Although not everyone experiences pigmentation or acne throughout their lives, everyone will experience sagging skin. Therefore, understanding facial sagging will help you in the long run. Because of increased demand for treatment of sagging skin, many devices and technologies have been created.
My experience as an aesthetic doctor in Singapore says that many of these devices are based more on hype rather than reality. I have written this guide to help you find the best HIFU treatment in Singapore.
I have included the different brands of HIFU treatments, benefits, side effects, up to the cost for each HIFU treatment (estimated in Singapore dollars). I hope this article can help you decide which treatment that suits you!
What is HIFU?
HIFU stands for high-intensity focused ultrasound and is an advanced medical technology that uses focused sound waves to treat medical and cosmetic problems in tissues.
It can penetrate the outer layer of skin to treat deeper skin tissue. This means HIFU does not cut into your body and is a completely non-invasive treatment.
The first HIFU treatments were developed to treat tumour growths in the body (benign and cancerous). Today, HIFU is a popular medical aesthetic treatment for its ability to tighten different skin layers non-invasively. 
What are the different types of HIFU in Singapore?
There are 2 types of HIFU, Macro-focused HIFU and micro-focused HIFU. 
- Macro-focused HIFU is usually used to remove unwanted tissues such as fat on the face or body.
- Micro-focused HIFU only damages or removes very small columns of skin tissues, with the main purpose of contracting the target layers and stimulating collagen.
However, some brands only have either technology, hence limiting its application.
Type of HIFU
Established and reliable brand
Efficacious and precise
Limited depths of application
Expensive for doctors and consumers
White elephant imaging system seldom used by doctors during treatment, because it would require a repetitive head movement for hundreds of times (you can easily check if your doctor is checking)
Both micro and macro-focused
Body slimming and tightening
Most number of applicator depths
Fastest yet precise HIFU that minimises pain
Less brand or marketing support
More expensive than other options
Body slimming and tightening
Good for body slimming
Efficient and efficacious
Can be very painful and intolerable
What are the benefits of a HIFU treatment in Singapore?
As mentioned above, HIFU is non-invasive. It can tighten skin at various different layers without harming the surface. An example of this strength of HIFU is in treating facial sagging. Facial sagging can occur at many layers, from the deep retaining ligaments, to the retinacular fibres within fat compartments and skin.
Below is a diagram showing layers of skin where collagen loss and sagging can occur.
A pleasant unintended effect of HIFU treatment is that patients often comment that their complexion improves and skin pigmentation appears clearer.  This is because the treatment stimulates growth factors in the deeper skin layers, resulting in collagen growth and overall skin rejuvenation.
What happens during a HIFU treatment?
- Special ultrasound transducers direct the ultrasound energy to a small focal point where high temperatures cause tissue coagulation.
- Similar to medical imaging, the focused beam of ultrasound energy can be made to pass harmlessly through the skin, allowing the focal point to target deeper tissues, such as the fat or muscle layers, where protein around the focal point will reach over 65°C and be denatured almost instantly.
- By targeting highly focused ultrasound energy in different depths within dermal and subdermal tissues, HIFU causes discrete thermal coagulation points while sparing adjacent non target tissues.
- The tightening of different depths allows to stiffen different saggy tissues, from saggy ligaments, to pendulous fat areas, all the way up to skin laxity and wrinkles.
This video illustrates how it works. Pay attention around the 55 second mark.
How is HIFU different from other non-surgical skin tightening procedures?
The main advantage of HIFU treatment is that it is ‘colour-blind’ and can tighten tissues at predetermined and specific depths. This is true regardless of your skin type or colour. Even though HIFU aesthetic treatments have a mild immediate effect, the long term results are visibly noticeable when used appropriately.
Compare this to radiofrequency skin tightening, which is very dependent on each individual’s skin’s ability to conduct electricity (skin impedance). Skin impedance varies from person to person.
Depending on the type of laser used, laser skin tightening could be dependent on the skin type or colour of the individual.
How long does it take to see results from a HIFU treatment?
You will see mild results right after treatment, mostly from immediate mild swelling and tightening. The full positive result of treatment appears after 2 to 3 months. This is because the collagen fibres take time to mature. 
Some long term results that are noticeable include:
- Firmer skin and less sagginess
- Smoother face contours
- Lesser wrinkles and pores
- Brighter skin
How long do HIFU results last?
The results are not permanent, although they can last for many years.
Your skin will age and gravity will pull your skin downwards, ultimately reversing the benefits of HIFU. However, the collagen synthesised from your own body remains present for years even after a single treatment. You can maintain and improve these results by going for yearly treatments.
”No, Aerial yoga will not reverse the effects of age and gravity, even though it may have other health benefits!”
