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HIFU Review (2022)

Let’s review HIFU treatments for face anti-aging and skin tightening.

HIFU facelift treatments are one of the foundational treatments in anti-aging as it helps to stimulate collagen production in the deeper layers of your skin. This slows down the aging process.

Being a “once a year” treatment, you will need to repeat these treatments consistently for “age maintenance”.

Hence, you need to know the differences between various brands of HIFU machines used by different doctors and clinics.

What is HIFU?

Relaxed young female client getting treatment

HIFU or High-Intensity Focused Ultrasound. It is a non-invasive, anti-aging aesthetic treatment that uses ultrasound energy to heat and destroys deep tissue below the skin surface without harming the skin itself.

HIFU has been used in medical treatments since the 1950s, but it was not until 2009 that the FDA cleared HIFU for use in aesthetic treatments.

Since then, HIFU treatment has become popular for wrinkle reduction, improving sagging skin, and even reducing facial fats (double chin).

Review of HIFU

Since ultrasound technology evolved in 2009, Ultherapy has set the bar for non-surgical skin lifting. There is no lack of studies to prove its efficacy in treating saggy skin on the face, chin, neck and decolletage and having a lifting effect on the brows.

Woman has Beautiful smooth skin

I have to say that Ulthera has produced reliable results with high patient satisfaction. The ability to visualise the treatment area claims to improve the procedure’s safety. The unique feature of real-time visualisation of the treatment site is also not seen in other HIFU systems, differentiating from Ulthera as a premium device. 

From the perspective of a frequent user of both Ulthera and Ultraformer III, I feel that complication rates are comparable, and they are both rather negligible. Besides, the visualisation function does not impact the energy delivery, so the results are not necessarily better because we can see the treatment area. That may be why subsequent HIFU systems were produced without this function.

Ultraformer lifting.

Ultraformer came soon after Ulthera. Adapting and continually improving on its technology, today, Ultraformer III, in its third generation, has emerged to be one of the most popular HIFU systems in the world. Although it is not FDA approved, its safety and efficacy are not lacking in international recognition from the Korean FDA, TGA (Australia), CE (Europe), etc.

Ultraformer has research not only for the treatment of skin tightening of the face, but it has also developed more versatile use in tightening and contouring the body with the use of different cartridges that can target deeper into the subcutaneous fat layers to induce the disposal of stubborn fat cells from the body. 

Compared to other HIFU systems, Ultraformer III relies on MMFU-powered cartridges that aim to deliver energy reliably and effectively, minimising pain and side effects.


Before the facelift procedure, the doctor will cleanse your face and apply a layer of numbing cream. The gel helps the transducer move smoothly over your skin and protects your skin from the ultrasonic waves.

The doctor will then use the transducer to target specific areas of your face or body. You may feel slight discomfort as the energy is delivered to your skin.

After the non-invasive procedure, patients can return to their normal activities immediately. There may be some redness and swelling, which is normal and should resolve within a few hours. You may also notice some skin or facial tightening immediately after the non-invasive procedure. However, results are typically seen after 2-3 months as new collagen is produced.

HIFU Treatment Results

Clinical studies have also measured objective markers using a cutometer, the number of brow lifts, and patient satisfaction. The results are followed up for 90 days, where we expect that the most collagen will be laid down following the HIFU treatment

Cutometer, measuring skin laxity, showed continual and significant improvement over 90 days for all the treated areas, including the cheeks, abdomen and thighs. There is also an average lift of 1.56mm brow over the 90 days. Ninety days of follow up have allowed us to see the gradual improvements from collagen stimulation.

While some HIFU facelift treatments can produce very good immediate effects after the procedure, this could be a consequence of immediate swelling. This is not what ultrasound skin tightening intends to achieve, as they are not sustained changes. We need actual clinical studies to accurately determine if the HIFU treatment in question has comparable results.

Now we know that Ultraformer III has good studies to prove its efficacy and safety for all skin types; how does it compare to the other HIFU systems in terms of pain, treatment regime, side effects, downtime and cost?

Treatment time

Compared to Ultherapy and other traditional facelifts, Ultraformer III has effectively reduced the treatment time by more than 50% by improving the rate of energy delivery. It takes only about 20 minutes to treat the face. This effectively reduces the ‘pain duration’. This discomfort experienced compared to other HIFU machines can be a little bit more intense as the energy delivered is, after all, higher. 

If you have very low pain tolerance, it would be best to consult first with a specialist before taking the treatment.

Downtime and Risks

The downtime or recovery time for Ultherapy, Ultraformer III and other HIFU systems is minimal. Immediately after the procedure, there may be mild swelling and temporary redness, which resolves spontaneously over the next hour or so.

The side effects of all HIFU systems are similar as the mode of energy delivery is the same. This may include bruising, nerve injury, and unintended fat atrophy. However, in a system that is well studied with strict and clear treatment protocols, like Ultherapy and Ultraformer III, the risk and side effects are proven minimal.

However, HIFU systems that have NO clinical studies or are developed by less established manufacturers are less reliable, and these systems cannot predict the results, downtime and side effects.

Treatment Protocols

The treatment regime for a high energy device like Ultherapy and Ultraformer III would only require treatment every once to twice a year for skin or facial rejuvenation. Only approved doctors in Singapore perform these treatments. Other HIFU treatments commonly deliver less energy and require more frequent treatments. Some HIFU systems may even require a weekly treatment, and each treatment can take up to an hour! Therapists commonly perform these.


The total cost to achieve the same results (if attainable) probably works out to be just the same, about $2000 – $3000 for the face. However, imagine having to frequent the clinic or salon every week consecutively for six weeks when it could be done in 20 minutes, just once!

What are the common brands of HIFU?

