A subtle improvement in selected areas where tissue has begun to loosen.
Consultation-led aesthetic medicine · Brighton & Hove · By appointmentConsultation-led · Brighton
ULTRASOUND · FIRMNESS · CONTOUR
HIFUFocused ultrasound.
For skin that has started to feel looser and a jawline that looks less defined.Focused ultrasound can encourage firmer skin over the following months.
At a glance
Firmer skin.
More defined contours.
Most relevant when loose tissue is contributing to a softer facial contour.
Small points of heating prompt collagen remodelling beneath the skin.
Allow time for a gradual response; the degree of visible firming varies.
Quick overviewYour appointment at a glance
- Consultation
- We examine your skin and deeper tissues, review previous treatment and discuss whether HIFU can usefully address the change. Treatment arrangements are confirmed after assessment.
- Appointment
- The device, areas and treatment plan are explained before you decide. You may feel bursts of heat, prickling or a deeper ache; comfort measures are discussed and you can ask for a pause.
- Preparation
- Tell me about your health, medicines, previous procedures, implants and any altered sensation. An important event should be discussed before choosing a date.
- Recovery
- There is usually little visible downtime, although redness, swelling, tenderness or bruising can occur. You receive written aftercare for your treatment.
- Course & review
- Change develops over the following months. We compare photographs and examine your response before suggesting further treatment; the number of sessions depends on the device and plan.
- Fees & booking
- See current HIFU fees. The proposed area, cost and what the fee includes are explained after assessment. Start with a consultation.
01
Surface
Pigment, redness or texture
A skin-quality or resurfacing approach02
Laxity
Tissue that has loosened
HIFU may have a role in selected cases03
Volume
Lost fullness or support
A volume-supporting assessment04
Movement
Expression-driven lines
An expression-lines assessment05
Advanced change
Marked sagging or excess skin
A surgical opinion may be more usefulThese causes can overlap. This is a guide to the questions an assessment asks, not a device protocol or a treatment recommendation.
Your questions, answered
Your questions about
HIFU
What HIFU can firm, how gradually results develop, and what its limits, discomfort and recovery mean for you.
odNOVA guide
- 1 You
- 2 Piotr
- 3 Clinical
- 4 In depth
Choose a question
What is HIFU, and what can it change?Piotr answers
Piotr
HIFU uses focused ultrasound to encourage gradual firming in tissue that has begun to loosen. The energy creates small points of controlled heating at selected depths, prompting a repair response and collagen remodelling beneath the skin.
The treatment is most relevant when mild-to-moderate laxity is the concern. I assess where that laxity sits and whether firmer tissue would make a useful difference to your face.[1][2]
Which layers does focused ultrasound treat?
Focused ultrasound concentrates energy in small areas at a chosen depth. The heat changes the structure of collagen proteins, creating controlled points of coagulation. Collagen can contract at these points, followed by gradual tissue remodelling.[16][17][2]
Depending on the system and treatment plan, the target may be the dermis or deeper supporting tissue, including the SMAS — a fibrous layer associated with the facial muscles. The same depth does not reach the same layer everywhere, because tissue thickness varies across the face. The depth and energy therefore need to match the anatomy and the intended treatment.[17][18]
Does the ultrasound device make a difference?
The category name tells you less than the protocol.
“HIFU” is used for a family of focused-ultrasound systems. Microfocused ultrasound, microfocused ultrasound with visualisation and other devices differ in how energy is delivered, what tissue depth is targeted and how much clinical evidence exists for the exact system and protocol.
A result produced by one studied device, in one area, with one protocol cannot be transferred automatically to another. The same applies to adverse-event data. Device quality, treatment planning, tissue depth, energy, line placement, coupling, operator technique and individual anatomy can all affect what happens.
More energy is not automatically better. A stronger setting does not correct the wrong diagnosis.
Is loose skin the reason my face has changed?Piotr answers
Piotr
A softer jawline can reflect loose skin, lost volume or changes in deeper support. More than one may be involved.
HIFU is intended to firm tissue; it does not replace lost volume. Heat delivered into fat can also affect that tissue, and unwanted volume loss has been reported.[6][15] In a face that is already slim or hollow, further loss of fullness may make the contour less balanced. Treatment depth, energy and placement all matter, because the thickness of the skin and tissue beneath it varies across the face.[16][18]
How much difference could I see, and when?Piotr answers
Piotr
The change is usually subtle and develops gradually over the following months. Some people notice firmer contours; others see little or no visible difference.
