Collagen provides elasticity to our skin and deeper tissues and helps keep us from sagging and looking older. As we age, everyone loses precious collagen. Our collagen bundles start to diminish the amount of collagen as young as in our 20’s. There are also environmental things we do to denature our collagen such as photo-damage from the sun and smoking; and there are repercussions on the elasticity of skin with repeated weight gain/ weight loss. Many individuals see the effects of aging and want to reverse this process or at least slow it down.
In 2012 a new non-surgical device was cleared by the FDA to lift and tighten the full face, neck and décolletage called Ulthera. Ultherapy lifts the skin based on a known physiologic process of collagen denaturalization, wound healing and neocollagenesis. Ultherapy focuses ultrasound waves to precise, well defined areas in the dermal and subcutaneous tissues delivering thermal coagulation points (TCP’s) below the surface of the skin. The creation of these TCP’s leads to an inflammatory wound healing response which stimulates long-term tissue remodeling and leads to further lifting and tightening.
First Stage: Inflammatory from Collagen Denaturation
The initial lift one sees after an Ultherapy treatment is from the heat energy –TCP’s producing an inflammatory response which is the body’s natural way of repair. Inflammation phase induces collagen contraction and denaturation. Macrophages breakdown the injured tissue and release cytokines that attract fibroblasts. The initial shrinkage in collagen fibrils results in the initial lift. This stage can last from 2 to 10 weeks. The next phase begins collagen repair and the development of new collagen.
Second Stage: Proliferation of Neocollagenesis
The TCP’s delivered to the dermis and below are recognized by the body as an “injury”. The response of microscopic wound healing involves tissue repair and the synthesis of “new collagen”. The neocollagenesis undergoes organization and cross-linking, which enable it to have more elastic properties and better resist mechanical stress. This is known as type III collagen. Research from biopsies after Ultherapy treatments indicates a significant increase in the amount of elastin compared to before treatment. This building or proliferation stage can be seen at 28 days and the face feels firmer.
Third Stage: Maturation and Remodeling
The collagen remodeling process is a crucial step in facial skin tightening and lifting. This stage can start at 3 weeks and continue up to a year. Remodeling represents the period during which type III collagen is replaced by type I collagen, which forms tight cross-links with itself and other proteins within the dermis and below. Good results are typically seen 6 months after Ultherapy.
Wound healing post treatment is an important factor.
Certain diseases such as diabetes can affect wound healing. Individuals with a compromised immune system have delayed healing which needs to be taken into consideration prior to treatment. Other systemic factors such as obesity, nutritional status of the person as well as stress have also been shown to interfere with one or more phases of the process, thus causing improper or impaired wound healing of the TCPs.
It is important to consider the mechanism of action of anti-inflammatory medicines such as NSAIDs (Ibuprofen, aspirin) and their chronic or regular use. They can impair the inflammatory process crucial to lifting and treatment efficiency.
Ultherapy is currently the only FDA approved technology that precisely heats tissues to optimal temperatures for collagen contraction and denaturation and remodeling at specific depths to the dermis and below the surface of the skin to lift the face, neck and decollatage.