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Facial lifting is a sought-after cosmetic procedure aimed at rejuvenating the face by tightening and lifting sagging skin, often resulting from aging, gravity, or loss of collagen and elastin. Non-surgical facial lifting methods, like HIFU, target deeper layers of the skin to stimulate collagen production, which provides a gradual but natural lifting effect.
High-Intensity Focused Ultrasound (HIFU) is one of the more popular non-invasive treatment methods for facial lifting and contouring. HIFU treatments, when done correctly, help to shape and contour the face effectively. However, thankfully quite uncommonly, it may deliver results which are not desired or unintended side effects of HIFU.
Sometimes, we hear complaints from patients who say that “they look older”, “their face lost volume and appears more haggard” or even “their face shape has changed for the worse”. This is quite the contrary to what they were hoping to achieve with HIFU treatments. So, why does this happen to some?
The Science behind facial fat volume loss from HIFU (how does HIFU work)
Originally, High-intensity focused ultrasound (HIFU) was designed as a minimally invasive procedure that uses ultrasound waves to treat medical conditions, such as tumours. The very high-intensity and highly focused sound waves interact with targeted tissues in your body to modify or destroy them. [1] When used for aesthetic indications, the focused ultrasound energy creates heat at a deep level in the skin. This heat causes controlled thermal injury to the cells at the layers deep into the skin, causing the body to try to repair them. To do this, the body produces collagen to aid in cell regrowth. [2]
At a cellular level, HIFU is said to increase nuclear and mitochondrial p53 expression, which leads to apoptosis and autophagy, and eventually decreases fat tissue thickness in an animal study. [3] In other words, the energy delivered from HIFU results in fat cells signalling programmed cell death and allowing these fat cells in the subcutaneous layer to be resorbed.
Sometimes, overly aggressive treatments may also deliver direct heat (thermal) damage to the fat tissues and cause them to shrink as well.
When used in the correct clinical situation, with an experienced operator, HIFU can certainly deliver consistent and reliable results.
FIGURE from (3) Byun KA et al. High-Intensity Focused Ultrasound Decreases Subcutaneous Fat Tissue Thickness by Increasing Apoptosis and Autophagy. Biomolecules. 2023
Recognizing Symptoms of unintended HIFU Volume Loss
Usually, patients who experience this phenomenon feel that they are generally unsatisfied with their HIFU treatment outcome.
Some of the common complaints include:
- Unintended or unwanted volume loss in certain areas of the face (i.e. cheeks, forehead/temples)
- The face seems more tired/haggard, with the appearance or increased prominence of certain wrinkles/lines (i.e. nasolabial lines)
- Change in overall face shape
Treatment Options for Restoring Facial Volume
To restore lost facial volume, the best way is to replenish the lost volume. The most ideal option is to consider facial fat grafting (LINK). This procedure involves the transfer of fat cells from areas with excess fat (for example, the abdomen or thighs) to areas that require additional volume. Fat grafting to the face, also known as fat transfer or structural fat grafting, is the most natural form of volume augmentation as we can utilise your tissue/fat to volumize the affected areas
Whilst a small portion of the fat undergoes natural resorption, the remaining portion that survives would be permanent and integrates naturally with the surrounding subcutaneous fat tissue.
The biggest advantage of fat grafting to the face is that it provides volume restoration or augmentation whilst maintaining the most natural form and appearance of the face.
As an alternative, various options of injectable fillers may also be possible as well.
Prevention Strategies
As with all types of energy devices, not all HIFU devices are made the same, just as different doctors may prescribe different treatment strategies for you.
Choose an experienced operator who may be able to advise, prevent and even treat unintended facial volume loss.
When used judiciously and in the correct clinical settings, HIFU is an effective treatment for facial contouring, and we should always strive to get personalised HIFU treatment and advice before considering any treatment.
References
- https://my.clevelandclinic.org/health/treatments/16541-hifu-high-intensity-focused-ultrasound
- https://www.medicalnewstoday.com/articles/hifu-facial#what-is-it
- Byun KA, Park HJ, Oh S, Batsukh S, Sun HJ, Kim T, Kim S, Kang D, Son KH, Byun K. High-Intensity Focused Ultrasound Decreases Subcutaneous Fat Tissue Thickness by Increasing Apoptosis and Autophagy. Biomolecules. 2023 Feb 18;13(2):392. doi: 10.3390/biom13020392. PMID: 36830763; PMCID: PMC9953651.
- Fatemi A. High-intensity focused ultrasound effectively reduces adipose tissue. Semin. Cutan. Med. Surg. 2009;28:257–262. doi: 10.1016/j.sder.2009.11.005.