Is HIFU considered safe?
HIFU aesthetic devices are considered medical equipment and should only be used at licensed medical centres. There is a wide range of brands in Singapore due to the interest generated around HIFU treatments, so not all HIFU treatments offer the same safety or efficacy.
You might be surprised to hear that cases with severe negative side effects sometimes involve the best and most branded machines. These side effects come from inappropriate use of the machine and poor technique, so doctor experience is extremely important!
What are the side effects of HIFU?
While HIFU is considered safe, I categorise risks and side effects into 2 categories, expected and unexpected:
Expected risks include:
Mild discomfort during and after the treatment. This is very common.
Mild swelling especially after an aggressive treatment.
Rarely, mild bruising can occur.
Mild skin irritation and redness right after treatment may occur especially when using the more surface transducers (1.5mm or 2mm), usually gone after a few hours.
Unexpected risks and rare side effects can happen from poor technique or placement:
Striated patterned “embossing” or swelling on the skin surface from poor contact of transducer on skin and poor technique.
Muscle weakness and skin numbness with major nerve damage from poor understanding of proper anatomy and placement of transducers.
Fat loss and facial sunkenness, usually from excessive treatment at the wrong depth.
How much does HIFU treatment cost in Singapore?
The cost of treatment in Singapore depends on three factors
- Brand (Ultherapy charges more than 10x the price of consumables from other branded HIFU treatments - this cost is passed on to consumers).
- Treatment time (Larger areas require more time and are more expensive).
- User expertise and experience.
HIFU for smaller areas can start from less than $500 (usually what you see on advertising promos), all the way up to >$6000 for larger areas.
You might come across “mini-HIFUs” that either try to upsell you with cross services or persuade you to repeat a small HIFU treatment on a regular basis. Avoid them! “Mini-HIFUs” seldom reach the baseline intensity needed for effective treatment.
Who is suitable for HIFU?
I talked about how HIFU works regardless of skin colour. Of course, it’s not all good news. There are still some limitations on who can use HIFU.
While it is usually suitable for almost everyone with facial sagging, it is less suitable for those with:
1. A lot of volume loss
In these cases, fillers or other collagen stimulators will be more beneficial.
2. Too much facial sagging
Too much facial sagging or individuals with extremely damaged skin. HIFU encourages your skin layers to repair itself and this process is too slow or insufficient to make much of a difference.
How do I get the best results from HIFU?
It is very important to get an experienced and detailed clinical consult to determine your problem and the various treatment options. A clinic that has various treatment options is more likely to give you an unbiased opinion of how HIFU can work for you. Therefore, you have to make sure:
- You find a doctor who is patient and knowledgeable in explaining the various options and who knows how to say NO to you when it’s unsafe or unnecessary.
- To look for someone experienced with many patients under his/her belt and with credible before and after case studies to show you.
Me teaching at a regional Ultraformer 3 training session
- Be open to other treatment options, if they are necessary, to manage your concerns. If you have a headache and a cough, cough medicine will not be useful for your headache. Similarly, you may have other aesthetic issues that HIFU is not suitable for, so be open to different treatment options if you’re looking for a proper medical solution!
What are other non-invasive face lifting treatments in Singapore?
Take note that many other treatments offer a different dimension for non-invasive face lifting with new exciting options in Singapore such as:
- LDM-Med which uses another type of ultrasound (HFUS) to provide cell massage and a completely regenerative way of generating collagen
- Lasers that are used for purposes other than treating the skin! One example is Ultra-long pulse lasers, such as the Fotona PIANO, which can treat bone deep in the face
- Mucosal lasers (lasers to be used inside the mouth or the eyelids) are uniquely
These options can be complementary depending on the individual's skin type and biggest concern.
Injectable collagen stimulators are also a frequent complement with HIFU treatments (since HIFU treatments cannot replace lost volume) - studies have shown that these injectables are especially synergistic with HIFU since they target different aspects of a face lift treatment, so be open to injectables if you want optimal results! They’re not a must, but they can be very helpful in some cases.
If you are still unsure of which treatments to choose, I would suggest you consult your trusted doctor.
There are multiple methods for facelifting, both surgical and non-surgical. HIFU remains an extremely useful weapon in non-surgical facelifts, is well tested, and remains a serious alternative despite rapid medical advancements.
Dr. Chua Cheng Yu (Veritas Medical Aesthetics) is a frequent trainer at medical seminars. He often shares his knowledge on multiple aesthetic technologies, including the Ultraformer HIFU and Teosyal fillers. Besides that, his clinic in Singapore mirrors his philosophy of functional aesthetics: holistic health and beauty. Also, in his spare time, he plays the piano, dabbles with amateur photography, and maintains a personal blog.