Noura Lebbar, MD, discusses her experience using focused ultrasound technology 

Noura Lebbar, MD, Cosmetic Surgeon, Anti-Aging Medicine, Milan, Italy email [email protected]

With the increasing number of millennials presenting to our practice, our aesthetic treatments have changed and now involve more contouring and profiloplasty than in previous years. Jawline contouring is increasing in popularity, but should we always inject fillers? We have all witnessed in the media that plastic surgery and medical aesthetics procedures are causing unnatural-looking results; are we really giving the patients a better version of themselves by exaggerating their contours?

Prior to injecting fillers, especially in patients with increased laxity, we should consider treating their skin, working to achieve neocollagenesis and neoelastinogenesis and treatment of the SMAS. With the right preparation, we can achieve excellent results and, in some cases, avoid fillers.

The objective of the study

What we propose is an innovative approach for treating the skin and redefining the contours of the face, using focused ultrasound rather than fillers.

Focused ultrasound has been available for a number of years and is now a popular treatment. However it is not without its downfalls, which include:  

  • It can be a painful procedure
  • Some patients were unable to finish the treatment or treatment course
  • In some patients, there was unwanted permanent fat loss from the face
  • It is a longer procedure, typically ranging from 1 hour to 1 hour and 30 minutes in length
  • Very costly to the doctor and patient.

Material and methods

So how can we overcome the negative aspects of focused ultrasound? One device I have seen success with in my practice is the CFU-Èlife (BIOTEC ITALIA SRL). A high-intensity focused ultrasound that involves:

  • EASYFLOW application technique using up to 10Hz that allows random coagulation points making the procedure faster < 30 minutes, safer and painless. The EASYFLOW technique can be used all over the face without limitation and with no risk of neuropraxia.
  • A virtually painless procedure
  • A centreless transducer for more precise coagulation points
  • By modifying the pulse duration together with a centreless transducer, we can avoid fat loss from the areas where fat loss is unwanted
  • Constant water flow within the handpiece ensures handpiece longevity. Offering approximately 2500 treatments without changing handpieces is a lot more cost-effective
  • Ability to work on seven different depths, ensuring effective treatments on the face and body.

We have treated patients aged 35–70 years of all skin types and ethnicities, with skin laxity on the jowls, nasolabial folds, and marionette lines, desiring a non-invasive lifting and tightening of the midface.

We excluded patients who underwent a previous face lifting surgery or HA filler surgery in the previous 6 months.

Patient assessment was performed using the Croma jawline sagging assessment scale, and photos were taken at 1 and 3 months following the treatment. Patients with severe sagging had three treatments, two treatments for moderate sagging, and just one treatment for mild sagging.

We used three depths (4.5, 3.0, and 1.5 mm) at 4MHZ, pulse duration 50 ms, emission frequency 5–10 Mhz and energy 0.8–2 J. 1000–3000 coagulation points were performed using each depth for a total of 5000–8000 points with the three depths used. No topical anaesthesia was required.


All the patients were evaluated 1 and 3 months after the treatment. The results were all extremely satisfying; 95% of patients were very satisfied with the results. No side effects were observed post-treatment. The maximum result of skin tightening and jawline contouring was achieved 3 months after the treatment.


I will usually treat the face and the neck in the same session. Often combining the treatment with a non-cross-linked hyaluronic acid skin booster. To achieve the best result for the jaw-line definition, I will incorporate a botulinum toxin treatment to deliver a ‘Nefertiti lift’ immediately after the focused ultrasound but never before.

Skin tightening is immediate with better jawline definition, while the definitive result is visible 3 months after the treatment due to the collagen and elastic fibre synthesis in the 3 months following the ultrasound procedure.

I will propose two sessions a year to the patient unless the results are not satisfactory in terms of jawline contouring and lifting of the lower face. 

The new generation of ultrasound technology allows us to achieve excellent contouring of the jawline, occasionally from the first session. As the treatment is painless, fast and very safe, we can also propose it to younger women from 35 years, avoiding the need to fill the jawline with an excessive quantity of filler, which is fast becoming a fashionable trend. The treatment is safe, very fast, painless and extremely effective. In the opinion of the author, CFU appears to be actually the most effective non-invasive medical lifting method on the market. 

  •   Declaration of interest None
  •   Figures 1–2 © Dr Noura Lebbar