Combination Treatment: HIFU and Thermagen
Combining HIFU, which targets and tightens the SMAS fascia, with Thermagen, which tightens subcutaneous fat, significantly enhances results in addressing skin laxity. Both treatments are available individually, so feel free to consult us about your preferences.
We compared before-and-after photos of a patient who received both HIFU and Thermagen treatments on the same day, with results evaluated one week and one month post-treatment. Noticeable improvements were observed in the midcheek groove, nasolabial folds, and sagging around the mouth. One month later, the cheek position was further lifted, and the jawline appeared more defined. Typically, the effects of Thermagen start to show after one week, while HIFU results become noticeable after one month.
Procedures: HIFU / Thermagen
Description: Medical treatments using high-intensity focused ultrasound and RF to tighten the dermis, subcutaneous tissues, and fascia.
Side Effects: Detailed under the side effects section on this page.
Prices:Full-face HIFU: ¥59,400 / Full-face Thermagen: ¥33,000 / Thermagen (under chin): ¥11,000
HIFU (High-Intensity Focused Ultrasound Therapy)
HIFU uses ultrasound energy to combat sagging skin by stimulating collagen production, resulting in firmer, more lifted skin.
At our clinic, we use the ULTRA FORMER III at Kojimachi and the ULTRA FORMER MPT at Koenji. These devices employ handpieces with depths of 2mm, 3mm, and 4.5mm, effectively delivering heat to the dermis, subcutaneous tissue, and SMAS fascia to improve deep-layer sagging.
This treatment offers a low risk of burns since the energy specifically targets deep layers of the skin. Additionally, it requires minimal downtime, allowing patients to return to their daily activities quickly.
ULTRA FORMER III vs. ULTRA FORMER MPT
| Feature | ULTRA FORMER III (Kojimachi) | ULTRA FORMER MPT (Koenji) |
|---|---|---|
| Mode | Dot | Dot + Line |
| Treatment Time | ~40 minutes | ~30 minutes |
| Shot Count | 680 | 680 |
| 4.5mm Output | 0.8J | 0.7J (adjustable to 0.8J) |
Line Mode: The MPT device combines dot and line modes, reducing treatment time and slightly minimizing discomfort.
Output Adjustment: The MPT standard output is 0.1J lower than the III, but it can be increased upon request, with a corresponding rise in discomfort and risks.
Optional 1.5mm HIFU Booster
The ULTRA FORMER MPT offers an additional 1.5mm booster to address fine wrinkles on shallow layers. (Available only at Koenji; limited stock).
Effects of HIFU
HIFU has been shown in multiple studies to be an effective and non-invasive treatment for sagging skin and wrinkles on the face and neck, making it highly beneficial for rejuvenation.¹²³⁴⁵
- Skin Tightening and Lifting
- HIFU delivers heat to three layers—the dermis, subcutaneous tissue, and fascia (SMAS)—to tighten and lift sagging skin.²⁵⁶⁷ By stimulating collagen production, which diminishes with age, it restores skin elasticity and provides a noticeable lifting effect.
- Wrinkle Reduction
- By heating the dermis, HIFU promotes collagen production, effectively improving fine lines and wrinkles around the eyes, forehead, and mouth. It also reduces deeper wrinkles, such as nasolabial folds, by tightening the dermis, subcutaneous tissue, and fascia.
- Localized Fat Reduction
- HIFU focuses heat energy on fat cells, breaking them down by creating small perforations. These damaged fat cells are gradually digested and eliminated by macrophages, a type of white blood cell. Recent studies have also highlighted HIFU’s ability to reduce subcutaneous fat and contour the body.⁸⁹
Differences Between HIFU and HIFU Shower
| Feature | HIFU | HIFU Shower |
|---|---|---|
| Target Depth | 3mm, 4.5mm | 2mm |
| Shot Count | 680 (Full Face) | 300 (Full Face) |
| Treatment Time | 40 minutes | 20 minutes |
| Pain Level | Strong | Mild |
| Frequency | Every 6 months | Monthly |
HIFU is designed to penetrate deeper layers, including subcutaneous tissue and fascia, making it highly effective for significant sagging. For maintenance, the HIFU Shower is recommended to provide ongoing improvements to skin texture and elasticity.
Thermagen and Thermaneedle
Thermagen
Thermagen is a treatment that uses radiofrequency (RF) energy to tighten subcutaneous fat and lift the skin. It effectively reduces sagging with less discomfort compared to HIFU, making it a popular choice. When combined with HIFU, it delivers synergistic results. The effects of Thermagen reach their peak 2 weeks to 1 month after treatment.
Research on RF treatments has shown significant results:
- In Italy, 17 participants underwent six RF treatments, with 25–30% of sagging reduced within two weeks and about 50% improvement after six months.
