Sagging Treatment with HIFU– High Intensity Focused Ultrasound –


High-Intensity Focused Ultrasound (HIFU) Therapy

Ultraformer III and Ultraformer MPT

HIFU (High-Intensity Focused Ultrasound) is a treatment that uses ultrasound to apply heat to tissues and improve skin sagging.

Similar to the principle of focusing sunlight with a lens to concentrate energy at one point, HIFU is a technology that focuses ultrasound energy at one point and instantly raises the temperature.

It doesn’t apply heat to the surface of the skin, but instead, it concentrates energy deep inside to generate heat. While the temperature on the surface of the skin during HIFU treatment ranges from 33.1 to 35.6°C, the temperature inside the tissues reaches over 60°C.9

In other words, by focusing ultrasound inside the skin, it doesn’t cause burns on the surface and promotes the production of collagen in the tissues, leading to rejuvenation.4

At our clinic, we offer “Ultraformer III” and “Ultraformer MPT” as medical-grade HIFU devices.

Ultraformer III and Ultraformer MPT

Ultraformer penetration depth

The Ultraformer III and Ultraformer MPT are medical-grade HIFU devices developed by CLASSYS. They are used for cosmetic treatments to improve sagging, wrinkles on the face and neck.

Because ultrasound can penetrate deeper than lasers, using different handpieces with depths of 2mm, 3mm, and 4.5mm, it applies heat from the dermis to the subcutaneous tissues and even the SMAS fascia, effectively improving sagging in deeper layers.

Since ultrasound is applied internally to the skin, causing burns on the surface is very rare, resulting in minimal downtime, such as redness.

Differences between Ultraformer III and Ultraformer MPT

Ultraformer MPT is the successor model of III. There is no difference in effectiveness, but the speed is faster and the pain is slightly less.

UltraformerⅢ (Kojimachi)Ultraformer MPT(Koenji)
ModeDotDot, Line
Whole face, Procedure time40 minutes30 minutes
Whole face, number of shots680 shots680 shots
4.5mm Standard Output0.8J0.7J (0.8J possible)
1.5mm boosterNoneYes (optional)
Differences in mode

Ultraformer III uses a dot method that irradiates with points, but Ultraformer MPT allows you to select a line method that irradiates with lines in addition to dots.

There is no difference in effectiveness between dots and lines, but lines take less time to irradiate and are slightly less painful.

Differences in standard output

The standard output of MPT is 0.1J lower than that of III. For those receiving the treatment for the first time, the irradiation will be performed at standard output, but the effect depends on the output, so for those receiving it for the second time or later, it is possible to increase the MPT output by 0.1J if desired. However, the risk of pain and side effects increases.

1.5mm booster

In addition to the three depths of MPT: 4.5mm, 3mm, and 2mm, treatment using a 1.5mm circular handpiece called a booster can be added as an option. The pen-shaped product makes it easy to irradiate small areas and is effective in preventing fine wrinkles in shallow layers.

*Although the booster claims to have the effect of introducing glutathione (a whitening ingredient), our hospital does not recommend it because the effect of introducing ultrasound into the dermal layer is poor, and the glutathione formulation used for introduction has a very low concentration.

Effectiveness of HIFU

The effectiveness of HIFU has been reported in multiple studies for non-invasively addressing sagging, wrinkles, and rejuvenation of the face and neck.1,2,3,4,5

  1. Tightening and Lifting Sagging:
    • By applying heat to three layers – the dermis, subcutaneous tissue, and fascia – it tightens the skin. This restores firmness to loose skin caused by a reduction in collagen, an essential component for skin elasticity, resulting in a lifting effect.2,5,6,7
  2. Improvement of Wrinkles:
    • By applying heat to the dermis and stimulating collagen production, it improves fine lines and wrinkles around the eyes, at the corners of the eyes, as well as fine lines and small wrinkles on the forehead. Additionally, the tightening effect on the dermis, subcutaneous tissue, and fascia helps improve larger wrinkles such as nasolabial folds.
  3. Spot Fat Reduction:
    • By focusing and delivering concentrated heat energy, it creates punctures in fat cells, essentially breaking them down. This leads to a reduction in fat cells. The fat cells destroyed by ultrasound are consumed by a type of white blood cell called macrophages, gradually digested, and then eliminated from the body. In recent years, the reduction of subcutaneous fat and body tightening effects through HIFU have also been reported.8,9

Case photos of HIFU Therapy

Before treament
After treatment
Before treament
After treatment
Before treament
After treatment

Case Photos: Provided by CLASSYS (Results may vary by individual)

Differences between HIFU and HIFU Shower

After receiving a HIFU treatment from a physician, it is recommended to undergo a HIFU Shower for maintenance purposes.

