HIFU (High-Intensity Focused Ultrasound): How Effective Is Non-Surgical Tightening?

What is HIFU and how does it work?

HIFU is an abbreviation of «high-intensity focused ultrasound». The type used in aesthetic treatments is also called «microfocused ultrasound». Without breaking the skin surface, the device concentrates ultrasound waves onto very small points at a set depth.

At these points the focused energy briefly heats the tissue and creates small areas of heat injury. As the body repairs these areas, it produces new collagen (the supporting protein that gives skin its firmness), and over time the tissue may tighten somewhat. Because this repair process is slow, the result is seen not immediately but over months.

Different transducers deliver energy to different depths. The layers targeted on the face include the lower part of the skin and the connective tissue layer beneath the skin. Which depth and how much energy are used is decided according to the structure of the area and the individual's characteristics.

There are many HIFU devices on the market with different technical specifications. Most studies were carried out with specific devices; results obtained with one device may not apply to every device.

What is it used for?

• Mild sagging of the lower face and jawline
• Mild laxity under the chin and on the neck
• Mild drooping around the eyebrows
• Fine wrinkles and laxity of the chest (décolletage) area (with some devices)

Some HIFU systems are also promoted for reducing localised body fat or tightening body skin. The evidence for these uses is more limited than for face and neck treatments.

Who is it suitable for?

Those who usually benefit most from HIFU are people with mild or moderate laxity whose skin still has a certain degree of elasticity. It may be an option for people who do not want surgery or are not suitable for surgery and who can accept a moderate change.

Who is it not suitable for, and what should you watch out for?

• There are not enough data on its safety during pregnancy and breastfeeding; postponing it is generally recommended.
• Active infection, an open wound, active acne or a cold sore in the treatment area
• If you have a metal implant, a pacemaker or another electronic device in the area, be sure to say so beforehand.
• If you have recently had filler, threads or another procedure in the area, tell your physician; the timing of the treatment can be planned accordingly.
• If you take blood-thinning medication, the risk of bruising may increase; do not stop your medication on your own, ask your physician.
• Conditions that impair wound healing or treatments that suppress the immune system
• Marked sagging and excess skin: in this case, the result expected from HIFU is often not achieved.

During the consultation, clearly mention all the medicines you take, any aesthetic procedures you have had before and your health problems. Suitability can only be decided after a physician's assessment.

Who should perform it, and where?

HIFU is a medical procedure that delivers energy beneath the skin and can cause nerve and tissue damage if applied at the wrong depth or in the wrong area. It is recommended that it be carried out under the assessment and responsibility of a physician who knows facial anatomy, especially the areas where nerves run.

The device's origin and maintenance also matter. With devices whose technical specifications are unclear, that have not been calibrated or that are sold for home use, the risk of burns and nerve damage may increase; reliable data on the effectiveness of these devices are also limited. Make sure there is a physician you can reach if a problem arises.

Preparing for the procedure

• Discuss your expectations openly; if possible, show your physician in front of a mirror what kind of change you hope for in which area.
• If your physician wishes, photos are taken before the procedure; this is useful for comparing the result months later.
• If you have a history of cold sores and the area around the lips will be treated, tell your physician.
• Do not apply make-up or cream to your face on the day of the procedure; the area should be clean.
• Ask in advance whether a painkiller or numbing cream is needed; do not take medicines on your own.

The day of the procedure, step by step

1. Your medical history and expectations are discussed; the structure of the area and the degree of laxity are assessed.
2. The informed consent form is read; risks and realistic results are discussed, your questions are answered and the form is signed.
3. The area is cleaned; if needed, the treatment zones and areas to avoid are marked on the skin.
4. Ultrasound gel is applied to the skin and the device's transducer is placed on the skin.
5. The pulses are delivered in sequence. With each pulse you may feel brief heat, a prickling or a deep aching sensation; this may be more pronounced in areas close to bone.
6. If the discomfort is too much, tell the practitioner; the energy level or treatment speed can be adjusted.
7. At the end of the procedure the gel is cleaned off, the area is checked and aftercare advice is given.

After the procedure: the first 24 hours and the first week

Mild redness and swelling are common immediately after the procedure and mostly settle within a few hours to a few days. Tenderness in the area that increases with touch, or a mild ache when chewing, may last a few days and sometimes a few weeks.

• Most people return to daily life the same day.
• On the first day, do not massage the area firmly or rub it.
• Do not use painkillers or medicines that your physician has not recommended.
• Continue with sun protection and regular skin care.
• If you notice numbness, marked bruising or a change in your facial movements, tell your physician.

Expected side effects

• Pain or discomfort during the procedure: varies by person, area and energy level.
• Redness and mild swelling: usually settle quickly.
• Tenderness to touch or aching: may last from a few days to a few weeks.
• Bruising: may occur especially in thin-skinned areas and in people taking blood thinners.
• Temporary raised lines or marks on the skin: mostly fade on their own.

Less common but important risks have also been reported: burns and blistering of the skin, temporary numbness in the area, and asymmetry in smiling or lip movements due to temporary involvement of the facial nerves. These usually improve within weeks or months, but they need follow-up.

Rarely, loss of volume or hollowing in some areas of the face has been reported after the procedure. Information on how often this risk occurs and in whom it is more likely is limited.

When is the result seen, and how long does it last?

Because collagen production is a slow process, the change usually appears over months; in many people the result can be assessed more clearly two to six months after the procedure. The fullness seen immediately after the procedure is often due to temporary swelling.

How long the result lasts varies from person to person. Because the ageing process continues, the effect decreases over time; in some people it may be noticeable for a year or longer. If your physician considers it necessary, they may suggest an additional session.

Although studies show that HIFU can produce a measurable improvement on the face and neck, the size of the change is usually moderate, and in some people no noticeable result may be achieved.

Realistic expectations: what can HIFU not do?

• It is no substitute for a surgical facelift; it does not remove excess skin.
• With marked sagging, the result is often insufficient.
• The result appears not immediately but slowly, over months.
• Not everyone responds in the same way; in some people the change may be very small.
• It does not stop ageing; the effect decreases over time.
• On its own, it is not a suitable method for deep wrinkles, pigmentation or volume loss.

Alternatives