HIFU: the ultrasound therapy that's raising eyebrows

Dr Zara Kassam, PhD

There’s a new treatment on the block for lifting and tightening sagging jawlines and drooping brows – it’s called HIFU. Dr Zara Kassam, PhD, looks at how it works and what it does.

You’d be forgiven for being confused when it comes to choosing a facial rejuvenating treatment these days because there are so many different machines on the market that all claim to do similar things. One of the newer ones in the skin tightening and lifting arena is HIFU – High Intensity Focused Ultrasound, and it’s attracting a lot of attention.

So what is this new treatment? HIFU is a non-surgical, non-invasive facelift. It’s backers say HIFU is a revolutionary alternative to going under the knife.  It can lift and tone the face, neck and area around the eyes resulting in a natural uplift which they claims can take years off your face. And its a treatment that they say keeps on giving: the initial gain may be small but over time the skin continues to tighten and improves in texture as it promotes collagen production.

How does it work?

HIFU works by targeting deep down in the dermis layer of your skin, the same layer addressed in cosmetic surgery. Unlike lasers, which penetrate the skin from the outside in, the HIFU procedure by-passes the surface of the skin, and delivers targeted energy specifically into the deep, structural tissues where the collagen is produced. Its penetrating ultra-sound energy stimulates collagen production in both the deep dermal and sub dermal levels of the skin. It does this by delivering heat of up to 60 degree Celsius to those deep layers, which in turn creates a ‘micro injury’ to the tissue that triggers a healing response.

As the tissue begins to repair itself, it increases collagen production and as the collagen fibres organise and contract, a tightening effect is seen on the skin.

Overall, studies show it can be quite effective in lifting, tightening and rejuvenating the skin with results improving over 90-180 days and lasting up to a year. HIFU is the only FDA approved non-surgical facelift treatment available.


illustration of double chin, not indicative or results

How many treatments will I need?

How many treatments you require will depend on your skin. In some cases only one treatment is required. In some cases however 2 or 3 subsequent treatments may be recommended every three months and one once a year. There should be a small instant result but the improvements will continue over time as the collagen production increases and the skin continues to tighten up.

The results should last about a year and touch up or maintenance treatments can then be done as required. How often you need those will depend on the individual’s rate of aging.


Does it hurt?

As with most facial treatments slight redness may occur; a small percentage of users of HIFU may have slight inflammation, numbness or sensitivity, but these are mild and temporary effects with no major discomfort for prolonged periods of time.

However during the treatment you may feel some pain, warmth or heat sensation that lasts less than a few seconds and only during the pulsation cycle when ultrasound energy is being applied. The discomfort is very brief and a good sign that the collagen building process has been stimulated.


Before HIFU

Is it safe?

Yes. So far clinical trials have also indicated no serious adverse events, and they’ve been on the look out for quite a few ranging from neuralgia (pain due to irritated nerves), nerve palsy (numbing or paralysis), severe oedema (swelling) and blistering, to fat atrophy 6 months after treatment – but so far there have been no adverse reports.

After the treatment it is, however, essential to look after your skin. A good sun block is advised. If you are very red you may need to use a mild anti-inflammatory cream.



3 days after HIFU. Mild improvements around jaw, eyes and nasolabial area.

What results can I expect?

This ultrasound treatment can individually target the brow, chin and the neck, as well as offer overall skin tightening and rejuvenation and as such has received fitting attention from the scientific community as a non-surgical way to improve wrinkles and skin laxity.

Just a single session of HIFU can deliver visible effects – although it probably wont be dramatic – in lifting and tightening the facial skin. And over time the results should continue to improve. Some studies showed up to 2mm in brow lifting and biopsy results have shown an improvement skin density due to the increased collagen production, which helps the skin maintain its smoother, youthful glow.

HIFU is just one many for many treatments in this skin tightening, non-surgical facelift market – Ultherapy is another, and they works in a similar manner although the machines used by practitioners may differ.

If you choose to have this procedure , make sure your practitioner is well trained, has a medical background and has attended an accredited training program.

*(Editors note: I have had the treatment. There was no swelling and only very mild redness – and I go red easily – which subsided within an hour. The vast majority of it was painless but there was a little bit of pain around the bone on the jawline, probably more to do with the pressure applied than the ultrasound itself. It didn’t feel hot. Please take a look at the video below so you can see what it was like. The procedure was performed at Artum Medi Spa in Kensington, London.)

Lee YB, Eun YS, Lee JH, Cheon MS, Cho BK, Park HJ. Effects of multi-polar radiofrequency and pulsed electromagnetic field treatment in Koreans: case series and survey study. J Dermatolog Treat 2014;25:310-313

Brobst RW, Ferguson M, Perkins SW. Ulthera: initial and six month results. Facial Plast Surg Clin North Am 2012;20: 163-176

Microfocused Ultrasound for Skin Tightening. https://www.ncbi.nlm.nih.gov/pubmed/27363772

Alam M, White LE, Martin N, Witherspoon J, Yoo S, West Ultrasound tightening of facial and neck skin: a rater- blinded prospective cohort study. J Am Acad Dermatol 2010;62:262-269.


Suh DH, Shin MK, Lee SJ, Rho JH, Lee MH, Kim NI, et al. Intense focused ultrasound tightening in Asian skin: clinical and pathologic results. Dermatol Surg 2011;37:1595-1602.

Chan NP, Shek SY, Yu CS, Ho SG, Yeung CK, Chan HH. Safety study of transcutaneous focused ultrasound for non- invasive skin tightening in Asians. Lasers Surg Med 2011; 43:366-375.


Chan NP, Shek SY, Yu CS, Ho SG, Yeung CK, Chan HH. Safety study of transcutaneous focused ultrasound for non- invasive skin tightening in Asians. Lasers Surg Med 2011; 43:366-375.

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