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Treatment depths

Each device heats a set depth. Noninvasive devices cool or spare the surface and heat the dermis or the SMAS. Minimally invasive devices heat the fat and fibrous tissue just under the skin from inside.

Devices

Outside to inside

The layers each device heats

1. Epidermis

The surface layer. Thermage sprays cryogen and SofWave uses a thermoelectric cooler to protect it. Focused ultrasound spared the epidermis in cadaver tests. The Renuvion Dermal handpiece is the exception: it makes part or all of the epidermis non-viable on purpose.[1][2][3]

2. Dermis and its collagen

The main target. SofWave heats the mid-dermis at 1.5 mm, with a cleared treatment depth of 1 to 2 mm. Focused ultrasound made confined lesions up to 4 mm deep in the dermis. Thermage collagen changes reached 6 mm in bovine tendon.[1][2][3]

3. Subcutaneous fat and fibrous septa

Treated from inside by FaceTite, BodyTite and Renuvion APR through a cannula under the skin. Bipolar radiofrequency-assisted liposuction heats the fat and the underside of the skin. Subsurface radiofrequency causes coagulation of the subcutaneous fat.[1][2][3]

4. SMAS

The superficial musculoaponeurotic system, described by Mitz and Peyronie in 1976. Microfocused ultrasound targets the deep dermis and SMAS at 1.5 to 4.5 mm. In cadavers, focused ultrasound made thermal injury zones in the SMAS up to 7.8 mm deep.[1][2][3]

5. Nerves, muscle and bone

Deeper structures to avoid. Ulthera DeepSEE imaging shows tissue to 8 mm so the operator can confirm depth and avoid bone. Marginal mandibular nerve neuropraxia followed 1.2% of FaceTite lower face and neck treatments and resolved.[1][2]