HIRONC

▶Introduction and Characteristics of the Device

The Doublo, launched in 2011, is the first HIFU lifting device produced in Korea. The quality and effectiveness of the device became recognized so quickly that it soon became Korea’s leading lifting device and it has even been selected as a “Global Leading Product.” Already there are more than 500,000 successful clinical cases involving the Doublo, so it can be said that the stability and clinical effects have been proved. The principle of Doublo is that high intensity ultrasonic waves are targeted at the SMAS layer of the skin that lies about 3mm−4.5mm beneath the surface creating thermocoagulations smaller than 1mm in size. In such thermocoagulations, thermal reactions occur when the heat exceeds 60℃ causing the skin tissues to contract and lift, recovering elasticity. As a result an intense regenerative reaction occurs causing the skin to naturally lift itself over a 2−4 week period, and collagen and elastin is consistently produced.

▶Advanced Cost-Effectiveness

Hironic has recently launched the Doublo Gold, the third-generation of the highly successful Doublo model. The main feature of this model is that treatment time has been cut in half from about 17 minutes to 8 for a 300-shot treatment. This makes it possible to treat more than twice as many patients. In addition, the Gold model comes equipped with Auto-Shot, a feature that has been added for faster and easier treatment. With Auto-Shot the shot interval can be adjusted (0.5−2.5sec) according to the clinician’s level, thus enhancing convenience and safety. What is more, the quality of the energy that is administered is maintained despite the speed being increased, and there are close to zero side effects.

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 Director Park Jae-woo (Dr. Park Plastic Surgery)

1) Increased Efficiency through Higher Speed 

There is a feature of Doublo Gold’s faster speed that is worth noting. In existing HIFU lifting devices the administration of ultrasonic waves is done in a one-way scan where the transducer injects one line then returns to its original position before administering the next line. The Doublo Gold, however, has a round-way scan mode that reduces the time for the transducer to return to the original position thus minimizing the movement of the transducer to enhance the device’s safety. From the doctor’s perspective, it is beneficial as the patient’s treatment can be completed in a shorter timeframe, increasing time efficiency. From the patient’s perspective, the shorter time for treatment makes it more accessible, and the effects can be seen visually right after the treatment, which will make this treatment more popular.

2) Maintains Stable Dot Quality Despite Increased Speed

Focused ultrasound energy is applied to the dermal and facial layers in HIFU lifting to induce lifting, collagen generation, elasticity, wrinkle reduction, and many other benefits. For maximum effect, energy has to be focused precisely on the target, and a large amount of thermal energy needs be delivered quickly. Doublo Gold produces coagulations of regular size despite its quicker speed, and enables more accurate targeting. Thus, repetitive thermal effects are feasible that are also well-received by the patients.

▶Warnings for Treatment

Basically, Doublo Gold has three cartridges; D4 (4MHz, 4.5mm), M7 (7MHz, 3.0mm), S7 (7MHz, 1.5mm). They are used in the appropriate ratio according to the treatment area.

1) Lower Face: This area is the most important for lifting. Here the SMAS is targeted later, so D4 is used as the main cartridge, using the ratio of D4:M7 as 6:4 or 7:3. Special attention is needed to lower the energy in the submental area, as it is an area that can be sharply painful.

2) Mid Face: The reason that nasolabial folds appear is because of the laxity that forms among the mid face constituents that causes the skin to sag. The main objective for this area is to tighten the deep dermis, so the D4 and M7 cartridges are used in a 5:5 ratio. Special attention is needed as a bruise may form around the eyes. M7 is recommended for the forehead and around the eyes instead of D4. Be careful to avoid direct treatment on Indian wrinkles.

3) Upper Face: Doublo has been approved for eyebrow lifting, however this area requires special care during treatment as there is a risk of side effects, so the M7 is recommended with the D4 at a ratio of 7:3. There is hardly any subcutaneous fat on the forehead, so use of the D4 cartridge may apply energy on the muscles or periosteum instead of the fascial layer causing a headache.

▶Programs to Maximize Effectiveness

Ever since the launching of Doublo in 2011, various programs have been combined at clinics to improve its effectiveness. Typical programs are as follows:

1) Natural Volume-up and Face Lifting

1 bottle of Scultura + 450 shots of Doublo + 1 Face contour treatment

2) Premium V-Line Lifting

450 shots of Doublo + Jawline Botox + V-Line Dermotoxin + Face contour treatment + Jaw filler

3) Face and Neck Lifting Program

700 shots of Doublo + Dermotoxin

Doublo is frequently used in combination with hospital programs that include face contour treatments, botox, dermotoxin, fillers, etc., and currently a variety of other combination programs are also being developed.

Doublo is effective by itself, but the effects can be maximized when it is combined with other programs. It is the most fundamental device for skin lifting.​

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 ​​▶ SCI Thesis

 Clinical Effectiveness of High-Intensity Focused Ultrasound for Skin Lifting

 Medical Laser 2014, Kim Jie-Hoon, So Byoung-Joon, Ryu Haw-Jung

The Doublo was highly effective on the eye area of a male patient of age 60 as can be seen comparing the before (A) and after (B) treatment photos.

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​Results
Follow-up, 3 months after treatment

3 out of 20 patients could not complete the F/up.

No. of Patients

Results

2 Considerable improvement

3 Moderate improvement

7 Good improvement

4 Outstanding improvement

1 No improvement​

HIFU is an excellent skin lifting treatment for the eye area of Asian patients. Although it was known that HIFU was potentially dangerous for the eye area, this study has proved that treatment was effective without any side effects. Lastly, in this study, 94% of the patients responded that the treatment was effective at lifting.

Intense Focused Ultrasound for Facial Tightening: Histologic Changes in 11 Patients

Journal of Cosmetic and Laser Therapy, 2015

Suh Dong-Hye, So Byoung-Joon, Lee Sang-Jun, Song Key-Yong & Ryu Hwa-Jung 

(A) Skin elasticity of a female patient, age 64; (B) Two months after treatment, reduction of fine wrinkles and improvement of elasticity

Follow-up, 8 weeks after treatment, 11 patients, average age 46