Microfocused Ultrasound with Visualization and Calcium Hydroxylapatite for Improving Skin Laxity and Cellulite Appearance

Abstract

Age-associated skin laxity contributes to worsening of cellulite appearance. This study evaluated the effects of microfocused ultrasound with visualization (MFU-V; Ultherapy) in combination with diluted calcium hydroxylapatite (CaHA; Radiesse) on cellulite appearance and on neocollagenesis.

Methods: Twenty women (18-55 years old) with skin laxity and moderate-to-severe cellulite on the buttocks and thighs were retrospectively enrolled. MFU-V was applied using 4 and 7 MHz transducers (25 lines/transducer/site) and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh). Photographs at baseline and 90 days were assessed by 2 independent, blinded evaluators using a 5-item cellulite severity scale. One subject scheduled for thighplasty received treatment with 6 different CaHA dilutions (0.3 ml/5 cm²) followed by MFU-V. Tissue specimens from each dilution site were examined under polarized light microscopy to assess neocollagenesis.

Results: Both evaluators reported statistically significant improvements compared with baseline for each item on the cellulite severity scale (P < 0.001) with a 4.5-point improvement in mean overall score (P < 0.001) after a single MFU-V/CaHA treatment. At 90 days, histologic analysis showed peak neocollagenesis in samples treated with the 1:1 dilution, whether with CaHA alone or in combination with MFU-V. The highest conversion of collagen type III into collagen type I at month 3 occurred in samples injected with 1:1 and 1:0.6 CaHA dilutions without subsequent MFU-V treatment. Both procedures were well tolerated, and subject satisfaction was high.

Conclusions: Combination treatment with MFU-V and diluted CaHA is effective for improving skin laxity and the appearance of cellulite on the buttocks and upper thighs.

Fig. 1.

Photographs before (A1, B1, C1) and after (A2, B2, C2) treatment in relaxed position (A1, A2), at maximal clenching (B1, B2), and at 45-degree angle view (C1, C2).

Fig. 2.

Mean numbers of collagen fibers detected after staining histologic sections with picrosirius red and observing under polarized light microscopy. C, control. A, CaHA treatment only. B, CaHA followed by microfocused ultrasound. Dilutions: A1, B1 (1:0.16), A2, B2 (1:0.3), A3, B3 (1:0.6), A4, B4 (1:1), A5, B5 (1:2), A6, B6 (1:6.5).

Fig. 3.

Picrosirius-red-stained histologic sections of the dermis viewed under normal microscopy (left columns) or with polarized light (right columns) are shown for control tissue (C1) and at 2 different CaHA dilutions (1:0.6, A3, B3; 1:1, A4, B4) for CaHA alone (A3, A4) or CaHA followed by MFU-V treatment (B3, B4).