title: Selective transcutaneous delivery of energy to porcine soft tissues using Intense Ultrasound (IUS).
abstract: OBJECTIVE
  Various energy delivery systems have been utilized to treat superficial rhytids in the aging face. The Intense Ultrasound System (IUS) is a novel modality capable of transcutaneously delivering controlled thermal energy at various depths while sparing the overlying tissues. The purpose of this feasibility study was to evaluate the response of porcine tissues to various IUS energy source conditions. Further evaluation was performed of the built-in imaging capabilities of the device.
  
  
  METHODS
  Simulations were performed on ex vivo porcine tissues to estimate the thermal dose distribution in tissues after IUS exposures to determine the unique source settings that would produce thermal injury zones (TIZs) at given depths. Exposures were performed at escalating power settings and different exposure times (in the range of 1-7.6 J) using three IUS handpieces with unique frequencies and focal depths. Ultrasound imaging was performed before and after IUS exposures to detect changes in tissue consistency. Porcine tissues were examined using nitro-blue tetrazolium chloride (NBTC) staining sensitive for thermal lesions, both grossly and histologically. The dimensions and depth of the TIZs were measured from digital photographs and compared.
  
  
  RESULTS
  IUS can reliably achieve discrete, TIZ at various depths within tissue without surface disruption. Changes in the TIZ dimensions and shape were observed as source settings were varied. As the source energy was increased, the thermal lesions became larger by growing proximally towards the tissue surface. Maximum lesion depth closely approximated the pre-set focal depth of a given handpiece. Ultrasound imaging detected well-demarcated TIZ at depths within the porcine muscle tissue.
  
  
  CONCLUSIONS
  This study demonstrates the response of porcine tissue to various energy dose levels of Intense Ultrasound. Further study, especially on human facial tissue, is necessary in order to understand the utility of this modality in treating the aging face and potentially, other cosmetic applications.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: W Matthew
authors.initials: WM
authors.lastname: White
authors.forename: Inder Raj S
authors.initials: IR
authors.lastname: Makin
authors.forename: Michael H
authors.initials: MH
authors.lastname: Slayton
authors.forename: Peter G
authors.initials: PG
authors.lastname: Barthe
authors.forename: Richard
authors.initials: R
authors.lastname: Gliklich
mesh_terms: D000818:Animals; D005240:Feasibility Studies; D017075:Laser Coagulation / Q000379:methods*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000473:pathology / Q000528:radiation effects*; D012867:Skin / Q000000981:diagnostic imaging* / Q000473:pathology / Q000528:radiation effects*; D013552:Swine; D013813:Therapy, Computer-Assisted; D046509:Tissue Culture Techniques; D014464:Ultrasonic Therapy / Q000379:methods*; D014463:Ultrasonography