Comparing photographs taken before and after treatment helps establish what has changed. Further treatment depends on your response, the device and the original plan.
Who might benefit, and when is HIFU unsuitable?Piotr answers
Piotr
HIFU may suit mild-to-moderate laxity when there is enough tissue volume and a subtle change would be worthwhile to you. More pronounced excess skin, heavier tissue descent or substantial volume loss may need another approach.
I review your health, medicines and previous procedures before recommending treatment. Active skin problems, altered sensation or implants near the planned area can change the decision. The checks below explain what to tell me.
When treatment may be unsuitable or deferred
The face and the medical history both matter.
HIFU may be unsuitable when the likely benefit is too small, tissue volume is already depleted, laxity is too advanced, another tissue layer is responsible for the concern or a person expects a facelift-level result.
Treatment may also need to be avoided, modified or deferred because of active skin problems, previous procedures, implanted devices, altered sensation, medical conditions, medicines, pregnancy or breastfeeding. These are assessed individually; this page is not a substitute for a full history and does not present a universal contraindication list for an unidentified device or protocol.
Can I have HIFU if I have dental implants or metal fillings?
It depends on where the implant or filling is and which area is being treated. Some areas may need to be left untreated. The treatment plan must follow the safety requirements of the specific device.[15]
What happens at the consultation?Piotr answers
Piotr
Your consultation covers the changes you have noticed, your skin and deeper tissues, and previous treatments. The discussion includes whether HIFU could help, the device and areas proposed, comfort, recovery, alternatives and cost.
You can take time to decide. A consultation does not commit you to treatment, and treatment arrangements are confirmed after the assessment.
Does HIFU hurt?Piotr answers
Piotr
Yes. You may feel short bursts of heat, prickling or a deeper ache as the energy is delivered. Some areas are more sensitive than others.
You can discuss comfort measures before treatment and ask for a pause at any point.
What recovery should I expect?Piotr answers
Piotr
The skin may look almost unchanged, but the treated area can feel sore or tender beneath the surface. An ache can remain after the treatment itself has finished, especially when the area is touched or your face moves. Redness, swelling or bruising may also occur.
Paracetamol can be used for discomfort after treatment, provided there are no contraindications.
Persistent or worsening burning pain, blistering, persistent numbness or a change in facial movement needs assessment rather than being treated as normal recovery. Your written aftercare explains what to expect and when to get in touch. Follow the action guidance.
What risks should I understand before deciding?Piotr answers
Piotr
Temporary redness, swelling, tenderness and bruising are the more familiar reactions. Less common but important complications include burns, pigment change, scarring, nerve symptoms and unwanted loss of tissue volume or a change in contour.
The risk depends on the device, treatment depths, anatomy and technique. Published reports do not provide one reliable complication percentage for everything called HIFU. I discuss the risks relevant to your proposed treatment before you decide.
You can message me on WhatsApp with recovery questions. Increasing pain, blistering, persistent numbness or a change in facial movement need prompt assessment; the guidance below explains when urgent medical help is needed.
Risks and red flags
The surface may look calm while the treatment acts deeper.
Short-term reactions
- pain or discomfort during treatment;
- redness, swelling and tenderness;
- bruising, welts or temporary altered sensation.
Reported complications
- pigment change;
- burns or skin injury;
- scarring;
- temporary or persistent nerve symptoms;
- unintended fat loss, hollowing or contour change.
Reliable class-wide frequencies cannot be given because devices, protocols, areas, reporting systems and study quality differ. A complication reported after one system does not establish the rate for every system, but it should not be dismissed simply because the overall treatment is non-surgical.
Facial muscle weakness is a recognised, rarely reported adverse effect of microfocused ultrasound.[14] It can cause an uneven smile. Any new change in facial movement needs prompt assessment. Recovery varies and can take longer than a few weeks.[15]
Can I still have a facelift after HIFU?Piotr answers
Piotr
Previous HIFU does not automatically prevent a facelift. Tell the surgeon about any energy treatments, threads or injectables and bring records of the dates, areas and devices where possible.
There is limited evidence about whether HIFU alone makes later surgery more difficult. Studies with mixed treatment histories cannot separate its effect from other procedures. If surgery is already on your mind, discussing it with the surgeon before another treatment is sensible.[8][9][12]
What should I discuss with a future surgeon?
Bring records of your treatments, including the device, dates, areas and number of sessions. Explain any changes in sensation, scarring or contour afterwards.