- In Korea, 73.5% of 34 patients reported visible improvements in sagging within 1–2 months post-treatment, and 82% expressed satisfaction.¹¹¹²
Thermaneedle
Thermaneedle combines RF energy with microneedles to deliver heat directly to the dermis. This stimulates collagen and elastin production, enhancing skin elasticity and reducing fine lines.
At our clinic, we recommend combining Thermaneedle with exosomes and placenta for enhanced results. Due to the use of microneedles, some downtime is expected.
Research on microneedle RF treatments has demonstrated promising outcomes:
- In Korea, 11 participants aged 30–75 underwent three treatments at four-week intervals, with all showing improvement in wrinkles around the eyes. Skin biopsies of two patients confirmed increased collagen and elastin production.
- Similarly, studies in the U.S. reported comparable collagen and elastin increases, albeit with smaller sample sizes.¹³¹⁴
Differences Between HIFU and Thermagen
Both HIFU and Thermagen use heat energy to improve skin tightening and reduce wrinkles or sagging, but they target different depths and address specific concerns.
- HIFU: Delivers focused heat energy to deep subcutaneous layers and the superficial muscular aponeurotic system (SMAS), making it ideal for deep wrinkles (e.g., nasolabial folds) and overall sagging.
- Thermagen: Distributes heat over a broader area, targeting the dermis and upper subcutaneous layers. It is better suited for improving skin elasticity, fine lines, and mild fat-related sagging.
By leveraging these differences, we recommend combination treatments of HIFU and Thermagen to achieve comprehensive results.
Comparison Table: HIFU vs. Thermagen
| Feature | HIFU | Thermagen |
|---|---|---|
| Mechanism | Ultrasound | Radiofrequency (RF) |
| Target Depth | Deep subcutaneous layers & SMAS | Dermis & upper subcutaneous layers |
| Downtime | Minimal | Minimal |
| Treatment Time | ~40 minutes | ~40 minutes |
| Pain Level | Higher | Lower than HIFU |
| Frequency | Every 6 months | Every 2–3 months |
Recommended for Thermaneedle Over Thermagen
- Individuals with Less Facial Fat
Thermaneedle is more suitable for those with minimal facial fat, while Thermagen is recommended for individuals with higher fat levels. - Those Concerned About Fine Wrinkles
The combination of microneedles and RF energy targets the skin’s surface layer, effectively improving fine wrinkles. - Neck Wrinkles and Sagging
While Thermagen is typically limited to the jawline, Thermaneedle can also be applied to the neck, making it ideal for addressing neck wrinkles and sagging. - Restoring Skin Elasticity and Firmness
Thermaneedle stimulates collagen and elastin production by delivering heat to the dermis, improving skin elasticity and firmness. Combining this treatment with exosomes (human adipose-derived stem cell culture fluid) or placenta extract can further enhance the results.
Differences Between Thermaneedle and Dermapen
Thermaneedle uses a combination of microneedles and RF energy to stimulate collagen and elastin production, improving skin elasticity and fine wrinkles. On the other hand, Dermapen utilizes adjustable needles and repeated punctures, making it more effective for breaking down scar tissue from acne scars.
| Feature | Thermaneedle | Dermapen |
|---|---|---|
| Mechanism | Microneedles + RF energy | Microneedles |
| Depth | Up to 1mm | Up to 3mm |
| Focus Areas | Fine wrinkles, elasticity, firmness | Acne scars (depressions) |
| Downtime | A few hours to 1 week | A few days to 1 week |
| Treatment Time | ~40 minutes (full face) | ~60 minutes (full face) |
| Pain Level | High | High |
| Frequency | Every 1 month | Every 1 month |
Recommended Treatment Intervals
- HIFU: Once every 6 months (every 3 months for the first 3 sessions)
- HIFU Shower: Once a month
- Thermagen: Every 2–3 months
- Thermaneedle: Once every 3 months (every month for the first 5 sessions)
Note:
- HIFU and Thermagen can be performed on the same day (available only at the Kojimachi clinic).
- Both HIFU and Thermagen can also be performed as standalone treatments.