Around eye
Dermis to subcutaneous
Subcutaneous to fascia
Subcutaneous to fascia

Optional, only available
in Koenji

Optional, only available
in Koenji
Number of Shots (Full Face)680250
Treatment Duration40 minutes20 minutes
Treatment IntervalEvery 3-6 monthsEvery 1-2 months

With the 2mm handpiece, it affects the dermis to subcutaneous tissue, while the 3mm and 4.5mm handpieces target the subcutaneous tissue to the fascia. In areas where the subcutaneous tissue is thin, such as the forehead or around the eyes, even the 2mm handpiece can reach the fascia. Therefore, the choice of handpiece depends on the specific area being treated.

Treatment Intervals and Duration of Effects

HIFU (Full Face Treatment)

For first-time recipients, undergoing the initial three sessions at three-month intervals enhances the likelihood of experiencing noticeable effects. While the peak effectiveness is typically around the second month, the results tend to last for approximately six months. Therefore, we recommend a treatment every six months.

HIFU Shower

We recommend treatments at intervals of one to two months.


To ensure the effectiveness of HIFU treatment, our clinic pays attention to the following aspects:

1. Output Level:

Since the principle of HIFU is based on thermal coagulation for remodeling, the effectiveness relies on the output level. Our clinic adjusts the appropriate output for each area. However, in cases where the treatment is administered by a nurse, there are medical facilities that lower the output during the procedure.

2. Number of Shots:

In addition to output and application technique, the number of shots is crucial for achieving a solid treatment effect. The manufacturer’s recommended number of shots for the entire face is 680 shots.

3. Physician-led Treatment:

Since HIFU reaches the subcutaneous tissues deep within the skin, anatomical knowledge and understanding of nerve pathways are essential. Therefore, at our clinic, a physician always performs the treatment.

4. Treatment Records:

These are the treatment records for full-face HIFU performed by physicians. It does not include HIFU Shower treatments administered by nurses.

HIFU (Performed by Physicians)2020: 183 cases
2021: 163 cases
Treatment Records for Full-Face HIFU (Performed by Physicians)

Treatment Costs

Whole face HIFU treatment fee (by doctor)

Treatment planShotsⅢ outputMPT outputFee (tax included)
Whole face
(under chin included)
2mm 3mm 4.5mm
First time ¥86,900 
After the 2nd time ¥97,900
Repeat discount -¥10,000
(within 6 months)
Tue/Wed discount -¥5,000
Neck (optional) 2mm2000.2J0.2J+¥20,900
Double chin (optional)
6mm (lipolytic effect)
Booster (optional) 1.5mm
※Koenji only, by nurse
  1. A consultation fee will be charged for the first treatment. If you only wish to undergo the second or subsequent treatment, the consultation fee will be waived.
  2. HIFU’s introductory discount rate applies to both Ultraformer III and MPT on your first visit. For example, if you have previously received Ultraformer III at Kojimachi Clinic and are receiving MPT for the first time at Koenji Clinic, the initial discount rate will be applied (please note that repeat discounts will not be applied in this case).
  3. HIFU repeat discounts apply to both Ultraformer III and MPT when receiving repeat treatments within 6 months. For example, if you receive Ultraformer III at Kojimachi Clinic within 6 months of receiving MPT at Koenji Clinic, a repeat discount will be applied.
  4. For the second and subsequent treatments, it is possible to increase the MPT output by 0.1J upon request.
  5. Please note that Ultraformer is an unapproved medical device that is not covered by insurance in Japan.

