Effectiveness of combined microfocused ultrasound with visualization and subdermal calcium hydroxyapatite injections for the management of brachial skin laxity

Abstract Background There is no publication to date on the combined use of microfocused ultrasound with visualization (MFU‐V) and calcium hydroxylapatite (CaHA) for brachial skin laxity. Aim To assess the effectiveness of combining MFU‐V with diluted/hyperdiluted CaHA in a single session for treating brachial skin laxity. Subjects/Methods Female subjects who had skin laxity in the brachial regions and who desired non‐surgical intervention were enrolled into this prospective, single‐arm pilot study. MFU‐V (Ultherapy ® , Merz North America, Inc. Raleigh, N.C.) was applied using the 4.0 MHz‐4.5 mm and 7.0 MHz‐3.0 mm depth transducers, followed by subdermal injections of diluted (1:1)/hyperdiluted (1:2) CaHA (Radiesse ® , Merz North America, Inc). Subjects were followed for six months after treatment. Objective biophysical skin assessments were conducted using a cutometer (Cutometer ® Dual 580 MPA; Courage & Khazaka, Cologne, Germany). Subjective assessments included the arm visual analogue scale (VAS), global aesthetic improvement scale (GAIS), and subject global satisfaction scale. Results Twelve subjects participated in the study. The mean R0 reading (measure of skin firmness) progressively improved from 0.515 mm at baseline to 0.433 mm at 24 weeks ( p < 0.05 for 12 and 24 weeks). The mean R2 reading (measure of skin elasticity) and mean arm VAS improved significantly from baseline at all visits ( p < 0.05 for all). The majority of subjects at each visit showed improved arm appearance and were satisfied with their treatment. Both procedures were well‐tolerated. Conclusions Combined use of MFU‐V with diluted/hyperdiluted CaHA demonstrates significant improvements in both objective and subjective measures of brachial skin laxity.