What is high intensity focused ultrasound?
High Intensity focused ultrasound delivers focused ultrasound energy deep into the skin layers to create a controlled thermal injury. This is supposed to stimulate collagen and elastin remodeling to improve skin texture and structure. Ultrasound is used everywhere to help tighten, lift and contour the skin. It is popular for obvious reasons. There is no downtime; it can give visible improvements in skin laxity and firmness, and it can be done in the office by nurses and nonsurgeon doctors.
Benefits vs. Drawbacks?
The benefits are obvious. Help your skin tighten? Improve the texture? Without surgery or downtime? What is not to love.
Drawbacks are not talked about as much. With all of these studies and treatments, follow up improvements are usually done months out, not years. I do think the high intensity ultrasound treatments work to tighten the skin. The issue is the results don’t last.
The biggest issue for me is the fat loss which happens for most, and that fat loss is permanent. Losing fat may sound great to you, but the subcutaneous fat loss is a big issue. Fat nourishes the overlying skin, which helps with skin quality and texture. Fat gives your face volume. As you age you lose fat volume in the face, which leads to sagging, jowls, increased wrinkles, the hollows in the temple and under the eye. I spend so much time trying to get fat back INTO the face to combat facial aging. It is why dermal fillers like Voluma, Juvederm, and Restylane are so popular.
Journal Article Review
This was a review article published in the Aesthetic Surgery Journal, July 2025. “A Systematic Review of High Intensity Focused Ultrasound in Skin Tightening and Body Contouring.” It talks about a comprehensive study of articles published between 2010 and 2024, looking at 45 clinical trials.
Findings:
- HIFU showed significant efficacy in skin tightening, particularly of the lower face, neck, and periorbital regions, ranging from 18-30%
- For body contouring HIFU reduced circumference 2.5-4.5 cm, notable in the abdomen and thighs
- Compared with mild surgical outcomes, HIFU gave effective noninvasive lifting with a favorable safety profile.
- Fewer than 5% of patients has redness, swelling, or mild discomfort
- Advances in HIFU technology, like parallel beam ultrasound have improved treatment precision
- ISSUES: Standardization of treatment protocols is a key challenge- what is the optimal energy? patient selection? Long term efficacy? Different skin types?
They conclude, “HIFUs ability to deliver noticeable improvements in skin laxity and fat reduction, with minimal downtime and a favorable safety profile.”
My thoughts on skin tightening by ultrasound?
I get why it is so enticing. My Palo Alto patients are running around, working, kids- they don’t have time for surgeries. I am all for noninvasive skin tightening IF it can be done where 1. it doesn’t destroy the subcutaneous fat and 2. it lasts longer. It may be with AI and newer technologies that those two things can be achieved. But as of right now it is not the case.
I have many fat transfer to the face patients who are thrilled with the improvements achieved who years later have done these noninvasive ultrasound tightening treatments and LOST THE FAT IN THEIR FACE. It was a direct noticeable issue.
I see patients who are 1-2 years out from these treatments who now have much worse skin quality and wrinkling, which I think is likely to the loss of the subcutaneous fat. This fat loss is not evident at first with the swelling and tightening. It is seen later, and they are told it is “aging.” I think the treatment likely accelerated their aging due to the fat loss.
In this journal article it talks about how there is fat loss as a benefit. It is not.
The journal article does not talk about long term tightening efficacy. I think that is a huge issue that needs to be addressed. Are these treatments that need to be done every 6 months forever?
I would much rather see you address collagen and elastin loss with treatments that don’t affect the fat and are improving you at a histologic level: medical grade skin care products like niacinamide and retinol, microneedling with exosomes, and products with the secretome (age zero exosomes and growth factors) like Provoque- all available in my Menlo Park office. If you want surgical improvement with fat grafting which adds volume and improves the skin quality with stem cells, there are no scars on the face for that (the “undetectable era” of plastic surgery, and there are studies showing the histologic improvement in the skin. This is done in my local outpatient surgery center in Palo Alto.
So for now, I am not a fan. If AI and the technology becomes so refined that it does not kill my precious subcutaneous fat or the tightening lasts forever, I may reconsider.
Medical citation
“A Systematic Review of High Intensity Focused Ultrasound in Skin Tightening and Body Contouring.”
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