Treating the SMAS* with focused ultrasounds to tighten up the face is a long-term solution for preventing or maintaining a face lift.
Dr Matthieu Le Flem
The motivations for having a “standard” lift vary greatly, as do the indications. Many patients have a mental block and can only imagine a person with tightly-pulled skin and a frozen expression, even though we can now achieve very natural-looking and harmonious results.
A wide range of indications for a lift with focused ultrasounds
The price, after-effects of the operation, downtime and general anaesthetic are all factors to consider when deciding whether or not to have surgery, or at least delay it for as long as possible. As a facial surgeon, I have many criteria to consider when recommending a surgical lift, and this is why I decided to work with microfocused ultrasounds over four years ago, in order to satisfy my patients’ demands while fulfilling my requirements for efficacy and safety.
I recommend the Ultherapy PRIME® treatment whenever the patient is too young or the sagging in the oval is too mild, as surgery is not yet indicated at this stage.
Another criteria is very thick skin with bad laxity and a lack of suppleness, as this would lead to a disappointing result due to the lack of mobility in the cutaneous and subcutaneous planes. Smoking hinders healing and I therefore recommend giving up smoking completely, several months before the operation. Ultherapy PRIME® is the perfect alternative if this is not feasible. Men, who rarely ask for a lift, are very good candidates, especially since their SMAS* is thicker than a woman’s and is therefore easy to spot. I recommend it for tightening up and galvanising the jawline, which is one of the principal features of a masculine face.
Retract, tighten, lift the features
I have worked with the Ultherapy® technology for the last 4 years and I offer it as an alternative to surgery, highlighting that we cannot promise the same results. I explain things honestly so that patients know what to expect, and they are still keen to have the treatment.
There is a real demand for oval treatments from women in their forties, who are too young for surgery. The aim is to retract and tighten up the deep planes of the face.
In order to achieve the best possible results and make the treatment comfortable, I always recommend a local anaesthetic, administered subcutaneously with a cannula, to avoid any discomfort or pain caused by the impact of the microfocused ultrasounds. Some regions, namely the area around the eyes, are delicate, but this is where ultrasounds can give a lovely tightening and smoothing effect. We work with a 1.5mm transducer, which treats the lower eyelids and upper eyelids subcutaneously to lift the eyebrows and lighten heavy eyelids, illuminating the expression and making it look relaxed and open.
The improvements made to the new Ultherapy PRIME® allow for even more precision and save time. The PRIME screen is larger and the ultrasound is better quality, so we can see more clearly. I think this is best thing about the device, because its efficacy relies on the fact that we can precisely target the SMAS* thanks to the ultrasound, as the depth at which it is found varies from one person to the next and even from one area of the face to the next. What is more, the delay in pulse delivery has been shortened, which allows us to shorten the length of the session.
Oval and neck together for an even result
Most demands concern the oval, so I explain to my patients that, in order to achieve a harmonious result, we should also treat the neck if it presents some sagging. With this aim in mind, I pass the device across the whole of the neck, avoiding any risk areas (thyroid and pre-larynx). The ultrasound scanner is very useful for locating the SMAS* in this area, as its depth varies from one person to the next. Depending on the thickness of the fatty tissue, I use either the 3mm or the 4.5mm transducer.
A full face is needed when the periorbital region is saggy, particularly in the case of droopy upper eyelids and eyebrows.
I do not set an age limit for the Ultherapy PRIME® treatment, as patients can respond well at any age, but if the sagging is severe I always warn them that it will be less effective than surgery. Most of the time, I go over the area twice in quick succession, because, as a surgeon, the aim is to target and treat the SMAS* as a whole and use the best transducer to obtain a tailored result. The SMAS* is the substratum of our skin. When it is tightened, the skin is mechanically re-tightened.
With regular upkeep, it is perfectly feasible to put off having surgery for several years. I recommend one session every 12 months, on average. With regard to women who have had a surgical lift, I recommend it to maintain the results, and they should start having maintenance sessions 3 to 5 years after their surgery. A well-executed lift should last around 15 years. Thanks to this device, we can make the results last even longer.
Dr Matthieu Le Flem
Otolaryngologist and Facial Plastic Surgeon. Hôpital Privé de Provence
in Aix-en-Provence. Universitary Degree in Face Plastic Surgery, 2017. Medical Trainer For Face Aesthetics Masterclass since 2021. Sleep Disorders training 2022. Key Opinion Leader and Medical Trainer for Merz Aesthetic Since 2023
*Superficial musculoaponeurotic system
