Dr Ashwin Soni explores the use of acoustic wave therapy in aesthetic medicine
Acoustic wave therapy is gaining global popularity and momentum within aesthetic medicine. Acoustic wave therapy (AWT), otherwise known as extracorporeal shock wave therapy (ESWT), refers to a mechanical stimulation that encourages natural healing processes in the body, and is a non-invasive treatment method.
AWT has been demonstrated to help with facial tightening, provide a facial lift, and to help with wrinkles and fine lines.1 It has also been shown to benefit the body, such as for sculpting, tightening, and improving cellulite.1,2
This article aims to explore the science and mechanism behind this technology, and whether this type of treatment has utility in the world of facial and body aesthetics.
A background on AWT
AWT was first discovered through aerospace technology in the 1960s when the effects of shockwaves on tissues were noticed in Germany, leading the government to research their further use.3 Shockwave therapy was introduced to treat kidney stones in the 1970s, when experiments began, and clinical application started in the 1980s.3
AWT was then utilised for the treatment of gallbladder stones and was then introduced in the field of orthopaedics where it became an established treatment for certain musculoskeletal disorders, such as plantar fasciitis of the heel, lateral epicondylitis of the elbow, and tendonitis of the shoulder, and patella. It was then introduced into the field of andrology and sexual medicine, where it was used to treat erectile dysfunction.4,5
The safety and utility of AWT in the human body has been established over the last few decades given its use in multiple specialties. In the past few years, the technology has leapt into the aesthetics space.
How AWT works
Acoustic waves are pulses that are characterised by their short lengths, high-pressure amplitudes, and rapid increases in pressure.6 The transmission of acoustic waves into the tissues has shown to stimulate vasodilation, increase cell metabolism and angiogenesis, and have anti-inflammatory properties by the release of nitric oxide.7 An increased release of growth factors, the reduction of subcutaneous fat, and the stimulation of blood and lymphatic flow have all been demonstrated, which can allow for safe facial and body tightening and rejuvenation.8 Given that there is an increase in circulation and blood flow, remodelling of collagen and elastin within the skin, and change in cell metabolism, there is a potential for a positive impact on facial rejuvenation.
In a clinic setting, AWT is administered through a handpiece, which generates focused and deep acoustic pulses electromechanically. The provider is able to set the energy level, the pulse frequency, and the number of pulses. Depending on what area you are treating, and the goal of the treatment, these can all be modified to suit the particular area. Ultrasound gel is applied during each treatment to ensure that the energy is transmitted efficiently and smoothly.8
AWT and aesthetics
Animal studies have shown promising results regarding the effects of shockwave therapy on skin and tissues.9,10 Alshihri et al. designed a study in goats to examine the potential of shockwave therapy application to enhance several soft tissue parameters in skin. It was observed that the treatment significantly stimulated dermal thickness, angiogenesis, and collagen production after only four days.9 In addition, the study also found AWT stimulates cell proliferation of collagen and elastin. Both human and animal studies have shown that detectable changes in tissue structure have been observed, specifically related to the network of collagen and elastin fibres, resulting in a denser and firmer tissue as a result.9,11
AWT may also have a role to play in body sculpting technology too, given that it can improve skin elasticity and enhance connective tissue firmness
In addition, a 2021 study by Kimura et al. evaluated a total of 333 patients, demonstrating the volumetric changes of the whole face, which were calculated using Vectra software. Only mild erythema, which resolved within 24 hours, was observed in three patients. No other side effects were observed in this study.8
A few high-profile US brands, such as Shani Darden, have started to design their own ‘at-home’ acoustic wave vibration devices, which claim to result in facial tightening and sculpting.12 Although the current data out there suggests that AWT may have a role to play in non-invasive facial tightening and rejuvenation, there are a few variables. It depends on the specification of the power of the acoustic waves, the pulse wave frequency, and how many pulses the machine gives off, and so the specifications of at-home devices would need to be known in order to understand its effectiveness, compared to the in-clinic devices that these scientific studies have been based on.
It has been suggested that AWT may also have a role to play in body sculpting technology too, given that it can improve skin elasticity and enhance connective tissue firmness, and can also be effective in patients with cellulite.11,1 Many global device companies have developed acoustic wave therapy technology for face and body sculpting including BTL Aesthetics (X-Wave), a range of devices from Storz Medical, Bio-Med Inc (Shock Med), Inceler Medikal (Modus ESWT), and MTS Medical (urogold100) to name a few. Studies have shown that the BTL X-Wave device stimulates regenerative processes in the dermal layers of the skin and can result in positive effects on skin elasticity and an improvement in cellulite.1,8,11 These effects have been shown clinically in studies conducted specifically for BTL, which involved 52 patients assessing the efficacy of this treatment by measuring skin elasticity and having a professional and self-evaluation of skin improvement. The results of these studies showed an improvement in skin elasticity and skin upon evaluation.13,14
Another study of 30 patients, conducted by Hexsel et al, used different AWT devices from Storz Medical. The results demonstrated a significant reduction in hip circumference, an improvement in thigh circumference, a significant reduction in adipose tissue thickness, and an improvement in cellulite.15
Side effects and complications
Theoretically, this non-invasive modality can be applied to any skin type given the type of technology that is being used. This is due to the safety profile associated with this non-thermal ultrasound device, and the fact that these acoustic waves are targeting the subcutis, which means that the side effects are reduced to a minimum; at most some mild discomfort and reddening of the skin during the treatment.7 Theoretically, it is possible to develop epidermal burns, adipose atrophy, and contractures, but these have not been observed in any of the studies mentioned in this article.8
The future of AWT
The future of aesthetics has shifted towards non-invasive or minimally invasive procedures that are able to provide a significant benefit for our patients. Based on current research, AWT certainly has a potential role in facial and body aesthetics, but more long-term data needs to be collected before recommending this as an alternative to other current and well-known treatment methods. In addition, training courses in the UK are also starting to launch teaching on AWT, which means that the clinical application of this in the field of aesthetics is growing and its use will become more widespread over the next year.16
It should be considered that several studies do not have formal objective three-dimensional assessments in order to evaluate the effectiveness of AWT. Larger patient cohorts with longer follow-ups are required to improve our knowledge in this particular treatment method. So far, the side effects of this treatment method have been shown to be negligible, and we know that this technology is safe given decades of use in other medical and surgical specialties. However, further long-term studies will prove the true safety profile of this therapy for the indications within aesthetic medicine.
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