Ultrasonic diagnosis of skin, facial, neck and hand soft tissue in women of different age: a non-randomised observational cross-sectional study

Background. A dynamic cross-layer visualisation of skin, its vascular structure in various anatomical facets during treatment in different age cohorts holds both scientific and practical value.

Objectives. A semiotic study of skin, facial, neck and hand soft tissues using high-resolution ultrasound in women of different age cohorts.

Methods. A total of 63 women aged between 22 and 59 years were enrolled. The study was designed with two comparison cohorts. The inclusion criteria were: women aged 22-59 years with no evident somatic or acute dermatological pathology not having aesthetic procedures for at least one month prior to the ultrasound examination of skin, facial, neck and hand soft tissues. The cohorts separated by age. Cohort 1 included 32 women aged 22-44 years (young), and cohort 2 — 31 women aged 45-59 years (middle-aged). High-resolution ultrasound (US) was performed in B-mode, colour Doppler and microV imaging.

Results. A maximal dermal thickness was facial middle-third in both cohorts, averaging to 1.87 ± 0.35 mm in the young and 1.57 ± 0.23 — in middle-aged cohort (p <0.0001). A minimal dermal thickness in both cohorts was periorbital (1.16 ± 0.15 mm in the 22-44-year and 0.95 ± 0.12 — in 45-59-year cohort) and in dorsal hand surface (0.89 ± 0.13 and 0.9 ± 0.16 mm, respectively, p <0.0001). The dermal thickness in face and neck diminished with age due to a thinning papillary layer. An adequate dermal vascularisation rate was greater in the young cohort (p = 0.038).

Conclusion. Ultrasound is effective in the diagnosis of skin, facial, neck and hand soft tissues at the planning and further control of safe injection and hardware aesthetic procedures, allowing a real-time thickness assessment of epidermis, dermis and its layers, vessels, subcutaneous fat and mimic muscles in norm and during complications.

1. Бондаренко И.Н. Ультразвуковое исследование высокого разрешения в диагностике отеков после контурной пластики. Кубанский научный медицинский вестник. 2021; 28(1): 32-42. DOI: 10.25207/1608-6228-2021-28-1-32-42

2. Бондаренко И.Н. Ультразвуковое исследование высокого разрешения косметологических нитей после их имплантации в мягкие ткани лица и шеи. Инновационная медицина Кубани. 2021; 1: 28-33. DOI: 10.35401/2500-0268-2021-21-1-28-33

3. Wortsman X. Identification and Complications of Cosmetic Fillers: Sonography First. J. Ultrasound Med. 2015; 34(7): 1163-1172. DOI: 10.7863/ul-tra.34.7.1163

4. Wortsman X. Sonography of Dermatologic Emergencies. J. Ultrasound Med. 2017; 36(9): 1905-1914. DOI: 10.1002/jum.14211

5. Schelke L.W., Decates T.S., Velthuis P.J. Ultrasound to improve the safety of hyaluronic acid filler treatments. J. Cosmet. Dermatol. 2018; 17(6): 1019-1024. DOI: 10.1111/jocd.12726

6. Иконникова Е.В., Круглова Л.С., Зубарев А.В., Поткин С.Б., Гаранкин Н.А. Применение ультразвука для дифференциальной диагностики осложнений после контурной инъекционной пластики: клинический случай. Пластическая хирургия и эстетическая медицина. 2019; 3: 70-74. DOI: 10.17116/plast.hirurgia201903170

7. Mlosek R.K., Malinowska S. Ultrasound image of the skin, apparatus and imaging basics. J. Ultrason. 2013; 13(53): 212-221. DOI: 10.15557/JoU.2013.0021

8. Wortsman X., Alfageme F., Roustan G., Arias-San-tiago S., Martorell A., Catalano O., di Santolo M. S., Zarchi K., Bouer M., Gonzalez C., Bard R., Mandava A.. Guidelines for performing dermatologic ultrasound examinations by the DERMUS Group. J. Ultrasound. Med. 2016; 35(3): 577-580. DOI: 10.7863/ultra.15.06046

9. Омурзакова А.Т., Изранов В.А. Ультразвуковые особенности строения кожи лица. Ультразвуко -вая диагностика. Лучевая диагностика и терапия. 2020; 1S: 208-229. DOI: 10.22328/2079-5343-2020-11-1S-208-229