HIFU Shower fee (by nurse)

Treatment planShotsOutputFee (tax included)
Face 2mm
(Including areas around eyes,
not including chin)
Tue/Wed discount -¥2,000
Neck 2mm
(under chin included)
Tue/Wed discount -¥2,000
Face+Neck 2mm
(Including areas around eyes and chin)
Tue/Wed discount -¥2,000
Under nose 2mm
Booster 1.5mm
(optional only Koenji Clinic)
Reservation Guidelines:
  • For same-day reservation changes or cancellations, a cancellation fee will be charged (HIFU: ¥11,000, HIFU Shower: ¥2,200). Cancellations made by 6:00 PM on the previous business day are free of charge. However, we kindly ask for prompt notification of any changes or cancellations.
  • If you arrive late for your appointment, the treatment will be administered within the remaining allotted time.

People who may not eligible to receive Ultraformer treatment

  1. Those who have a pacemaker or gold thread implanted in the body
  2. Areas with prosthesis, silicone, implants, or metal plates cannot be treated.
  3. Patients with severe diabetes, infection or severe skin disease in the area wished to be treated.
  4. Patients with keloids.
  5. Those who are or may be pregnant.
  6. Patients who have received injections such as hyaluronic acid or Botox within 2 weeks.
  7. Patients who have received peeling therapy, topical tretinoin, laser or phototherapy (including hair removal) within 2 weeks.
  8. Patients who received oral isotretinoin (Roaccutane, Isotroin) treatment within 3 months
  9. Patients who have taken gold preparations (rheumatoid drugs)
  10. Patients who have allergies or shock symptoms caused by anesthesia (optional anesthesia is not available).
  11. Patients who have undergone thread lifts or surgery within 1 month.

Side effects

1. Pain:

During the treatment, you may experience heat and a dull ache. While it is possible to undergo the procedure without anesthesia, for individuals sensitive to pain, we offer the option of applying a cream anesthesia (¥3,300) for added comfort.

After the treatment, you may experience a muscle soreness-like pain when touched, which may last from a few days to two weeks. There is no cause for concern. Please refrain from applying any excessive pressure or massage.

2. Redness and Swelling:

Any redness or swelling that occurs will typically subside within a few hours after the procedure. In rare cases, a feeling of puffiness or warmth may persist for a few days. If you experience intense redness, there is a possibility of a burn. In such cases, please cool the area with an ice pack wrapped in a towel.

3. Burns:

Although rare, there is a risk of burns. The area under the chin is more susceptible to burns, and there may be scarring (raised skin) due to deep burns. For most individuals, improvement occurs over time. However, in extremely rare cases, there may be a residual risk. We will prescribe ointments and medications, so please cool the area and seek prompt medical attention if you experience any of the mentioned symptoms.

4. Bruising:

While rare, pinpoint or linear bruising may occur. It may take 1-2 weeks for improvement.

5. Melasma:

Although rare, there is a possibility of melasma exacerbation. If you experience increased dullness after the procedure, please consult a physician.

6. Fat Reduction:

Frequent irradiation with a handpiece of 3mm or more may, in rare cases, lead to a reduction in fat at the treatment site. Generally, the higher the number of sessions, the higher the risk.

7. Thread Lift Disconnection:

One month or more after thread treatment, when the threads have encapsulated, it is generally considered safe to undergo HIFU. While extremely rare, there have been reported cases of thread lift threads breaking due to HIFU.

8.Nerve Damage:

While extremely rare, there may be impairment of facial and neck nerves, leading to numbness, discomfort, and motor impairment. There may also be symptoms such as discomfort when touched, caused by minor peripheral nerve damage on the skin surface. Improvement usually occurs within three months, but in very rare cases, there may be a residual risk.

9. Anesthesia Allergy:

Although extremely rare, due to individual constitution, there is a possibility of severe allergic reactions (anaphylaxis) to cream anesthesia (containing lidocaine, trace amounts of propylene glycol, ethanol, methylparaben, etc.), which may include systemic rash, swelling of the skin, lips, and tongue, difficulty breathing, palpitations, low blood pressure, loss of consciousness, and seizures.

List of references/websites
  1. 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
  2. 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
  3. 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.
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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.
  9. 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.

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