Who Should Avoid These Treatments
- 1.Pregnant or possibly pregnant women
- 2.Severe diabetes or keloid history
- 3.Pacemakers, gold threads, or gold treatment
- 4.Areas with prosthetics, silicone, implants, or metal
- 5.Isotretinoin users within the past month
- 6.Hyaluronic acid or thread lift within the past month
- 7.Botulinum toxin injections within the past 2 weeks
- 8.Hair removal or peeling within the past 2 weeks
Side Effects and Risks
| Pain | ●HIFU: Can cause heat and strong pain; muscle soreness and dull pain may last for about 2 weeks. Cream anesthesia (¥3,300) is available, but pain may still occur. ●HIFU Shower: May cause mild pain or heat; anesthesia is not needed. ●Thermagen: Pain and heat may increase with more passes; anesthesia is usually not needed. ●Thermaneedle: Due to discomfort, a topical anesthesia cream (¥3,300) is applied before the procedure. Soreness and dull pain may last for a few days after treatment. |
|---|---|
| Redness | ●HIFU / HIFU Shower / Thermagen: Redness usually subsides within a few hours. Severe redness could indicate burns; cool the area and consult a doctor or nurse. ●Thermaneedle: Redness, swelling, peeling, or itching may last for a few days to a week. |
| Melasma | Treatment could rarely worsen skin pigmentation (melasma). |
| Bruising | Rare, but if it occurs, it usually heals within 2 weeks. |
| Burns | Extremely rare; cool the area and see a doctor. Scarring may occur depending on your skin type. |
| Fat Loss | Frequent treatments may rarely lead to fat loss in the treated area. |
| Nerve Damage | Very rarely, numbness, tingling, or movement disorders have been reported. These usually improve within three months, but in rare cases, they may persist. |
| Fillers / Threads Dissolution | Treatment may accelerate the breakdown of Hyaluronic Acid or Threads. Wait at least 1 month after such procedures before undergoing treatment. |
| Anesthesia Allergy | Extremely rare but severe allergic reactions (anaphylaxis) to cream anesthesia (contains lidocaine, propylene glycol, ethanol, methylparaben, etc.) are possible, including rash, swelling, breathing difficulties, and more. |
Prices
HIFU Full Face Fee
| Treatment Menu | Depth | Shots | Price (tax incl.) |
|---|---|---|---|
| Full Face HIFU (including under the chin) | 2.0mm (dermis) 3.0mm (fat layer) 4.5mm (SMAS layer) | 680 | ¥59,400 |
HIFU Shower Full Face Fee
| Treatment Menu | Depth | Shots | Price (tax incl.) |
|---|---|---|---|
| Full Face HIFU Shower | 2.0mm (dermis) | 300 | Regular Price: ¥29,700 HIFU Discount: ¥19,800 |
※The HIFU discount applies if you receive HIFU Shower within 6 months of a full-face HIFU treatment. You can use this discount multiple times within the period.
HIFU / HIFU Shower Additional Treatment Fees
Add-on treatments offer reduced rates when combined with full face HIFU or HIFU shower:
| Treatment Menu | Depth | Shots | Price (tax incl.) |
|---|---|---|---|
| Neck | 2.0mm (dermis to SMAS) | 200 | With full face: ¥13,200 Standalone: ¥19,800 |
| Double Chin (fat dissolution) | 6.0mm (deep fat layer) | 60 | With full face: ¥5,500 Standalone: ¥7,700 |
| Under Nose (philtrum shortening HIFU) | 2.0mm (dermis to SMAS) | 36 | With full face: ¥2,200 Standalone: ¥3,300 |
| HIFU Booster (Koenji only) | 1.5mm (superficial dermis) | 200 | With full face: ¥8,800 (limited stock) |
Thermagen Fees (available only at the Kojimachi clinic)
| Treatment Menu | Area | Price (tax incl.) |
|---|---|---|
| Thermagen | Full Face | Regular Price:¥44,000 HIFU Discount:¥33,000 |
| Under Chin | With full face：¥11,000 Standalone：¥19,800 |
※The HIFU discount applies if you receive Thermagen within 6 months of a full-face HIFU treatment.
Thermaneedle Fees (available only at the Kojimachi clinic)
| Treatment Menu | Area | Price (tax incl.) |
|---|---|---|
| Thermaneedle | Full Face | ¥33,000 |
| Under Chin | With full face：¥11,000 Standalone：¥19,800 | |
| Neck | With full face：¥24,200 Standalone：¥29,700 | |
| Options | Exosome 1V (human adipose-derived stem cell culture medium) | ¥24,200 |
| Juvelook（1/4V） | ¥19,800 | |
| Placenta 1A（2mL） | ¥990 | |
| Other | Cream Anesthesia (face) | ¥3,300 |
- Using placenta or exosomes requires a consent form due to blood donation restrictions.
- We use one vial of exosomes per patient. To maintain effectiveness (activity), it is dissolved just before use.
- Exosomes are dissolved in 2-3 mL of saline. One vial can be dissolved in 4 mL for use on the face and neck, and more than one vial can be used if needed. Exosomes can also be mixed with placenta (Laennec or Melsmon).
- If you wish to have anesthesia under the chin or on the neck, an additional fee will be charged based on the area.
