attach the transducer to the skin surface so as not to damage the skin surface and leave scars. I'll be careful.

・Facial nerve (mandibular marginal branch) injury: Drooping of the corners of the mouth occurs. The mandibular ramus extends from the angle of the jaw to the outside of the lip and runs between the superficial and deep lobes of the parotid gland. On the mandible, the parotid gland is also thin, so care must be taken when performing the procedure.

・Infraorbital nerve injury: It is safer to avoid irradiating the nerve running area below the infraorbital margin with a deep transducer, and avoid irradiation at a depth of 3 mm or more around the lips.

・Supratrochlear nerve and frontal nerve damage: When irradiation is applied to the forehead, paresthesia is likely to occur, and discomfort and tingling in the scalp (from the frontal area to the middle area of the occipital area) may continue for about half a year. I don't know about others, but I experienced it myself in the past, but it was painful to comb my hair, shampoo, and even have my head touched.

Please tell me how to deal with the above risks.
Dr. Rie Yamashita
Neuropathy improves in about a month, but the only treatment is oral administration of vitamin B12 preparations. Prior to treatment, it is necessary to fully explain to the patient that nerve paralysis such as the above answer may occur, that even if it does occur, it will subside over time, and how long it will take to recover if it does occur.
What would you say are the advantages and disadvantages of hyphens?
Dr. Rie Yamashita

Advantages: Non-surgical sagging treatment leaves no scars. Highly satisfying treatment with immediate effect, combination with other treatments possible, high repeat rate.

Disadvantages: There is pain during the treatment, it is not possible to make the face less fatty (patients may complain that it is not effective in cases where it is not indicated), most of them are effective after one treatment, but the effect lasts requires regular treatment.

This is a technical question, but please tell me how to effectively irradiate hyphens against slack.
Dr. Rie Yamashita
Inspect and palpate in standing and sitting positions, and sterically design and irradiate areas that should be lifted, areas that should not be lifted, areas that are easy to lift and areas that are difficult to move. As with surgery, this design is important. It is also necessary to change the pressing force according to the thickness of the fat in the irradiated area.
Does the result of hyphen treatment vary greatly depending on the practitioner? Please tell me why.
Dr. Rie Yamashita
I think that the treatment effect will be different between a person with low experience who performs according to the manual and an advanced person who can change the treatment according to the patient's face.
Do you have the information and knowledge that you think is necessary to achieve a high treatment effect with hyphen treatment?
Dr. Rie Yamashita
Knowledge of the location of the neural foramen, the course of the nerve, and the symptoms of possible nerve damage are critical to avoiding complications. In addition, knowledge of the position of facial fat and facial muscles, such as arms, has muscles under the fat, but the face has an intricate anatomical structure, so from the bones to the epidermis, it is three-dimensional. Let's irradiate while considering the anatomical position of.
I heard that combination treatments such as HIFU, radio frequency (RF), hyaluronic acid, and Botox are effective for sagging skin.
Dr. Rie Yamashita
Non-surgical, immediate effects and short downtime are injections like hyaluronic acid and botox. I recommend hyaluronic acid injection first, and then I often perform hyphenation as a combination, but I recommend hyphenation for those who don't like injections. Injections and equipment can be treated after about a month. In addition, surgeries such as high frequency, laser, thread, etc. are planned in consideration of wishes, adaptations, and economic aspects.
Thank you very much, Mr. Yamashita.