Is HIFU good or bad for the face?

Question

I am 44 years of age- Female. I got fat transfer on my face twice in the last 2 years. But my skin is NOT tight but have no wrinkles. I live in Denmark. I have heard that HIFU is really good and gives very natural results with skin tightening but I also read somewhere a lady wrote that she got HIFU done and it was a disaster for her. She started to lose the fat in her face after a month she got HIFU treatment. Is there an expert who can please guide me on this? Should I go for it or not?

Philip J. Miller, MD, FACS · Answer

It's difficult to determine if this is a good treatment for you without pictures or an in-person evaluation. Ultherapy can be used for skin tightening. Once facial aging progresses to skin laxity and dissent, I recommend a micro or many facelift. I actually have found that patients who get treated surgically sooner end up looking better longer.
Sincerely, 
Philip J. Miller, MD, FACS
Double Board Certified Facial Plastic Surgeon

Jonathan Kulbersh, MD · Answer

This may improve skin laxity, but without pictures, it's difficult to determine if this is a good treatment for you. Concentrate on preventing sun damage by protecting your skin with sunscreen, hats and clothing. Have your dermatologist recommend a medical-grade skin care regimen with retinol and hyaluronic acid. Get regular chemical peels. If you do start to see some jowling, a mini lift, with or without a neck lift would give improvement. I hope this helps.

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

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling, resting photos of your face from the front-end side would help in the evaluation.   Hifu is a high energy, focused ultrasound that would not tighten the SMAS, might minimally tighten the skin (several mm's) and might dissolve facial fat.   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. 
 The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  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.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 In my experience, this is the "key" factor in making the face soft, feminine and naturally beautiful.  An essential part of any facelift on a woman.  Conversely, men look chiseled and handsome when angularity is created in the cheeks, chin and mandibular angles.  The ability to provide precise, facial shaping separately or in combination with a facelift is in my humble opinion the definition of a "facial shaping expert".
 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 anesthesiaproper SMAS Imbrication techniqueno incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost 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.
  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 flat or concave in the front, cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If the chin is 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.
Hope this helps.

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