The principle behind ultrasound and radiofrequency lifting lies in stimulating the skin to boost elasticity through targeted waves. What we typically refer to as "youthful skin" is actually skin with a "thickened dermis." The dermis is the layer sandwiched between the epidermis on top and the subcutaneous fat layer below. As we age, both the skin and fat layers thin, and the collagen and elastin fibers in the dermis break down, leading to fine lines. Ultrasound and radiofrequency devices can counteract this process by enhancing elasticity.
Radio Frequency (RF) treatments deliver heat of around 40-50 degrees Celsius to the lower dermis without damaging the epidermis. This heat stimulates collagen contraction (tightening) and production, which improves skin elasticity. Common RF devices include Scarlet, Thermage, and Inmode.
For wrinkle reduction using ultrasound, High-Intensity Focused Ultrasound (HIFU) technology is used. When ultrasound waves are focused through a lens onto a specific point, physical heat is generated only at that focal area. This allows targeted treatment, promoting skin regeneration and elasticity. HIFU devices penetrate deeper than RF, reaching the SMAS (Superficial Musculoaponeurotic System) layer where the skin meets muscle, as well as the subcutaneous fat layer under the dermis. Notable HIFU devices include Ulthera, Doublo, Shurink, and Liftera.
Most Side Effects Are Mild, But Nerve Damage Is Possible
Ultrasound and radiofrequency devices primarily target the lower dermis without affecting the epidermis, making side effects relatively uncommon. However, because skin thickness varies by individual, those with thinner skin may experience heat-related side effects such as burns, blisters, or swelling if the heat reaches the epidermis. Other possible side effects include redness, skin hardening due to collagen contraction, dryness, inflammation, and surface irregularities. Skin irregularities occur when collagen contracts unevenly within the dermis, causing a bumpy or uneven appearance on the skin’s surface. In the case of HIFU, which focuses heat on specific areas, thin skin or treatment near nerve-rich areas can lead to neuralgia (nerve pain). While damaged nerves generally heal on their own, the recovery period may extend from six months to a year, so caution is advised. That said, side effects from ultrasound and RF devices are usually mild and tend to resolve within two weeks to two months with proper care.
For individuals who have previously received filler, Botox, or have implants or lifting threads under the skin, can they safely undergo ultrasound or RF treatments? Generally, there’s no significant risk. However, if filler is injected closer to the surface than the typical range of HIFU, there is a possibility that the filler could be absorbed or scarring might occur in that area. Informing the practitioner about any previous filler in the treatment area can effectively prevent these issues.
Does Starting Treatments Early Cause Skin to Sag? "Lack of Scientific Evidence"
Regarding the myth that “starting lifting treatments in your 20s makes skin sag more as you age,” Dr. Eun-Soo Park from Soonchunhyang University Bucheon Hospital’s Plastic Surgery Department explains, “There is limited scientific evidence to fully support this claim.” While it’s true that lifting procedures aim to improve elasticity and aren’t necessarily needed in one’s 20s, undergoing such treatments at a young age isn’t likely to harm the skin. Dr. Ji-In Jung of Yonsei Star Dermatology Clinic adds, “Since lifting treatments aim to regenerate skin, there’s no theoretical harm in having them in one’s 20s.” However, he notes that there is currently insufficient scientific backing for this belief.
Dr. Jung does caution that for procedures like “thread lifting,” which physically lifts the skin by inserting threads, starting in one’s 20s could place unnecessary strain on the skin. Addressing concerns about excessive lifting treatments potentially leading to reduced skin elasticity, Dr. Park explains, “If treatment intervals are too short, excessive stimulation could stress the skin. Rather than reducing elasticity, it may increase the likelihood of complications from over-treatment.” He further clarifies that “the concept of placing stress on the skin is more accurate.
Get Treatments at Proper Intervals, Tailored to Skin Thickness, from a Specialist
The recommended treatment interval varies depending on individual needs and clinic guidelines. Generally, Thermage is performed every 1 to 1.5 years, while HIFU treatments involve an initial touch-up three months after the first session, followed by annual treatments.
While these treatments are effective for wrinkle reduction and improving skin elasticity, expecting “rejuvenation” levels of transformation may be unrealistic. If aging has already progressed and sagging is significant, the improvements from these treatments may be subtle. Ultrasound and radiofrequency treatments are ideal for individuals looking to appear “a bit younger than their age.” The most suitable age range is the late 30s to early 40s, although those in their 50s may also benefit as part of a long-term maintenance plan.
For individuals with thicker-than-average skin, the lifting effect might be less noticeable even if the dermis tightens. It’s also advised to avoid these treatments on areas affected by conditions like acne, atopic dermatitis, or sensitive skin lesions. Additionally, patients who have received fillers or similar treatments should inform their specialist beforehand.
