I am considering HIFU to tighten saggy jowls, are there any risks or side effects I should be aware of?

Question

I am nervous about it and would like to know the risks and possible side effects before i take the plunge, can you advise me please.

Jack Zoumaras, MBBS, FRACS (Plast) · Answer

Unfortunately HIFU even though it promises a lot will not and cannot lift the jowl. The jowl is caused by weakness in the mandibular ligament and results in movement of facial skin into the neck that hangs down over the jaw. Movement of fat also complicates the jowl. Correcting the jowl involves release of the ligament, moving of fat, tightening of muscle and removal of skin. HIFU simply cannot achieve any of this. In fact, pre-jowl filler is more effective even though it has its own limitations. Only a Facelift (even a Short Scar which is aimed at the jowl only) will lift a jowl.

Jason Emer, MD · Answer

In our practice, we perform a non-surgical face lift / skin resurfacing treatment using Renuvion Helium Plasma Radiofrequency. ​To get the most improvement with skin tightening, we combine Renuvion (formerly J-Plasma) with lasers (Fraxel, Clear + Brilliant, CO2), microneedling/PRP, Ultherapy and InMode FaceTite. I suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer​​​​

Marc Pacifico, MD, FRCS(Plast) · Answer

Many thanks for posting your question. HIFU (high intensity focussed ultrasound) is an "energy based treatment" that has shown promise for some skin tightening.However, the effects are limited, as it does not act on the deeper tissues that are the fundamental cause of jowl development - the SMAS layer.At the moment, the only way to comprehensively address the SMAS layer is to undergo a facelift.However, if you feel this is more than you are happy to undertake at the moment, then I think it is perfectly reasonable to try HIFU, however, please lower your expectations of the results it will provide.I hope this has been helpful - good luck

Jag Chana, MD, FRCS(Plast) · Answer

My main concern with non-surgical options for jowls is that they do not address the true anatomical reason for the jowls to have occurred in the first place which is a descent of the soft tissues and fat compartments in the face along with a weakening of the muscles. The use of a non-surgical energy based treatment  will not relocate the tissues back to their youthful position and will only provide a shortlived temporary minor improvement. The best procedure is a lower face and necklift which will relocate the tissues to their normal position and provide a longlasting effect. Of course facelift and necklift procedures is not one all-encompassing procedure since every face is different and the specific type of surgery and adjustment to the deep tissues ( the SMAS layer and platysma) will be different. It is best to seek out a surgeon who is experienced in all types of facelift surgery and who is able to individualise your surgery to the specific ageing features in your face. Beware of surgeons promoting one type of branded facelift or enticements into a local anaesthetic procedure. The ageing face needs an overall assessment and may require multiple techniques during the facelift to provide the best longlasting natural result.

Rajat Gupta, MD, MS, DNB · Answer

It’s a good decision. HIFU is a good option to tighten saggy jowls. Even though I am saying this without examining you or seeing you, but HIFU does give the lift in the desired areas. You may need to repeat it for more than couple of sessions. Don’t expect magical results immediately after the surgery. Slowly & slowly the collagen will form and you will get the desired lift.

John Michael Thomassen, MD · Answer

Jowls are best treated with a facelift type procedure.  HIFU will result in very limited results.  Considering the cost of such treatments, you would be best served with a surgical approach.

Thomas Romo, III, MD · Answer

First a correct diagnosis must be made. Do you have soft tissue volume loss to your face? Do you have falling redundant facial skin? Do you have both? Surgical facial lifting elevates,repositions and smooths loose excessive facial soft tissues lasting for years. Ultrasound and radio frequency facial treatments provide short term improvements usually at high fiscal cost.

Nora Nugent, FRCSI (Plast) · Answer

Dear mosser,
Thank you for posting your question. The most effective and most long lasting treatment for saggy jowls is a lower face and necklift. Non-surgical treatments such as HIFU are improving but will still give milder effects than surgery, will not last as long and usually need multiple treatments. This is okay and suits some patients better than surgery but you need to know what to expect in terms of effect and longevity. In the short term, HIFU may be cheaper (although not cheap!) but in the long term a facelift may be the procedure with better value for money.
I would advise seeing a board certified plastic surgeon in your area who offers a surgical and non-surgical facial rejuvenation practice including HIFU. They should be able to show you before and after photos of each treatment and talk you through the pros and cons of each including protential risks. 
I hope this is helpful and good luck in your research!
Best wishes

Matthew Hansen, MBBS, FRACS (retired) · Answer

Saggy jowls are caused by a variety of age and health related issues. These include loss of volume over the upper cheek area, displacement of volume of the SMAS layer downward and forward into the jowl, loosening of the retaining ligaments of the face, loss of volume in the pre-jowl area, loosening of the skin and loss of elasticity. There are other contributing causes as well including dental health and bone changes combined with variations in facial structure such as a weak chin that can predispose to an ealy appearance of heavy jowls. HIFU uses ultrasonic energy to heat tissues to promote collagen deposition (scarring) and volume loss by destroying fat. It does not reposition tissues nor enhance volume where it has been lost so its benefits are very limited and highly dependent on the experience and skill of the person performing the treatment. Volume loss caused by HIFU may be counterproductive and if applied inexpertly can lead to contour irregularities.There may be some people in whom the HIFU treatment will offer some short to medium term improvement but most with saggy jowls will need surgery for a long lasting and worthwhile gain. Of couse the skill and experience of the surgeon performing the surgery is paramount in obtaining a good result, choose carefully.

Talmage J. Raine, MD, FACS (retired) · Answer

High Intensity Focused Ultrasound is a relatively new technology. I would look at actual before and after pics that are not sales pics, provided by the company, but actual results from the practice. Then I would ask to speak to a patient or two with anonymity for privacy sake. The result is highly dependent on the expertise of the provider.All the best,Talmage Raine MD

I am considering HIFU to tighten saggy jowls, are there any risks or side effects I should be aware of?

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