Designation Fee
| Service | Price (tax incl.) |
|---|---|
| Designation Fee | ¥1,100 |
- You can designate a nurse for your treatment. No fee is charged if you don’t specify.
- If HIFU and Thermage are performed on the same day, the designation fee is charged only once.
- Depending on the nurse’s schedule, your preferred date and time may not be available for designation.
How to Reserve:
Please make your reservation through our online booking form or via email.
Changes and Cancellations:
- Same-day cancellations or changes will incur a cancellation fee of ¥11,000.
- Cancellations made by 6:00 PM on the previous business day are free of charge.
- We kindly ask you to contact us as early as possible for any changes or cancellations.
Late Arrivals:
If you arrive late for your appointment, the treatment will be adjusted to fit the remaining scheduled time.
References and Sources
- Zehra Aşiran Serdar, “Efficacy of high-intensity focused ultrasound in facial and neck rejuvenation” J Cosmet Dermatol. 2020 Feb;19(2):353-358. doi: 10.1111/jocd.13008. PMID: 31141286
- Sabrina Guillen Fabi. “Noninvasive skin tightening: focus on new ultrasound techniques” Clin Cosmet Investig Dermatol. 2015 Feb 5;8:47-52. doi: 10.2147/CCID.S69118. PMID: 25709486
- Arié Azuelos, “High-Intensity Focused Ultrasound: A Satisfactory Noninvasive Procedure for Neck Rejuvenation” Aesthet Surg J. 2019 Jul 12;39(8):NP343-NP351. doi: 10.1093/asj/sjz093.
- Parvaneh Saket, “Study of efficacy of esthetic High-Intensity Focused Ultrasound system on Iranian skin for reducing the laxity and wrinkles of aging” J Cosmet Dermatol. 2017 Sep;16(3):336-341. doi: 10.1111/jocd.12317. PMID: 28150435
- Hyunchul Park, “High-Intensity Focused Ultrasound for the Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas” Ann Dermatol. 2015 Dec;27(6):688-93. doi: 10.5021/ad.2015.27.6.688. PMID: 26719637
- Karol A Gutowski, “Microfocused Ultrasound for Skin Tightening” Clin Plast Surg. 2016 Jul;43(3):577-82. doi: 10.1016/j.cps.2016.03.012. PMID: 27363772
- Dong Hye Suh, “Intense focused ultrasound tightening in Asian skin: clinical and pathologic results” Dermatol Surg. 2011 Nov;37(11):1595-602. doi: 10.1111/j.1524-4725.2011.02094.x. PMID: 21806707
- E J Ko, “Efficacy and safety of non-invasive body tightening with high-intensity focused ultrasound (HIFU)” Skin Res Technol. 2017 Nov;23(4):558-562. doi: 10.1111/srt.12371.
- T-R Kwon, “Improved methods for evaluating pre-clinical and histological effects of subcutaneous fat reduction using high-intensity focused ultrasound in a porcine model” Skin Res Technol. 2017 May;23(2):194-201. doi: 10.1111/srt.12319.
- Elsaie ML, Choudhary S, Leiva A, Nouri K. “Nonablative radiofrequency for skin rejuvenation” Dermatol Surg. 2010 May;36(5):577-89. doi: 10.1111/j.1524-4725.2010.01510.x. Epub 2010 Apr 2. PMID: 20384760.
- Hwang Y, Arayaskul S, Vachiramon V, Yi KH. “Subjective evaluation of monopolar radiofrequency treatment by patients in aesthetic rejuvenation. Skin Res Technol” 2024 Feb;30(2):e13593. doi: 10.1111/srt.13593. PMID: 38279602; PMCID: PMC10818126.
- Taub AF, Tucker RD, Palange A. “Facial tightening with an advanced 4-MHz monopolar radiofrequency device” J Drugs Dermatol. 2012 Nov;11(11):1288-94. PMID: 23135076.
- Kim KE, Park JH, Seul TW, Kim IH, Ryu HJ. Periorbital Skin Rejuvenation of Asian Skin Using Microneedle Fractional Radiofrequency. Ann Dermatol. 2023 Oct;35(5):360-366. https://doi.org/10.5021/ad.22.217
- Elena Flegontova, “Correction of age-related changes in the skin at the dermal and subdermal level using radiofrequency macroneedling therapy” J Cosmet Dermatol. 2024 Jul;23(7):2401-2410. doi: 10.1111/jocd.16361. PMID: 38778550
- Nobari NN, Tabavar A, Sadeghi S, Dehghani A, Kalantari Y, Ghassemi M, Atefi N, Goodarzi A. A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers Med Sci. 2023 Feb 7;38(1):67. doi: 10.1007/s10103-022-03694-x. PMID: 36749436.
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