Common brands of medical devices that use HIFU technology are Ultherapy and Ultraformer. There are other brands like Ultraskin and Ultracel. Here at Sozo Aesthetic Clinic, we offer both Ultherapy (Ulthera) and Ultraformer III HIFU treatments. Below is a comparison table of the four mentioned HIFU technologies:

Ultraformer III
US FDA, and Europe CE approved non-invasive skin tightening and skin-lifting device
Korea FDA, Europe CE and HSA Singapore approved non-invasive skin tightening and skin-lifting device
Korea FDA, Europe CE and HSA Singapore approved non-invasive skin tightening and skin-lifting device
Not yet FDA-approved in the U.S., but is considered safe by many providers in the U.K.
Uses micro-focused ultrasound energy waves
Uses micro and macro-focused ultrasound energy waves
Uses micro-focused ultrasound energy waves
Uses HIFU and radiofrequency microneedling.
Results start to appear in 2-3 months and then continue to improve and last up to 6-18 months.
Results start to appear in 2-3 months and then continue to improve and last up to 6-18 months.
Results start to appear in 4-6 weeks and then continue to improve up to 9-12 months.
Results start to appear after 3 months and then continue to improve up to 6 months.
Minimal discomfort
Minimal discomfort
Minimal discomfort
Minimal discomfort
Can target the three usual depths (1.5mm, 3.0mm and 4.5mm)
Can target the three usual depths (1.5mm, 3.0mm and 4.5mm)
Can target the three usual depths (1.5mm, 3.0mm and 4.5mm)
Can target depth of 3mm
Little to no downtime
Little to no downtime
Little to no downtime
Uses needles. Longer recovery time
Treatment of full face and neck
Treatment of full face and neck with an additional 2.0mm handpiece that allows for treatment of the peri-orbital (eye region)
Treatment of full face and neck
Treatment of full face, jowl, eyebrow area, and neck

I hope to share my experience as a doctor who has performed multiple HIFU treatments and personally undergone these treatments. I have also personally tried both Ultherapy and Ultraformer 3.

Ultrasound is long used for medical imaging. Many people did not realise that the commonly mentioned HIFU for skin tightening actually stands for High Intensity Focused Ultrasound.

Focused ultrasound energy is aimed at different depths of the skin, stimulating collagen and elastic tissue for a more lifted, youthful appearance.

Ultherapy is the first HIFU system that evolved as the first FDA-approved non-invasive skin-lifting device. With the ability to target the SMAS layer with Ultrasound energy, HIFU is able to stimulate collagen in the deeper layers of the skin without the use of any needles or surgery like never before.

Since then, many HIFU systems have been developed using the same technology. In this review, we will discuss the differences between some of the popular HIFU systems used in Singapore.

It is also worth reviewing HIFU versus Thermage and Threadlifts to have more comprehensive understanding of your non-surgical face lift treatment options.

HIFU Machine specifications

Special features of High-Intensity Focused Ultrasound (HIFU) using Ultraformer III include

  • Microfocused and macrofocused ultrasound cartridges to adjust the different needs for different purposes. In microfocused cartridges, ultrasound beams are delivered accurately and precisely to specific focal regions, as used for cartridges used to target the SMAS layer of the skin for a lifting effect. Macrofocused ultrasound allows deeper penetration with larger energy density for the effect of targeting the adipose tissue. The use of macrofocused ultrasound technology, in my opinion, has led to better results for sculpting and contouring, especially in the double chin and chubby faces.
  • Ultraformer III with Dual Engine High Peak Power allows uniform ultrasound energy to be directed into target layers of the skin without heat diffusion to the surrounding tissue. This minimises pain and side effects. High-Intensity Focused Ultrasound (HIFU) devices with lower peak power have less precision and result in more surrounding tissue damage.
  • Being able to generate thermal energy of 65.4°C into the target layers, MMFU in Ultraformer III can effectively induce coagulation and trigger the wound-healing process to enhance collagen production and renewal underneath the epidermis.

HIFU treatment devices of lower energy that cannot achieve the therapeutic coagulation temperature between 60 to 70°C will not be able to induce new collagen growth to the same extent. And ‘high-energy’ HIFU treatment devices without safety mechanisms and a lack of clinical studies can be dangerous when the temperature is sufficient to vaporise and ablate the tissue, where the unintended damage is unrepairable.

This can result in subsequent burns, scarring, necrosis of skin tissue, infection and blindness. 


HIFU and all of its subcategories are considered safe and effective for skin tightening with little to no downtime. HIFU treatment is a popular choice for those looking for a non-invasive, non-surgical facelift alternative.

Side effects are rare but can include slight redness, swelling, bruising, and pain. These side effects are generally mild and temporary.

Risks associated with High-Intensity Focused Ultrasound (HIFU) are low, but there is always a potential for risks and complications, as with any treatment. My take is always to believe in the evidence. Before you invest in any treatment:

  1. Do your ‘homework’.
  2. Go for machines that are tirelessly tested.
  3. Go for brands that are of international standards.
  4. Go to a trusted clinic or salon that will use genuine machines.

Newer technology and machines do not necessarily guarantee better results and safety. Do your research first if you have never heard of this so-called new non-surgical face lift called HIFU facelift treatment! The worst that can happen may not be just disappointment and a waste of time and money. These are, after all, energy devices, and you could end up with complications that you are least expecting. 

If you want to know more about Ultraformer III HIFU treatment that we at Sozo Aesthetic Clinic offer, feel free to give us a call or click here to read more about the treatment.


Medical Director

After graduating from the National University of Singapore, Dr Boey’s journey in aesthetics brought him to esteemed institutions such as Harvard Medical School, American Academy of Aesthetic Medicine and Queen Mary University of London in diverse cities like Seoul, London, Boston and New York.