Ultrasound lifting (HIFU): how it works and how effective it is

How does HIFU work?

High-intensity focused ultrasound (HIFU) is a method that concentrates ultrasound energy at a specific depth beneath the skin to create heat, without cutting the skin surface. One review explained that microfocused ultrasound delivers heat to small areas at a fixed, consistent depth, reaching the deep connective tissue below the dermis ^[1].

The goal is said to be triggering a deeper wound-healing response in multiple layers, strongly stimulating collagen remodeling, and achieving a longer-lasting clinical response ^[1]. The literature notes that radiofrequency and infrared laser devices, which were in use before, deliver heat to the dermis to stimulate new collagen production and produce some degree of tissue tightening with a short recovery ^[1].

What research shows about its effects

A 2020 systematic review and meta-analysis analyzed 17 studies with 477 participants published before December 2017 ^[3]. The objective improvement score was 2.74 out of 5 (95% confidence interval, 2.06 to 3.43), and the subjective satisfaction score was 2.68 (95% confidence interval, 1.92 to 3.45), indicating moderate improvement ^[3].

A 2025 systematic review examined 45 clinical trials and cohort studies published from January 2010 to October 2024 ^[2]. It summarized that the skin-tightening effect was especially clear in the lower face, neck, and around the eyes, and that improvement in skin laxity ranged from 18% to 30% ^[2].

Both reviews acknowledged limitations. The studies included in the 2020 analysis used different outcome measures and scores at various time points, and most did not report long-term follow-up results ^[3]. The 2025 review also stated that more research is needed to confirm long-term effects and to examine its use across different skin types ^[2]. These research summaries alone make it difficult to judge whether the same results would be seen in Korean skin.

How is it different from surgery?

A 2013 review explained that because less invasive methods have so far fallen short of surgery in effectiveness, surgery is still the treatment of choice for moderate or more severe tissue sagging ^[1]. A review of nonsurgical treatments for the lower face also considered surgery to still be the standard method, and suggested that nonsurgical treatments such as lasers, radiofrequency, and HIFU may be used together with surgery to enhance the overall result ^[4].

A review of body-contouring devices summarized that these noninvasive devices do not produce the same results as liposuction, but can be an alternative for people who do not want the risks or costs of surgery ^[6]. The 2025 review also summarized results showing that the circumference of the abdomen and thighs decreased by 2.5 to 4.5 cm ^[2].

Therefore, when considering HIFU, it is good to know that changes equal to those of surgery are difficult to expect for moderate or more severe sagging ^[1].

Pain and side effects

In the 2020 meta-analysis, the average pain score on a scale of 0 to 10 was 4.2 ^[3]. Swelling and redness varied widely between studies, and no darkening of the skin (pigmentation) was reported in the included studies ^[3]. The authors concluded that HIFU is safe in the short term and has a moderate effect on rejuvenating the face and neck ^[3].

The 2025 review summarized that fewer than 5% of patients reported temporary redness, swelling, or mild discomfort ^[2]. However, it is pointed out that the optimal energy settings and the criteria for selecting candidates have not yet been standardized ^[2]. Because the procedure uses heat, problems such as burns can occur, and an expert consensus on ultrasound devices summarized the types of preventable complications and how to prevent and treat them ^[5].

Differences by device and technique

There are many types of ultrasound lifting devices. In an independent evaluation published in an expert consensus paper, the devices differed in several factors that affect safety and effectiveness, and features such as real-time imaging, the size and uniformity of the heat coagulation points, the ability to concentrate energy accurately at the focal point, and temperature control during use were compared ^[5].

This consensus concluded that real-time imaging, which allows the skin layers and the contact between the device and the skin to be checked, helps prevent complications and improve safety ^[5]. However, the evaluation centered on a specific device, so it should be interpreted with caution. A review of nonsurgical treatments for the lower face stressed that to improve results, practitioners need a detailed understanding of how each device works ^[4].

What to check during your consultation

The effects of HIFU vary from person to person depending on the degree of sagging, the condition of the skin, and the technique used. It is best to understand that the evidence is mostly based on short-term results and to discuss which treatment suits you with a specialist ^[3].

• Whether the degree of your sagging is suited to nonsurgical treatment
• How the treatment depth and energy are set and checked
• The pain, redness, and swelling to expect
• When results appear and whether repeat treatments are needed
• The pros and cons compared with surgery or other procedures