RU2717548C1 - Method for determining condition of skin structure and underlying soft tissues of face in correcting age-related changes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cosmetology, and can be used for determining the state of skin structure and underlying soft tissues of the face with age correction. Ultrasonic examination of skin is performed. In the vertical position of 22 MHz sensor along the mid-eyelid line, the epidural and dermal echo characterisations are determined: echostructure (A), echogenicity (B), thickness (C) within the forehead and cheeks. Using 18 MHz sensor in the same position along the mid-eyelid line in the forehead and cheek region, the same echo characteristic of the subcutaneous fat, frontal muscle and muscle lifting the upper lip are determined. Papillary layer of the dermis (D) within the forehead and cheeks is visualized by Doppler examination (DI) in same 22 MHz position along the mid-eyelid line. If observing epidermic echo characteristic: A - inhomogeneous, B - hyperechoic, with hypoechoic interlayers, C - 0.3–0.5 mm; derma: A - inhomogeneous, B - reduced echogenicity in the upper parts, increased in the lower, C - 1.6–2.0 mm; surface subcutaneous fat: A - inhomogeneous, B - fat slices of lower echogenicity, separated by hyperechoic fibrous partitions; C - 2.5–6.0 mm; muscles: A - inhomogeneous, B - reduced echogenicity with clear hyperechoic contours; C - 0.6–1.2 mm; D - accurate visualization of vessels of derma papillary layer, detecting absence of age-related changes of facial skin. If at least one of the values A, B, C, D deviates from said characteristics, they are available.

EFFECT: method provides higher reliability of skin examination, improved results of correction of age changes by determining ultrasonic criteria of skin condition of face.

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Description

The present invention relates to cosmetology and can be used to diagnose the condition of the skin and underlying soft tissues of the face with the correction of age-related changes.

A modern approach to planning cosmetic procedures involves a preliminary diagnosis of the condition of the skin and soft tissues of the face. However, studies to diagnose the condition of the skin and soft tissues of the face before cosmetic procedures are few. The choice of the implantation zone of fillers, threads is not personalized, the introduction is carried out under the control of vision according to the "schemes" in the subcutaneous fat, the severity of which is individual and varies with age.

The work of domestic and foreign scientists in cosmetology is mainly aimed at studying the diagnosis and differential diagnosis of complications after injection contour plastics using ultrasound.

Despite the few scientific data available, semiotics have not been developed to date, the ultrasound technique has not been optimized, modern technologies have not been studied in assessing the state of the structure of the skin and underlying tissues when correcting age-related changes.

A known method for the diagnosis of soft tissues of the face using magnetic resonance imaging (MRI), which allows you to visualize such structures as muscles, adipose tissue, to detect the presence or absence of edema, fibrotic changes [Pravin Mundada et al. Injectable facial fillers: imaging features, complications, and diagnostic pitfalls at MRI and PET CT. Insights into Imaging. December 2017, Volume 8, P. 557-572.]. With the introduction of contrast, blood vessels are determined, differential diagnosis of pathological processes is carried out. However, MRI does not allow to assess the condition, structure of the skin, its change, to visualize the vessels in it.

To assess the condition of the epidermis, dermal layers of the skin, standard histology is used. The method requires a biopsy specimen with its subsequent preparation and analysis, which takes time. The method itself is traumatic and its use is not justified for routine examination in cosmetology.

The closest analogue of the invention is a method of aesthetic correction of soft tissues of the face [RF Patent for the invention No. 2663391], in which indirectly protect the determination of the state of the structure of soft tissues of the face, when using ultrasound when installing the sensor in the sagittal plane along the mid-pupil line, measure the thickness of the deep fat package " canine fossa ”- between the muscle that raises the angle of the mouth and the muscle that lifts the upper lip and the thickness of the subcutaneous fat between the dermis and the muscle that lifts the upper lip with an 18 MHz sensor. Based on the data obtained, the required volume of filler or lipolytic is calculated to correct the excess or deficiency of adipose tissue. However, this method does not allow to reliably assess the structure of the dermis and epidermis, as well as the echostructure and echogenicity of adipose tissue, describes soft tissues of the middle third of the face, while other areas undergo aesthetic correction.

