Face HIFU treatment. Does HIFU melt fat?

Question

i had a face HIFU treatment, but right after the session I noticed that both right & left side of my face are not the same. Moreover, I noticed that my face became thin, my lovely cheeks were disappeared. Does HIFU melt fat? In addition, I asked my doctor if I can be exposed to the sun. She said it is OK, so i went for tanning the next day. Now my face is not looking good and a grove under my eye appeared. Please advise what I can do. Will my face come back as it was with the lovely cheeks? thanks

James H. Rogers, MD · Answer

High intensity focused ultrasound is a technique used to ablate or remove soft tissue, as in treatment of prostate cancer. It is not approved by the FDA in the United States for use in facial cosmetic procedures. Used in this manner, one could certainly experience sigificant loss of facial fat, which is permanent. Sun exposure after treatment is cotraindicated, and can contribute to a condition called postinflammatory hyperpigmentation. I would recommend consutation with an experienced plastic surgeon to see what can be done to address your problem

Rian A. Maercks, MD · Answer

High energy focused treatments like HIFU or Ulthera certainly cause fat atrophy which is why I advocate avoiding these treatments in the face.  They can cause premature facial aging or even worse.    I have treated a large number of  patients with adverse outcomes from Ulthera.   Treatment is usually focused on restoring healthy appearing volume around the high cheeks and eyes with either fillers or fat grafting.  Some patients need blepharoplasty with support from damaged eyelids and some need a composite facelift.  The good news is that it is treatable and usually with a volumetric approach. I hope this helps!All the best, Rian A. Maercks M.D.

Brian K. Machida, MD, FACS · Answer

Yes any treatment like this is capable of reducing fat.  But its also possible that you could have swelling as well which is distorting your features.  Stay out of the sun, use sunblock if your do, moisturize your skin and get lymphatic massage if needed.  At that point, it will just take time to see what your final appearance will be and don't rush into any corrective treatment.  Best of luck.

Anil R. Shah, MD · Answer

HIFU has been reported to cause fat loss.  Patients should chose treatments with an experienced provider to deliver results and procedures which provide benefit for their specific anatomy.  Not all patients respond the same after treatments so patients should be cautious.  Best Dr. Anil Shah

Thomas Romo, III, MD · Answer

Ultrasound is not magic. It is an energy mode initiated by electricity and delivered to the body in different methods and strength. Recent disclosure that US foreign service personnel have been injured by powerful directed ultrasound should at least put people on notice that this treatment modality is not innocuous. The active and aggressive pursuit by companies to devise a limited invasive device to manage facial soft tissue ptosis is ongoing. Until the long term complications of using these devises is documented it"s buyer beware.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  Energy based skin treatments using either RF (radio frequency), HIFU (high frequency focused ultrasound) or lasers that deliver heat to the underlying tissues are all capable of dissolving subcutaneous fat which would change the shape of the face. I have performed facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  When the cheeks are either concave or flat in the front, cheek augmentation with precise placement of a dermal filler or using silastic cheek implants (permanent enhancement) will create full, round cheeks that will feminize the entire face.
 Should the chin be weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. It's important to keep all of these "heavily marketed" non-invasive skin tightening procedures in the proper perspective.  Non-invasive techniques typically shrink the skin several mm's.  There are 25.4mm's in one inch.  The minimally invasive facelift described here can remove 2 to 3 inches of skin which equals 50.8 to 76.4 mm's or up to 25 times the amount of loose skin provided by non invasive techniques.  That reality should always be front and center in the decision making for prospective facelift patients.  It should also be noted that non invasive techniques have no ability to properly dissect, elevate, trim and re-suture the SMAS layer making them one dimensional at best.  Finally, it would seem logical to replace lost fat from your treatment with injected fat (fat transfer), however the fat removed from your body is dead tissue and as such is far less reliable at creating volume to shape and contour the face.  I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

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