There is no validated waiting interval that applies to everyone. Ask a consultant plastic surgeon, whose specialist registration you can check with the GMC, how your treatment history affects the operation they would recommend. The research below explains why current reports cannot isolate the effect of HIFU alone. [9] [10] [11] [12] [13]
What could I consider instead?Piotr answers
Piotr
The alternative depends on what is causing the change. Lost volume may be better addressed with dermal fillers or biostimulators. Texture or pigmentation calls for a treatment directed at the skin surface.
For pronounced laxity or excess skin, a surgical opinion may be more useful. I will explain the options relevant to your face, including leaving things as they are if the likely benefit is too small for you.
What do the clinical studies actually show?Piotr answers
Piotr
In one study of Ulthera microfocused ultrasound, independent photographic reviewers saw improved laxity in 58.1% at three months. Of 103 enrolled adults, 93 were evaluated; 65.6% reported improvement themselves. It was a prospective study without a randomised control group. [3]
The studies below used different devices and methods. They show both potential benefit and non-response, and explain why a result for one system should not be promised for another.
What the research actually tells us
Real evidence, but not one simple answer.
These results show the changes recorded in clinical studies. HIFU is intended to improve firmness and contour; it does not offer the same correction as a surgical facelift. Systematic reviews report measurable improvements after specific focused-ultrasound protocols, but studies vary in device, area, method and outcome measure. Many are small or short; manufacturer funding is present in parts of the evidence, and women make up most participants.[1] [2] [7]
A 2025 review of microfocused ultrasound with visualisation reported improvement on both investigator and patient assessments. Results varied between studies, and satisfaction estimates were lower when people were offered a neutral response.[7]
The appearance on the day is not a reliable guide to the final result. Temporary swelling can affect the early contour, while tissue remodelling develops over the following months. Later photographs are more useful for judging whether a lasting change has occurred.[2][4]
Studies commonly assess results at around three and six months.[3][4]
Some studies have recorded improvement a year after treatment. That does not mean the effect lasts a year for everyone. Duration varies with the device, treatment area and individual response.[4]
Further treatment should depend on the result that remains, rather than an automatic annual appointment.
The number of sessions depends on the device and plan.
Focused-ultrasound studies use different devices and treatment protocols. Photographic assessments and patients’ own ratings do not always agree. The studies below show who was treated, how results were measured and when they were assessed.[3] [4] [5]
Prospective study · 103 enrolled; 93 evaluated
Oni et al. · 2014
58.1% improved on independent photographic assessment at three months; 65.6% reported improvement themselves.
Study details and original results
Oni et al. [3]
- Design
- Prospective study
- Participants
- 103 enrolled; 93 evaluated
- Assessment
- Blinded photographs, measurements and patient ratings
- Methods and limitations
- Three blinded reviewers assessed the photographs. Patients also rated their own change. The study had no randomised control group. Ten of the 103 enrolled participants were not included in the reported three-month evaluation. These findings apply to the Ulthera device and protocol studied.
Prospective open-label pilot · 20 treated
Werschler et al. · 2016
At one year, blinded reviewers judged 6 of 14 evaluable participants improved. Twenty people were treated.
Study details and original results
Werschler et al. [4]
- Design
- Prospective open-label pilot of microfocused ultrasound with visualisation.
- Participants
- 20 treated; 14 evaluable for blinded photographic assessment at one year.
- Assessment
- Blinded photographs, clinician and patient ratings. Follow-up at 90 days, 180 days and one year.
- Result
- Six of the 14 evaluable participants were judged improved on the one-year photographs. Patient and practitioner ratings were more positive.[4]
- What this means
- The photographic finding applies to the 14 evaluable participants. It does not show what proportion of everyone treated with another HIFU system will improve.
- Funding
- The study was sponsored by Merz Device Innovation Center.
Retrospective study · 24 evaluated
Yalici-Armagan & Elcin · 2020
At a median of 4.3 months, blinded reviewers rated 5 of 24 participants improved, 15 unchanged and 4 worse.
Study details and original results
Yalici-Armagan & Elcin [5]
- Design
- Retrospective lower-face study after one treatment session.
- Participants
- 24 evaluated.
- Assessment
- Blinded photographs and patient ratings, at a median of 4.3 months.
- Result
- Photographic reviewers rated 5 improved, 15 unchanged and 4 worse. Eleven patients reported improvement themselves.[5]
- What this means
- The photographic and patient ratings describe different outcomes. This small series cannot provide a response rate for every focused-ultrasound treatment.
