HIFU Technology Explained

In this article we answer the most asked and most common questions about HIFU – High Intensity Focused Ultrasound.

3D, 4D,5D, even 14D HIFU…. Why D and what is the difference?
I get asked this question almost daily – what is the difference between 3D, 4D, 7D or even 14D HIFU? This was also one of the main questions at our stand at Sydney Expo recently.

Most of you know me as a Biomedical engineer, educator with close to 30 years in this business. The answer is simple. Let me explain the facts and this whole D business of China.

There are 3 known HIFU technologies.
The first group are HIFU devices with pen like handles. I have seen some calling them MINI HIFU. The Ultrasonic Transducer Head in these devices is stationary, it does not move. The Treatment Head is long and narrow. Therapists have to move the whole HIFU head constantly during treatment usually in circular motion.

The second group of HIFU is called Single Liners. The Ultrasonic Transducer head in these devices is moving inside the head in a line motion up and down delivering a line of heat dots. Therapists move the head by few mm after each line of dots is delivered to the next spot. Heads are usually fairly light and small.

The first ever HIFU introduced to the market, over a decade ago, was the famous single liner Ultherapy or Ulthera by Merz Aesthetics. That is the most copied HIFU by China. Koreans are the biggest manufacturers of Single liner HIFU devices. Many well know Korean brands like Ultraformer 3, Doublo Gold, UTIMS, HIPRO-S, Ultracell Q, Eclip, Microson. None of these well known global HIFU brands ever used a D in definition of the device.

The third technology of HIFU is the multi liners. Developed in China, this technology is manufactured by Chinese manufacturers only. Multi liners are more complex devices as Ultrasonic Transducer Head moves up and down in a line and then head moves left or right to the next position to deliver the next line. Most can go up to 11 lines. Therapists move the head to the next spot after each set of lined is delivered. Head assembly of these HIFU contains a complex gearing assembly. Heads are usually heavier and chunkier.

This is how Chinese come up with this HIFU D in their HIFU devices description.
In the beginning Pen like handle HIFU devices were named by China as 1D.
Single Liners moving in one line were named 2D by China.
Multi liners were named 3D by Chinese.
We can say there are 1D, 2D and 3D HIFU devices.

How it is we now have some HIFU called 4D, 5D, 6D even 14D! Why???
In the beginning Chinese added a vaginal single liner 2D head to the 3D HIFU and named it 5D. Some Chinese added a multi liner 3D vaginal head to the 3D HIFU and named it 6D. Many Chinese HIFU have a 3D main head and added a 1D second pen handle and named it 4D. Some Chinese say HIFU has 7 different cartridges available to treat 7 different depths so it is 7D. There are no rules as to how Chinese use the D. They use it to confuse you, as a marketing tool to sell their devices.

Even now clinic owners make up their own descriptions for online posts like 14D and 16D HIFU trying to make an impression on customers that they have better devices..

Which technology is faster? Pen like HIFU? Single Liners? Multi Liners?
It reality most modern HIFU are pretty fast. Treatment times depends mostly on skills, quality of training and experience of the therapist.

Pen like HIFU or 1D lacks uniformity in delivering heat , therapists use circular motion to deliver energy , delivery of heat energy is random. To the best of my knowledge there is only one TGA approved pen like HIFU, it is made in Korea and it is called HIPRO – V.

Single Liners or 2D deliver one line of dots at the time, distance between the dots is precisely adjustable in the device setting. Therapists need to move the handle by few mm to deliver each line of dots. Ultrasonic cartridges and handles are generally much smaller lighter comparing to multi liners. Most cartridges have 10,000 line life time and replacement cost is around $1,800 – $2,500 per cartridge. Clinic cost for one facial listing treatment is generally between $130 – $200 .

The first commercially available HIFU was the USA made well known Ulthera or also called Ultherapy. Now there are many models available, most well known TGA approved single liner HIFU are made in Korea, brands like Ultraformer , Doublo Gold, Eclip, Utims, Hipro-S UltracellQ, Lipocell. Italians manufacture the HIFU called RENOVA.

Multi liners or 3D are Chinese made HIFU cartridges and handles are generally larger and heavier comparing to 2D. Most multi liners can be set up to 11 lines, therapists place the cartridge to the premarket spot, the head will deliver the set lines and when this is done, the therapist will move the head to next position. Multi liner cartridges usually have 20,000 lines life time and average replacement cost of cartridges is $1,200 each. Clinic cost for one facial treatment is generally between $40 – $50.

“To the best of my knowledge there are only 2 multi liner HIFU included on TGA’s ARTG registry, which are called Ultrasonix and ApoloMed”.

Multi Liner HIFU is possibly the best choice for body treatments due to much lower running cost compared to the single liner HIFU.

Micro Focused and Macro Focused HIFU, what is behind it?
Micro focused HIFU heads target the upper layers of the skin, creating tiny heat spots under the skin, these are designed for face lifting purposes.

Macro Focused HIFU heads are designed for deeper layers, generating much larger diameter heat dots and deliver more energy, these are designed for fat melting body treatments.

Many are questioning if HIFU is considered by TGA as medical devices?
The answer is yes. All HIFU devices are classified by TGA as medical aesthetic devices and have to be included on ARTG registry or, as many say TGA approved.

HIFU being a second best treatment after going under the surgeon’s knife is not a pampering treatment for sure. Ask any doctor about HIFU and pain, they all will say the same, more pain more gain.

If you read any medical studies, Doctors like to go hard and they use Valium or Demerol to make patients more comfortable. Pain is received very different way from a therapists. Therapists can not prescribe or administer any pain killers, in the beauty industry we actually do not even like to use word pain, most use wording like minor discomfort or a stinging sensation. Beauticians in professional HIFU training are trained to use a bit lower energy and still get great results .

Topical anaesthetics and HIFU – why it is not recommended and why it does not work?
HIFU heads generate heat by focusing sound energy to a specific depth under the skin, generating heat up to 70°C. Not much heat is delivered to the surface of the skin.

Does HIFU treatment destroy facial fat?
When HIFU treatments are delivered properly, with the correct cartridge depth – HIFU does NOT destroy facial fat cells (apoptosis). It’s when the 3mm cartridge is utilised on a degraded or thinning dermis, that HIFU can cause unwanted apoptosis, this is where HIFU has earned a negative reputation.

It is imperative to prepare the skin and thicken dermal thickness by other means or forego the use of 3mm cartridge altogether if in doubt.

This is why good training, delivered by experienced and knowledgeable trainers is vital – we teach you how to push the boundaries, safely.