Ultherapy vs HIFU: What you need to know about non-surgical skin tightening

Ultherapy vs HIFU: What you need to know about non-surgical skin tightening

written by Dr Bernard Tan, June 2024

In the past, individuals looking to address age-related facial sagging and loose skin would opt for a surgical facelift, usually in their 50s and 60s. A surgical facelift involves the removal of excess loose skin and the remaining skin is pulled back. Although effective, it came with significant surgical risks, downtime and left a long scar on the face. 

Modern patients now seek pre-juvenation, performing regular non-surgical skin tightening in their 30s and 40s to delay the natural ageing process. Instead of a single life-changing procedure, people wanted small and incremental treatments to achieve their goals and delay the natural ageing process.

With advancements in technology, medical aesthetic innovations that could tighten and lift skin without downtime or scars were developed and quickly grew in popularity. Amongst these – Ultherapy and High-Intensity Focused Ultrasound (HIFU) have become the most prevalent for non-surgical skin tightening and face lifting.

In the case of HIFU and Ultherapy, frequently asked questions include: 

• What is the difference between the two treatments? 
• Which is more effective? 
• Which is better for me? 
• Why is the price of Ultherapy higher than HIFU?

In this article, we take a deep dive into both these treatment modalities to provide conclusive answers to the public’s burning questions. By the end of this article, we hope to equip you with relevant information to make the best decision for yourself. 

Content

1. The science of ultrasound energy in aesthetic medicine 
2. What is Ultherapy?
3. What is HIFU?
4. Ultherapy VS HIFU 
5. Conclusion

1. The science of ultrasound energy in aesthetic medicine 

Ultrasound technology has been used in medicine for over 50 years- for diagnosis and treatment. In hospitals, ultrasound technology is commonly used in radiology and obstetrics. In the field of medical aesthetics, ultrasound-based treatments refer to Ultherapy and HIFU; both utilise focused ultrasound energy to address skin laxity, loss of collagen and signs of ageing. 

Ultrasound treatment works by directing focused ultrasound waves bypassing the skin’s surface and penetrating deeper layers. This subsequently stimulates collagen production by heating tissue to 60°C-70°C to create thermal coagulation points (TCPs). Consequently, a controlled wound-healing process is triggered where skin cells known as fibroblasts are stimulated to lay down new collagen in the treated area. 

So, does ultrasound skin tightening really work? Yes. The evidence of Ultherapy’s efficacy is proven by over 50 clinical studies and 90 published papers [1], both independent and industry-supported. HIFU devices have also been proven by  2-3 published papers though mostly industry-supported and are of small-scale studies [2].

2. What is Ultherapy?

Developed and manufactured in the USA, Ultherapy is a US FDA-approved device which utilises micro-focused ultrasound energy waves for skin tightening. Ultherapy is approved by almost all health regulatory agencies worldwide including- US FDA, CE (Europe), and Korean FDA. Ultherapy has US FDA approval for; 

1. Non-surgical skin tightening and facelifting
2. Treatment of submental fat “double chin” 
3. Non-surgical brow lift.

Using the patented DeepSEE® technology, the Ulthera system provides real-time visualization of the skin allowing practitioners to deliver the treatment at the optimal tissue depth and avoid accidental injury to nearby anatomical structures such as nerves, blood vessels or bone.

Ultherapy treatments need to be administered by licensed medical practitioners. In Singapore, Ultherapy devices need to be registered with government regulatory bodies and only registered medical doctors and medical clinics can provide Ultherapy treatments. Postgraduate training is required for doctors to develop their expertise as Ultherapy providers as it requires intricate knowledge and rigorous training to meticulously deliver the treatment for the best results.

Ultherapy can only be administered by registered medical doctors in Singapore. 

3. What is HIFU?

After Ultherapy was developed and launched in 2009, Korean medical device companies quickly reverse-engineered and launched similar products that utilised High-Intensity Focused Ultrasound for non-surgical skin tightening and face lifting. 

One key feature that could not be replicated was Ulthera’s patented DeepSEE system allowing for real-time ultrasound imaging- hence HIFU is a blind treatment– the operator will not know the exact layer of skin the energy is being delivered to. 

