Thermage vs HIFU
Thermage is the better choice for skin quality. It heats a block of skin with radiofrequency, it is comfortable enough that most people need no medication, and it is the one used on crepey eyelids. HIFU is the better choice for a dropping jawline. Focused ultrasound places heat much deeper, in the layer a surgeon tightens in a facelift, and that depth is what makes it hurt. Both are one session, both take months to show, and neither replaces surgery.
What it is
Current passes through the tissue to a pad on your back. The skin's resistance to that current is what makes the heat.
Sound energy is focused so it does nothing until it reaches the chosen depth, where it makes a tiny spot of heat.
Where the heat goes
Warmest in the upper skin, spreading down. It cannot be aimed at one layer.
Usually about 1.5, 3 and 4.5 mm. The deepest setting is under the fat, in the layer that holds the lower face up.
What you should see
Crepey texture, fine wrinkles and mild slackness, including thin skin around the eyes.
Jowls, a heavy jawline, a loose neck, a drooping brow. Firmer skin as well, but lift is the point.
What it will not do
What it feels like
The tip is stamped across the area, with a spray of coolant before and after each pulse. Uncomfortable, rarely unbearable.
Numbing cream is standard and many clinics add oral pain medicine. Thin areas like the brow and neck are the worst of it.
How long until it works
Collagen contracts slightly on the day, then rebuilds slowly.
Occasionally a small lift on the day, but the real change is the collagen.
How long it lasts
Downtime
Redness and slight swelling for a few hours.
Swelling and tenderness for a few days. Patchy numbness along the jaw can last a week or two.
Cost
The at-home or drugstore version
They warm the top of the skin a little. The clinic device drives current through the full thickness with a return pad on your back, which is a different scale of heating.
Home ultrasound wands do not focus. They spread a fraction of the power across the surface and never reach the depth this treatment works at.
Who each suits
Two different kinds of energy
Radiofrequency heats tissue by pushing current through it: Your skin resists that current, and the resistance makes heat. The warming is broad, so a whole area firms up a little.
Focused ultrasound heats one spot at one depth: Everything above the focus is left alone. That is how the deep layer can be reached without burning the surface.
Neither depends on colour in the skin, unlike lasers, which work by aiming energy at pigment. Both are therefore usable across skin tones.
Depth is the whole argument
Thermage cannot pick a depth: It heats a volume. If your complaint is the texture and thinness of the skin itself, that is fine, because the skin is what you want warmed.
HIFU can pick a depth, and its deepest setting is the reason people book it: That is the fibrous sheet below the fat which a surgeon pulls on in a facelift.
Deeper is not automatically better: Deep heat is what makes the lift, and it is also what makes the pain and the small nerve risks. If your skin is only slightly loose, the extra depth buys you very little.
HIFU is a category, not one machine
"HIFU" covers many devices with very different reputations: Ultherapy is the original and has the longest published record. Ultraformer and a long list of other machines use the same principle.
Thermage is one named device with one maker: When a clinic says Thermage you know what is in the room.
So ask which HIFU machine will be used: The word alone tells you almost nothing about what you are buying.
The risks worth knowing
Both are low risk in trained hands: Redness, swelling and tenderness settle within days with either.
Thermage's rare problems come from heat concentrating too much: Burns and blistering are uncommon. So is fat loss under the skin, which leaves a small dent.
HIFU's rare problems come from working deep: Temporary numbness or tingling along the jaw is the usual version. Rarely a nerve is irritated enough to cause a few weeks of weakness or a drooping lip, and it recovers. In a very slim face, deep heating can also thin the fat and leave a hollow look.
Before you book
Point at what bothers you in a mirror. Thin, crepey skin and a hanging jaw are different problems.
Ask which machine, and how many pulses or lines are planned. That drives the result more than the brand name.
Ask what pain relief is offered for HIFU, and say plainly how much you are willing to accept.
Tell the clinic about a pacemaker, an implanted defibrillator or metal near the treatment area before booking Thermage.