Tasks:

1. Improving the effectiveness of restoring the state of the structure of the skin and underlying soft tissues of the face;

2. Improving the tactics of correcting the structure of the skin and soft tissues of the face;

Technical result:

1. The method improves the reliability of the study;

2. Improve the results of correction of age-related changes;

3. To increase the medical and social significance of U3 diagnostics of the condition of the skin and underlying soft tissues of the face when planning correction of age-related changes by using a high-frequency sensor of 22 MHz, which allows not only differentiating skin structures, such as epidermis, dermis layers, recording changes in their state, compaction , thickening, thinning, but also visualize blood vessels of the skin, including the papillary dermis. High-resolution U3 skin scanning has advantages over standard biopsy, namely, it is an “in vivo” method that allows real-time assessment of the condition of the epidermis, dermis, its blood supply, while it is non-invasive and does not injure the skin. Using a sensor with a frequency of 18 MHz, the structures of the underlying soft tissues of the face in the scan area and their characteristics are determined: echogenicity, echostructure, thickness of the facial muscles, surface fat, the presence of pastiness, ultrasound signs of fibrotic changes.

In the complex, the expansion of information about the condition of the skin and soft tissues of the face refines the examination tactics and provides an increase in the effectiveness of correction of age-related changes.

The essence of the invention is that in the complex the vertical position of the 22 MHz sensor is determined by the mid-pupil line of the echocharacteristic of the epidermis and dermis: echostructure (A), echogenicity (B), thickness (B) in the forehead and cheeks, and using an 18 MHz sensor in in the same position along the mid-pupil line in the forehead and cheeks, the same echo characteristics of superficial subcutaneous fat, frontal muscle and muscle that lifts the upper lip are determined, then using Doppler imaging (CI) in the same position of the 22 MHz sensor along the mid-pupil line of the visa the papillary layer of the dermis (G) is analyzed in the forehead and cheeks; and with echoes of the epidermis: A - heterogeneous, B - hyperechoic, with hypoechoic layers, C - 0.3-0.5 mm; dermis: A - heterogeneous, B - decreased echogenicity in the upper sections, increased in the lower, B - 1.6-2.0 mm; superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa; B - 2.5-6.0 mm; muscles: A - heterogeneous, B - reduced echogenicity with clear hyperechoic contours; B - 0.6-1.2 mm; G - a clear visualization of the vessels of the papillary dermis, reveals the absence of age-related changes in the skin of the face, and if at least one of the values A, B, C, D deviates from these characteristics, their presence is revealed.

The method was tested on 100 patients for 4 years. The group included women aged 25 to 60 years who applied to correct age-related changes. At the same time, 30 volunteers who were not shown correction showed the following state of echo characteristics:

for the epidermis, the echostructure (A) is heterogeneous, echogenicity (B) is hyperechoic, with hypoechoic layers, thickness (C) is 0.3-0.5 mm; for the dermis A - heterogeneous, B - reduced echogenicity in the upper sections, increased in the lower, B - 1.6-2.0 mm; for superficial subcutaneous fat, A - heterogeneous, B - fat lobules of reduced echogenicity, separated by hyperechoic fibrous septa; B -2.5-6.0 mm; for the frontal muscle and the muscle that lifts the upper lip A - heterogeneous, B - reduced echogenicity, with clear hyperechoic contours; B - 0.6-1.2 mm; (D) - a clear visualized vascular papillary dermis.

The method is as follows. Using ultrasound on the MyLab Twice device (manufacturer Esaote, Italy), when installing a 22 MHz linear sensor in a vertical position, the echogenicity, echostructure, and thickness of the epidermis and dermis in the forehead and cheek are successively determined using the mid-pupil line. After, a linear sensor of 18 MHz in the same position along the mid-pupil line examines echogenicity, echostructure, the thickness of the superficial subcutaneous fat, frontal muscle and muscle that lifts the upper lip. Then, using a Doppler study using a linear 22 MHz sensor in the same position along the mid-pupil line, the papillary dermis is visualized. The mid-pupil line is selected to standardize the study protocol. To facilitate the visualization of these muscles, a mimic test is performed: they ask the patient to smile or be surprised, which allows you to accurately determine muscle structures, as well as surface fat, between them and the dermis. After the study, the results obtained are compared with the values of the state of the echo characteristics of volunteers who are not shown the procedure. If at least one of the values deviates from the characteristics of the volunteers, age-related changes are revealed.

According to the results of the study, a description of the echo characteristics is given with a conclusion that reflects which structures are changed. The resulting conclusion is interpreted by a cosmetologist who prescribes the correction of age-related changes based on the data. Subsequently, at the discretion of the cosmetologist and the patient, a re-examination after correction can be carried out to evaluate its results.