10. Barcaui Ede O., Carvalho A.C., Pioeiro-Maceira J., Barcaui C.B., Moraes H. Study of the skin anatomy with high-frequency (22 MHz) ultrasonography and histological correlation. Radiol. Bras. 2015; 48(5): 324-329. DOI: 10.1590/0100-3984.2014.0028

11. Карымов О.Н., Калашникова С.А., Соловьева И.О., Полякова Л.В. Гистотопографические особенности строения кожи лица. Журнал анатомии и гистопатологии. 2017; 6(1): 29-32. DOI: 10.18499/2225-7357-2017-6-1-29-32

12. Tanghetti E.A. The histology of skin treated with a picosecond alexandrite laser and a fractional lens array. Lasers Surg. Med. 2016; 48(7): 646-652. DOI: 10.1002/lsm.22540

13. Mogilnaya G.M., Fomicheva E.V., Blatt J.E. Morpho-gistoschemical characteristic of the implant from polylactic acid. Kuban Scientific Medical Bulletin. 2018; 25(6): 114-118 (In Russ., English abstract). DOI: 10.25207/1608-6228-2018-25-6-114-118

14. Mogilnaya G.M., Fomicheva E.V., Blatt Yu.E. Status epidermis in introduktion of the drug “radiesse” and “luminaire”. Kuban Scientific Medical Bulletin. 2015; 4: 93-96 (In Russ., English abstract). DOI: 10.25207/1608-6228-2015-4-93-96

15. Agabalyan N.A., Su S., Sinha S., Gabriel V. Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness. Burns. 2017; 43(3): 531-538. DOI: 10.1016/j.burns.2016.09.008

16. Alfageme Roldan F. Ultrasound skin imaging. Ac-tas Dermosifiliogr. 2014; 105(10): 891-899 (English, Spanish). DOI: 10.1016/j.ad.2013.11.015

17. Ambroziak M., Noszczyk B., Pietruski P, Guz W., Pa-luch L. Elastography reference values of facial skin elasticity. Postepy Dermatol. Alergol. 2019; 36(5): 626-634. DOI: 10.5114/ada.2018.77502

18. Ambroziak M., Pietruski P, Noszczyk B., Paluch L. Ultrasonographic elastography in the evaluation of normal and pathological skin — a review. Postepy Dermatol. Alergol. 2019; 36(6): 667-672. DOI: 10.5114/ada.2018.77069

19. Paluch L., Pietruski P, Noszczyk B., Kwiek B., Ambroziak M. Intra-rater reproducibility of shear wave elastography in the evaluation of facial skin. Postepy Dermatol. Alergol. 2020; 37(3): 371-376. DOI: 10.5114/ada.2018.81144

20. Paluch L., Ambroziak M., Pietruski P, Noszczyk B. Shear Wave Elastography in the Evaluation of Facial Skin Stiffness After Focused Ultrasound Treatment. Dermatol. Surg. 2019; 45(12): 1620-1626. DOI: 10.1097/DSS. 000000000000188121. Malherbe K. Traction apophysitis of the knee: A case report. Radiol. Case Rep. 2018; 14(1): 18-21. DOI: 10.1016/j.radcr.2018.09.012

21. Sobolewski P, Maslinska M., Zakrzewski J., Paluch L., Szymanska E., Walecka I. Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis. Rheumatol. Int. 2020; 40(5): 737745. DOI: 10.1007/s00296-020-04539-y

22. Chen K.H., Tam K.W., Chen I.F., Huang S.K., Tz-eng PC., Wang H.J., Chen C.C. A systematic review of comparative studies of CO2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles). J. Cosmet. Laser Ther. 2017; 19(4): 199-204. DOI: 10.1080/14764172.2017.1288261

23. Graber E.M., Tanzi E.L., Alster T.S. Side effects and complications of fractional laser photothermolysis: experience with 961 treatments. Dermatol. Surg. 2008; 34(3): 301-305; discussion 305-307. DOI: 10.1111/j.1524-4725.2007.34062.x

24. Privalova E.G. High-resolution ultrasonography in differential diagnosis of complications after face contouring. Imaging in dentistry, otolaryngology and ophthalmology. Diagnostic radiology and radiotherapy. 2020; 1S: 43-55 (In Russ., English abstract). DOI: 10.22328/2079-5343-2020-11-1S-43-55