A treatment with the second-generation DOUBLO machine is a face lift procedure using HIFU technology, which can be a non-invasive alternative to plastic surgery. High intensity focussed ultrasound creates heat points in specific layers of the skin, which causes collagen production in the skin. By stimulating skin’s collagen production, it induces the remodelling process, reducing skin sagging and visibly and permanently elevating the eyebrow line, tightening the double chin and highlighting the youthful line of the jaw.
Compared to other devices using HIFU technology, a special feature of the second-generation DOUBLO device is that it is the only one that has a medical certificate, which means that the treatment is under medical control. In addition, many of its parameters can be more precisely controlled, including the density, energy, and depth of the delivered focussed ultrasound points in the skin.
Why is physician control important during treatment? A qualified medical operator can safely increase the density of the heat points and the energy of the delivered ultrasound pulses, guaranteeing the best results without increasing the risk of complications. Numerous studies have shown that higher energy treatments with higher impact densities have delivered significantly better results than low-energy treatments. How do we reduce potential complications to the lowest level? This requires a crucial feature of the DOUBLO machine, namely the high-resolution real-time imaging unit, which allows the physician experienced in image analysis to separate the layers of the skin from each other and to determine the presence of blood vessels, nerves and bones. Imaging helps physicians prevent complications such as burns, vascular, nerve damage, numbness, haematoma, and radiating pain, practically zeroing the risk of treatment.
- The structure of the skin
Our skin, covering our entire body, is actually the largest organ, and by separating the body from the outside world, it also maintains contact with it. Its construction is therefore a result of a complicated and very finely regulated process. It consists of three layers. The function of the epidermis is to maintain the skin’s highest protective layer by continually renewing the dying callus. The dermis is made up of loose fibrous connective tissue, collagen and elastic fibres, and connective tissues; its role is to ensure elasticity and durability of the skin. The hypodermis is composed of collagen fibrous support columns and fat cells, and its purpose is to store energy, regulate temperature and mitigate greater physical impacts. The three layers of the skin are linked by a strong connective tissue (aponeurosis) to the underlying muscle layer, which contains a significant amount of collagen and plays a role in regulating skin tightness. The deep layer of the dermis, the collagen-fibrous support columns of the hypodermis and the muscular aponeurosis, are referred to as the SMAS layer (superficial muscular aponeurotic system) (Figure 1).
The SMAS layer contains most of the collagen that holds the fat tissue in the skin and the epidermis over it. Collagen is a fibrous connective tissue that is found in almost every organ and plays a vital role in making the skin and tissues elastic and tight. As a result of biological aging, the amount of collagen is reduced by 1% per year, so the tissues lose water, lose their tightness and reduce their resistance. Focused ultrasound results in micro lesions in the appropriate layers that, despite aging, encourage local collagen production, thus returning the solid support system of surrounding tissues and giving the skin a firmer look.
- Safe DOUBLO HIFU treatment at different depths
To appropriately support all layers of skin on the face, the production of 3 layers of collagen should be induced. The most superficial layer is about 1.5 mm deep in the superficial dermis layer and because it is directly beneath the epidermis, it has an important role in smoothing out tiny wrinkles and crow’s feet. The middle layer is a deep dermis layer at a depth of 3 mm and the deepest is the SMAS layer at 4.5 mm. In these layers, increased collagen production supports and tightens connective tissue fat and bound moisture (Figure 2). In these depths it is not about a surface filling of tiny wrinkles, but the complete remodelling of the connective tissue support structure, which causes the skin structure to become more compact. Because of its higher collagen content after treatment, the structures will be able to absorb more water, resulting in a more flexible and tighter feel.
Since the depth of 1.5 mm is very close to the surface, the treatment can easily be performed safely and without side effects. However, at depths of 3 and 4.5 mm, it is important to take into consideration that blood vessels and nerves run throughout the dermis and hypodermis. The arteries of the skin run parallel to the surface at a depth of 3.5-4 mm and the smaller nourishing blood vessels grow upward from there. At the same depth run larger nerves that carry stimuli of touch, pressure and vibration. Since the face has a total skin thickness of approx. 4.5-5 mm, a deeper layer than this cannot be handled safely.
- How does an ultrasound imaging unit help?
When using an ultrasound imaging unit, we can distinguish skin layers, skin blood vessels, nerves and muscles in the hypodermis and just above the bone (Figure 3).
The imaging device uses a piezoelectric crystal that emits high-frequency broadband sound waves, which are reflected by different tissues to different degrees. By reading the reflected waves, we obtain a two-dimensional image of structures such as epidermis, blood vessel or bone. In order to safely apply HIFU technology in the deeper layers of the skin, it is absolutely necessary to distinguish and avoid these structures. In the absence of an imaging unit, hitting the blood vessels leads to formation of haematocele, hitting the nerves leads to numbness and muscle twitching, and hitting the bones may cause lasting bone pain. The skilled use of an imaging unit by a qualified physician minimizes these complications.
- Analysis of facial skin thickness distribution
The thickness of our skin differs in different areas of the body and in the parts of the face. Another great benefit of DOUBLO HIFU treatment using the imaging unit is that it is possible to assess the thickness of the skin to be treated. The device can then be precisely adjusted to create coagulation points exactly as deep as the SMAS layer, but no deeper. In the forehead and eye area, the total skin thickness is approx. 3.5-4 mm, so the SMAS layer is only at 3 mm. If these areas were treated using the 4.5 mm treatment head, the heat points would impact the bone. Contrastingly, in the chin line and double chin, the SMAS layer is deeper, mainly due to the thickness of the dermis. Because it’s about 4.5 mm thick, the combination of 3 mm and 4.5 mm treatment heads achieves the highest degree of collagen production (Figure 4).