Example No. 1. Patient A, 33 years old, requested aesthetic correction to prevent age-related changes. Ultrasound examination with a 22 MHz sensor in a vertical position along the mid-pupil line determined the echostructure (A), echogenicity (B), thickness (C) of the epidermis and dermis in the forehead and cheek, after, with an 18 MHz sensor in the same position along the mid-pupil line in the forehead and cheeks determined the same parameters of superficial subcutaneous fat, frontal muscle and muscle that lifts the upper lip, then with a 22 MHz sensor using a Doppler study (CI) in the same position, the degree of vascularization of the papillary c loya dermis (G).

Revealed:

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.3 mm. Derma: A - heterogeneous, B - reduced echogenicity in the upper sections, increased in the lower, B - 1.6 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa, C - 2.5 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 0.6 mm. The degree of vascularization of the papillary dermis - a clear visualized vascular papillary dermis.

Conclusion: in the study, deviations from the norm were not detected.

In the correction of age-related changes at the moment does not need.

Example No. 2. Patient B, 49 years old, complained of gray skin, small wrinkles all over her face, a “floating oval”, which sharply manifested after the onset of surgical menopause. Ultrasound was performed as described.

Revealed:

Epidermis: echostructure (A) - homogeneous, echogenicity (B) - hyperechoic, without hypoechoic layers, thickness (C) - 0.29 mm. Derma: A - homogeneous, B - increased echogenicity in the upper and lower sections, with hyperechoic inclusions in the lower, B - 1.5 mm. Superficial subcutaneous fat: A - homogeneous, B - a uniform increase in echogenicity, C - 2.4 mm. Muscles: A - homogeneous, B - increased echogenicity, C - 0.5 mm. The degree of vascularization of the papillary dermis is the lack of visualization of the vessels of the papillary dermis.

Conclusion: The ultrasound picture corresponds to atrophic processes and fibrotic changes in the skin, subcutaneous fatty tissue and muscles, a marked decrease in blood supply to the dermis.

Beautician diagnosed with senile skin atrophy. A course of mesotherapy has been prescribed with drugs that improve microcirculation. Consultation of an endocrinologist, gynecologist is recommended.

Example No. 3. Patient B, 45 years old, complained of age spots, the presence of vascular "stars", and deep wrinkles in the frontal and buccal areas. From the anamnesis it was found that the work is associated with prolonged exposure to the sun. When ultrasound performed as described, the following results were obtained.

Revealed:

Epidermis: echostructure (A) - homogeneous, echogenicity (B) - hyperechoic, without hypoechoic layers, thickness (B) - 0.51 mm. Derma: A - homogeneous, B - increased echogenicity in the upper and lower sections, C - 2.1 mm. Superficial subcutaneous fat: A - homogeneous, B - a uniform increase in echogenicity, C - 6.1 mm. Muscles: A - homogeneous, B - increased echogenicity, C - 1.3 mm. The degree of vascularization of the papillary dermis is not a clear visualization of the vessels of the papillary dermis, the alternation of the avascular sections of the papilla of the dermis with the areas where the vessels of the papilla are visualized.

Conclusion: An ultrasound picture corresponds to hypertrophic processes and fibrotic changes in the skin, subcutaneous fatty tissue and muscles, and a decrease in blood supply to the dermis.

The beautician was diagnosed with unspecified skin changes due to chronic exposure to non-ionizing radiation. A course of mesotherapy has been prescribed with drugs that improve microcirculation, microcurrent therapy. Recommended externally means with an SPF factor, cosmecephics, aimed at reducing pigmentation.

Example No. 4. Patient G, 38 years old, complained of the presence of “pores” and black spots in the forehead and cheeks. Ultrasound was performed as described above.

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.5 mm. Derma: A - heterogeneous, B - decreased echogenicity in the upper sections, increased in the lower, B - 2.0 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa, C - 6.0 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 1.2 mm. The degree of vascularization of the papillary dermis - a clear visualized vascular papillary dermis.

Conclusion: in the study, deviations from the norm were not detected.

In the correction of age-related changes at the moment does not need. A beautician established a constitutionally oily skin type, recommendations are given for the care of oily skin.

Example No. 5. Patient D, 25 years old, complained of the presence of “pores” and black spots in the forehead and cheeks, oily sheen. Ultrasound was performed as described above.

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.6 mm. Derma: A - heterogeneous, B - decreased echogenicity in the upper sections, increased in the lower, B - 2.0 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa, C - 6.0 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 1.2 mm. The degree of vascularization of the papillary dermis - a clear visualized vascular papillary dermis.

Conclusion: ultrasound signs of thickening of the epidermis (hyperkeratosis).

Beautician diagnosed with acne, comedonal form. Exfoliants are prescribed, recommendations for oily skin care are given.