The treatment depths are based on anatomical studies, with the provider assuming that the collagen-rich layer known as the SMAS (Superficial Musculo-Aponeurotic System) is at 4.5mm (this is the case in ~70-80% of individuals).  While this assumption generally holds, without real-time imaging capability, there is a potentially higher risk of injury to vital structures such as bones, blood vessels or nerves.

Developed and manufactured in Korea, most HIFU devices have not obtained US FDA approval or European CE Mark and are largely in use in their home market.  Currently, in Singapore, HIFU treatments are not yet regulated and can be performed by doctors or beauticians in a spa. Even in medical clinics, it is not uncommon for HIFU to be delegated to clinic staff to perform. The Ministry of Health Singapore is aware of this and is taking steps to restrict such practices

4. Ultherapy VS HIFU

Apart from the country of origin, regulatory approvals and training level of providers, there are significant differences in the Thermal Coagulation Points (TCPs) created by Ultherapy vs HIFU

Below is a table [3] summarising the  differences between Ultherapy and HIFU

Table 1: Differences between Ultherapy and HIFU (source: Customized Treatment Using Microfocused Ultrasound with Visualization for Optimized Patient Outcomes: A Review of Skin-tightening Energy Technologies and a Pan-Asian Adaptation of the Expert Panel's Gold Standard Consensus)

i) Depth and accuracy

Whilst both treatments deliver focused ultrasound energy into the skin to create thermal coagulation points, recently published studies have shown that Ultherapy delivers energy more accurately and at precise depths than HIFU, where the depth of energy delivery was inconsistent. 

ii) Thermal coagulation point uniformity and spacing 

Apart from delivering energy to the correct depth, the thermal coagulation points (TCPs) created by the treatment should be uniform and evenly spaced. An independent lab study [4] comparing Ultherapy (MFU-V) to 3 leading Korean brands of HIFUs analysed the TCPs created by these devices on tissue-mimicking gel blocks. As shown below, TCPs created by Ultherapy (MFU-V: Microfocused Ultrasound with Visualisation) were consistent in size, depth and spacing. The same could not be said for HIFUs 1,2 and 3. 

The study presented above thus concludes that real‐time visualisation and the capability to detect coupling, features found in devices such as Ultherapy help prevent complications and enhance the safety and effectiveness of energy‐based devices. 

iii) Cost and treatment frequency

5. Conclusion

Ultherapy and HIFU utilise similar technology but with significant differences. To understand more about which treatment is most suitable for you, it is best to consult a doctor with experience in both treatments. At Bay Aesthetics Clinic, Dr Hoe Ying Min and Dr Bernard Tan have both undergone advanced postgraduate training for Ultherapy and have been performing Ultherapy and HIFU treatments for over 5 years with over 1000 successful cases. Bay Aesthetics Clinic is a certified authentic Ultherapy provider that provides treatments to a high standard. 

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Price of Ultherapy at Bay Aesthetics Clinic

First-time clients $1788 nett for Full face Ultherapy (400 lines)

$1800 + GST – Full face 400 lines: suitable for younger patients with early skin laxity

$2800 + GST – Full face 600 lines: for mild-moderate skin laxity

$3200 + GST – Full face and neck 800 lines: for patients with moderate skin laxity of face and neck

References

1. Khan, U. and Khalid, N. (2021) A systematic review of the clinical efficacy of micro-focused ultrasound treatment for skin rejuvenation and tightening, Cureus. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8722640/ (Accessed: 19 June 2024). 
2. Park, H. et al. (2015) High-intensity focused ultrasound for the treatment of  Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas, synapse.koreamed.org. Available at: https://synapse.koreamed.org/articles/1046104 (Accessed: 19 June 2024). 
3. Park JY et al. Customized Treatment Using Microfocused Ultrasound with Visualization for Optimized Patient Outcomes: A Review of Skin-tightening Energy Technologies and a Pan-Asian Adaptation of the Expert Panel's Gold Standard Consensus. J Clin Aesthet Dermatol. 2021 May;14(5):E70-E79. Epub 2021 May 1. 
4. Pavicic, T. et al. (2022) Microfocused ultrasound with visualization: Consensus on safety and review of energy-based devices, Journal of Cosmetic Dermatology. Available at: https://pubmed.ncbi.nlm.nih.gov/34951735/ (Accessed: 19 June 2024). 

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