A patient rating describes the person’s experience. A photographic assessment asks reviewers to judge visible change in images. They measure different things, and each has limitations.
Tissue volume matters. A separate randomised study of 20 women found measurable tightening and also a small reduction in treated-tissue volume. That does not prove every HIFU treatment removes facial fat, but it supports caution in a slim or volume-depleted face.[6]
The future-facelift evidence is limited in both directions. A small pre-facelift phase 1 tissue study in 15 patients demonstrated discrete thermal effects in tissue removed within 24 hours or 4–12 weeks later, but it did not assess operative-plane difficulty, operating time or facelift outcomes. A later retrospective 20-patient series included 13 people with previous MFU-V. All patients had also received injectables, there was no untreated comparator, and the study did not assess operative planes or fibrosis, so it cannot isolate HIFU’s effect on later surgery.[8] [9] [12]
These findings support an individual assessment and a review of the result before further treatment.
How do I book a HIFU consultation?Piotr answers
Piotr
Book a consultation to find out whether loose tissue is contributing to the change you have noticed and whether HIFU could make a useful difference.
The consultation covers the proposed area, treatment plan and alternatives. You can take time to decide before arranging treatment.
Question index
All your questions,
by topic.
Open a topic and choose a question to go straight to its answer.
Browse all 16 questions
Your concern and how HIFU works4 questions
Suitability2 questions
Results and research2 questions
Consultation and comfort3 questions
Recovery and safety2 questions
Alternatives and future surgery3 questions
References & sources
These sources concern specific focused-ultrasound studies and professional context. A finding from one device, protocol or population is not a promise for another. The later-surgery evidence includes mixed treatment histories and cannot isolate HIFU as a cause.
View all 18 references
- Haykal D, Sattler S, et al. (2025) — systematic review of HIFU in skin tightening and body contouring. View the source
- Contini M, Hollander MHJ, Vissink A, et al. (2023) — systematic review of microfocused ultrasound for facial skin tightening. View the source
- Oni G, Hoxworth R, Teotia S, et al. (2014) — prospective lower-face cohort, 103 enrolled; 93 evaluated. View the source
- Werschler WP, et al. (2016) — prospective study of 20 patients treated with microfocused ultrasound with visualisation. View the source PubMed abstract (Abstract accessed: 9 September 2026).
- Yalici-Armagan B, Elcin G. (2020) — retrospective lower-face study, 24 patients. View the source
- Zhu et al. (2023) — randomised controlled trial, novel MFU, 20 women. View the source
- MFU-V systematic review and meta-analysis (2025; first published online 14 November 2024). View the source
- Humphrey VS, Rambhia PH, Gmyrek R, Chapas A. (2025; Epub 3 December 2024) — adverse-event systematic review and risk of subsequent facelift compromise. View the source
- Gliklich et al. (2007) — prospective pre-facelift tissue study, 15 patients. View the source
- Skouras et al. (2023) — single-surgeon retrospective facelift series, mixed prior treatments. View the source
- O'Daniel and Patton (2026; published online 25 July 2025) — retrospective neck-lift series, mixed prior procedures. View the source
- Myers et al. (2026) — 20-patient retrospective pilot, 13 with previous MFU-V. View the source
- ISAPS Patient Safety Update (19 June 2026) — category-level context on mixed prior fillers and energy devices; not HIFU-specific outcome evidence. View the source
- Hitchcock TM, Dobke MK. (2014) — Review of the safety profile for microfocused ultrasound with visualization. Journal of Cosmetic Dermatology, 13(4), 329–335. DOI 10.1111/jocd.12111. View the source
- Ulthera System Instructions for Use, Rev 05 (April 2024) — nerve effects and post-market surveillance. View the instructions for use
- Laubach et al. (2008) — focused ultrasound and controlled thermal coagulation in postmortem human skin. Primary laboratory study of the effects of power, exposure time and focal depth. View the PubMed abstract (Accessed: 8 October 2026).
- White et al. (2007) — targeted thermal collagen changes in the SMAS. Primary study in human cadaveric tissue; mechanism evidence, not a patient outcome estimate. View the PubMed abstract (Accessed: 8 October 2026).
- Kwon et al. (2022) — regional thickness of lower facial skin, superficial fat and SMAS. Ultrasound anatomy study; supports individual depth selection, not a complication-rate estimate. View the PubMed abstract (Accessed: 8 October 2026).
This page provides general information about HIFU. It does not replace individual assessment, consent or treatment-specific aftercare.