A month after treatment, a cosmetologist prescribed ultrasound in dynamics. The normalization of the thickness of the epidermis, which amounted to 0.3 mm, was revealed. Exfoliants are canceled. Cosmeceuticals are recommended for oily skin prone to acne in home care.

Example No. 6. Patient I, 35 years old, complained of horizontal wrinkles in the forehead. On examination, the hyperkinetic type of expression activity, expression wrinkles are noteworthy. Ultrasound was performed as described above.

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.3 mm. Derma: A - heterogeneous, B - decreased echogenicity in the upper sections, increased in the lower, B - 1.5 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa, C - 2.5 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 1.3 mm. The degree of vascularization of the papillary dermis - a clear visualized vascular papillary dermis.

Conclusion: thickening of the facial muscles, thinning of the dermis while maintaining its vascularization.

The cosmetologist was diagnosed with hypertonicity of facial muscles, atrophy of the dermis. A course of microcurrent therapy was prescribed to relieve muscle hypertonicity and improve trophic dermis. After the end of the course of microcurrent therapy, botulinum therapy of facial wrinkles in the forehead is recommended.

Example No. 7. Patient K, 51 years old, complained of changes in the contours of the oval of the face, small wrinkles, and the presence of nasolabial folds. Ultrasound was performed as described above.

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.3 mm. Derma: A - homogeneous, B - increased echogenicity in the upper and lower sections, C - 1.6 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa, C - 2.5 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 0.5 mm. The degree of vascularization of the papillary dermis is not clear visualization of the vessels of the papillary dermis, the alternation of the avascular sections of the papilla of the dermis, with the areas where the vessels of the papilla are visualized.

Conclusion: increased echogenicity of the dermis, against the background of a decrease in its vascularization. Reducing muscle thickness. This ultrasound picture may correspond to atrophic processes in the dermis and muscles.

Beautician diagnosed with senile atrophy. A course of myostimulation, PRP-therapy was prescribed, after which contour plastic surgery of nasolabial folds with fillers based on hyaluronic acid is recommended.

Example No. 8. Patient L, 41 years old, complained of facial swelling, especially in the periorbital zone, which intensified in the morning. Ultrasound was performed as described above.

Epidermis: echostructure (A) - heterogeneous, echogenicity (B) - hyperechoic, with hypoechoic layers, thickness (C) - 0.3 mm. Derma: A - homogeneous, B - increased echogenicity in the upper and lower sections, C - 1.6 mm. Superficial subcutaneous fat: A - heterogeneous, B - fat segments of increased echogenicity, separated by hyperechoic fibrous septa, C - 8.0 mm. Muscles: A - heterogeneous, B - decreased echogenicity, with clear hyperechoic contours; B - 1.2 mm. The degree of vascularization of the papillary dermis is a clear visualization of the vessels of the papillary dermis.

Conclusion: increased echogenicity of subcutaneous fat, against the background of its thickening. The ultrasound picture corresponds to septal panniculitis, edema of subcutaneous fat.

A cosmetologist has prescribed a course of lymphadrening procedures, LPG in the lymphadrening regimen. Endocrinologist consultation recommended.

Claims (1)

A method for determining the state of the structure of the skin and underlying soft tissues of the face when correcting age-related changes, including ultrasound (ultrasound), characterized in that the complex is determined in the vertical position of the 22 MHz sensor according to the mid-pupil line of the echocharacteristic of the epidermis and dermis: echostructure (A), echogenicity ( B), the thickness (C) in the forehead and cheeks, and using the 18 MHz sensor in the same position along the mid-pupil line in the forehead and cheeks, the same echo characteristics of superficial subcutaneous fat, frontal muscle and the muscle that lifts the upper lip, then using a Doppler study (DI) in the same position of the 22 MHz sensor, the papillary dermis (G) is visualized along the mid-pupil line in the forehead and cheeks; and with echoes of the epidermis: A - heterogeneous, B - hyperechoic, with hypoechoic layers, C - 0.3-0.5 mm; dermis: A - heterogeneous, B - decreased echogenicity in the upper sections, increased in the lower, B - 1.6-2.0 mm; superficial subcutaneous fat: A - heterogeneous, B - fat segments of reduced echogenicity, separated by hyperechoic fibrous septa; B - 2.5-6.0 mm; muscles: A - heterogeneous, B - decreased echogenicity with clear hyperechoic contours; B - 0.6-1.2 mm; G - a clear visualization of the vessels of the papillary dermis, reveal the absence of age-related changes in the skin of the face, and if at least one of the values A, B, C, D deviates from these characteristics, their presence is revealed.