Emerging High-Frequency Ultrasound Imaging in Medical Cosmetology

Abstract

Cosmetic skin diseases are a part of many dermatological concerns brought up by patients, which negatively affect mental health and quality of life. Imaging technology has an established role in the diagnosis of cosmetic skin diseases by recognizing information on deep skin lesions. Due to the complex physiological and pathological nature of cosmetic skin diseases, the diagnostic imaging performance varies greatly. Developing noninvasive technology models with wide applicability, particularly high-frequency ultrasound (HFUS), which is able to achieve high-resolution imaging of the skin from the stratum corneum down to the deep fascia, is of great significance to medical cosmetology. To explore the great potential of HFUS in cosmetic skin diseases, a narrative review of literature from PubMed and Web of Science published between 1985 and 2022 was conducted. This narrative review focuses on the progression of HFUS imaging in medical cosmetology, especially on its promising application in the quantitative evaluation and differential diagnosis of cutaneous pathological scar, port wine stain (PWS), acne, skin aging, and other cosmetic applications.

Keywords: dermatology; high-frequency ultrasound; medical cosmetology; pathological scar; port wine stain.

FIGURE 1

HFUS identifying the different types of skin scars. (A,E): Hypertroplic scars; (B,F): Keloids; (C,G): Atrophic scars; (D,H): Normal skin. (A–D): The optical characteristics of various scars observed by skin microscopy; (E–H): audio-visual characteristics of scar skin detected by 20 MHz HFUS.

FIGURE 2

HFUS assessing the therapeutic efficacy of scars. A keloid before (A) and after (B) intralesional steroids injection. B-mode ultrasound images (longitudinal) of normal skin (C), pretreated keloids (D), and post treated keloids after an intralesional steroid injection (E). (F), (G), and (H) are the corresponding elastography images of (C), (D), and (E), respectively. Images (A) to (H) were captured from the same patient. Arrows in images (D) and (E) showed an obvious reduction in the scar thickness after treatment. The depth × width of the images (C–E) were 1.5 × 2.25, 1.6 × 2.4, and 1.5 × 2.25 (cm), respectively. As shown in the images, the quantitative elasticity values, including Young’s modulus and shear wave velocity, decreased after treatment.

FIGURE 3

Color-Doppler ultrasonography evaluates the characteristic vasculature of scars. Photography of a scapular keloid before treatment (A) and after 1 month of treatment with a Pico device (B). B-mode Ultrasound images of the keloid before treatment (C), after 1 month of treatment (D), and after 2 months of treatment with a Pico device (F), show that the keloid thickness was reduced from 0.42 to 0.27 cm and then to 0.23 cm. Color-Doppler ultrasound images showed palisade vessels in the keloid before treatment €, and palisade vessels disappeared after 2 months of treatment with a Pico device (F).

FIGURE 4

Scores of the blood flow signals in PWS lesions with Power Doppler ultrasound. (A) Grade 0, absence of color signals in a pink-type lesion; (B) grade 1, mild color signals in a thickened-type lesion; (C) grade 2, moderate color signals in a thickened-type lesion; (D) grade 3, marked color signals in a nodular-type lesion.

FIGURE 5

HFUS in identifying the different types of acne. (A) A false cyst-type dermis and subcutaneous tissue within a low-echo nodule; the arrow indicates the rich blood flow around the nodule; (B) The hair follicle type between the two arrows shows a slightly tilted low echo across the dermis; (C) A fistula type low-echo structure of the belt between the two arrows is located in the dermis and subcutaneous tissue layer; (D) The calcification arrow shows the dot calcification stove in the dermis. (d: dermis, st: subcutaneous tissue, m: face muscle).

FIGURE 6

Skin photoaging: subcutaneous low-echo band (SLEB) on HFUS images. (A) Photography of the ventral and dorsal areas of the forearm; (B) Decreased dermis echogenicity (arrow) on HFUS image. (C) Discrete degeneration of collagen fibers. Hematoxylin and eosin (H and E) staining (10X). (D) SLEB (arrow) on the HFUS image. (E) Solar elastosis. H and E staining (10X).

FIGURE 7

Monitoring complications of esthetic treatments by HFUS imaging. Sagittal plane (A) Hyperechoic lips (arrows); (B) Hypoechogenic area (filler deposit, arrow) surrounded by a hyperechoic region (T-teeth, M-orbicularis muscle, C-cutaneous tissue, Mu-mucosa). Sagittal plane (C) B-mode sonogram: The superior labial artery (left arrow), invisible inferior artery (right arrow); (D) Color Doppler sonogram: visible blood flow of the superior labial artery (left arrow), invisible blood flow of the inferior labial artery (right arrow); (LL: lower lip; UL: upper lip). Transverse plane (E) Color Doppler sonogram: collateral circulation of the left inferior labial artery (arrow).

FIGURE 8

HFUS detection of retroocular artery occlusions resulting from cosmetic facial filler injections. Case 1. An ophthalmic artery occlusion caused by a cosmetic autologous fat injection. (A) Fundus photograph displaying diffuse retina edema and segmented retinal arteries; (B) Fundus fluorescein angiography showing severe damage to choroidal and retinal filling; (C) CDFI displaying no retrobulbar blood flow signal; (D) Diffusion weighted image showing a large area of acute infarction in the left posterior temporal lobe and occipital lobe. Case 2. A case of central retinal artery occlusion caused by a cosmetic autologous fat injection. (E) Fundus photograph image showing retinal whitening with a cherry red spot. (F) Optical coherence tomography image indicating inner retinal edema. (G–I) CDFI shows no retrobulbar blood flow signal in the central retinal artery, a slight reduction in the posterior ciliary arteries, and a normal blood flow signal in the ophthalmic artery. Case 3. A case of anterior ischemic optic neuropathy after a hyaluronic acid injection. A fundus showing optic disc edema at baseline (J) and pale optic disc at follow-up (L); (K) CDFI showing a decreased end diastolic velocity and an increased resistance index and pulsatility index of the central retinal artery and a high peak velocity of arterial blood.