Ultrasound/HIFU

What are the different types of ultrasound treatment?

As with most tweakment categories, there are different brands offering ultrasound treatments. When discussing ultrasound treatments, you may have heard them referred to as HIFU, Ultherapy and/or Sofwave. All these names refer to non-invasive collagen-stimulating ultrasound treatments used for skin tightening. But, the technologies do have some key differences, including how and where they are used.

Sofwave

Sofwave is a type of ultrasound technology that works by non-invasively targeting the mid-dermal layer of the skin. There it stimulates collagen production, resulting in a skin tightening and lifting effect. It can help improve some of the most common concerns associated with ageing, including skin laxity, wrinkles and overall tone and texture. It can also be used to lift the eyebrows non-surgically and tackle sagging skin under the chin and on the neck (using a specific neck treatment protocol).

Targets: Targets the mid-dermis with parallel beams, so the ultrasound energy is aimed solely at the collagen within the skin. It offers a comfortable experience and quick results.

Mechanism: Sofwave works on a more superficial level within the skin itself. It is the only ultrasound device to use Synchronous Ultrasound Parallel Beam technology, which creates – with each ‘shot’ of energy – seven cylinders which go straight down, parallel to the surface of the skin, and which link up 1.5mm beneath the skin, to create a line of collagen-remodelling heat. This means that each shot treats an area of tissue far greater in size and the energy delivered is up to around six times higher than with other ultrasound devices. The device also has an integrated cooling mechanism to protect the skin’s surface.

Depth: Targets the mid-dermis (1.5 mm depth), focusing on collagen production within this specific layer for skin rejuvenation. Due to its more superficial nature, it is safe to use from the top of the forehead down to the bottom of the neck without any risk of nerve injury or fat loss.

Pain threshold: Generally associated with minimal discomfort and downtime, so suitable for patients seeking milder, quicker treatments. Patients usually report a mild warmth or tingling sensation during the procedure. Topical anaesthetic can be used and you can also ask your practitioner for oral painkillers if you know you’ve got a low pain threshold.

Duration: Typically short sessions, lasting around 30 to 60 minutes

Results: Sofwave often delivers results in just one or two treatments. A small initial lift can be seen from the immediate thermal response, and full results are visible after around three months. The results from just one treatment last for up to a year.

HIFU

HIFU is the shorthand acronym for High-Intensity Focussed Ultrasound, a treatment that uses ultrasound waves to tighten, firm, and contour your face and body. As its name says, HIFU uses ultrasound waves at high intensity and focuses the waves to a single point. The focussed ultrasound waves don’t hit the surface of the skin, as a laser would, but a predetermined spot up to 4.5mm below the skin’s surface.

There are different types of focused ultrasound treatment on offer, some of which are branded. Any of them can be called HIFU, as this is the type of treatment rather than a brand, in the way that not all vacuum cleaners are Hoovers. So if two different clinics offer ‘HIFU’, it may not be the same treatment at each.

Targets: Penetrates deeper layers, including the SMAS, providing more significant lifting but with more discomfort and longer treatment times.

Mechanism: HIFU devices target the SMAS layer, which lies well below the surface of the skin. More specifically, they work by concentrating ultrasound energy to create a focal hotspot between 1.5mm and 4.5mm below the skin surface. The deeper penetration allows for more pronounced lifting for both the face and body. A variation of the treatment can also be used to specifically target and destroy fat cells in the tissue beneath the skin, leading to more targeted fat reduction that sculpts the treated area.

Depth: Targets multiple depths, including deeper layers such as the SMAS (up to 4.5 mm).

Pain: Most people find HIFU treatment to be uncomfortable or even painful. Patients often describe the sensation as a series of brief, intense pulses of heat. Ibuprofen or diazepam can help, but because the treatment area is well below the surface of the skin, numbing cream isn’t an effective option. That said, most of the discomfort or pain is short-lived. After the treatment, you may have some redness, swelling and soreness in the treated area, but this discomfort is likely to be minor.

Duration: Sessions can vary in length depending on the treatment area but often take 30 to 90 minutes. A brow treatment may take only 30 minutes, while treatment of the full face and neck may take 90 minutes.

Results: You may find that HIFU treatment has a small immediate effect on the tautness of your skin, but the main effect comes from the increased collagen production that the treatment stimulates. This takes several months, so results may take longer to appear, with full effects visible after about three to six months.

Ultherapy

Ultherapy is a leading, FDA-approved non-invasive method for skin lifting and tightening. It uses high-intensity focused ultrasound waves which target collagen as deep as the SMAS layer. To help the therapist aim each pulse of ultrasound waves into precisely the right spot, the Ultherapy device contains a visualiser pane. This pane uses what you might call ‘normal’ ultrasound – unfocused ultrasound waves – to show the layers in the skin.

Ultherapy can be used on the neck, under the chin, on the brow, and to improve lines on the decolletage. It is also used by some practitioners on the body, including the tummy, knees, thighs and bottom, for improving skin texture and for tightening.

Targets: Pairs precise micro-focused ultrasound with visualisation technology to target multiple skin layers, combining precision with efficacy.

Mechanism: Ultherapy works by using precise micro-focused ultrasound with visualisation energy to target the deep structural layers of the skin, without disrupting the skin’s surface. The device has a ‘visualiser’ panel to show the therapist exactly at what depth each shot of energy is landing within the skin. It allows for precise targeting by providing real-time imaging of the treatment area.

Depth: Ultherapy targets both the deep dermis and SMAS layer, offering a range of depths to address different levels of skin laxity. The device can be set to focus the ultrasound waves at 1.5mm, 3mm, and 4.5mm below the surface. At 4.5mm, the ultrasound can reach the SMAS. The usual procedure with Ultherapy is to do two ‘passes’ at varying depths, in order to catch the SMAS and a layer of tissue above it.

Pain: Can be quite uncomfortable, with a sensation similar to HIFU, involving intense heat and tingling. Redness, some swelling and tendness occur frequently. Ibuprofen will take the edge off the discomfort and some clinics also offer diazepam (Valium) for heavier-duty relief. Numbing cream isn’t an option, as the focused ultrasound treatment area lies well below the skin.

Duration: Treatment duration varies but an Ultherapy session to treat the whole neck-to-jaw area takes about 45 minutes. An Ultherapy session to treat a single area, such as your brow, takes around 30 minutes.

Results: Ultherapy doesn’t give a sudden change in appearance. Instead, results develop gradually over three to six months. Results tend to last around 18 months.