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Blog: Hitting the sag

Prevent or reverse facial sagging with HIFU

Talk to any plastic surgeon and he or she would tell you,

“Asian faces don’t wrinkle, they sag.”

Caucasians tend to have thinner and drier skin. So as they age and lose the elastin, collagen and fat that keep the skin firm and lifted, the skin tends to dry up and wrinkle.

Asians tend to have thicker and oilier skin compared to Caucasians. And when they lose elastin, collagen and fat especially in the upper and mid-face areas, they tend to jowl and develop deep nasolabial lines (smile lines around the nose and mouth).

What I’ve been doing

In the last five years, I’ve been lucky to have had hyaluronic acid filler injections in the cheek and the nasolabial areas which have staved off the deep smile lines and jowling. However I’ve been thinking about undergoing energy-based treatments such as high-intensity focused ultrasound (HIFU) that is touted to be able to stimulate the skin to tighten from inside out.

HIFU targets the superficial musculo-aponeurotic system or SMAS, a system of connective muscular tissue made of elastin and collagen fibres. In other words, SMAS is a frame that supports your facial contours. Ageing causes SMAS to become less elastic and weak, causing the eyebrows, cheeks and jawline to descend, and deforming the facial contours.


For HIFU to be effective in tightening the facial skin, I was told it needs to be at high intensity AND painful. Treatments featuring topline HIFU brands can also be prohibitively expensive.

One acquaintance said she felt as if she had been punched in the face after the treatment, and the soreness took more than a week to go away. Another patient said it was so painful she had to cease the treatment mid-way. However, as it was so effective, the said patient returned to the clinic to undergo the full treatment; this time after taking painkillers to take the edge off the pain.

So when I approached Xpress Medical Aesthetics to give the Doublo Gold HIFU treatment a whirl, I was naturally concerned about the pain, and how much pain I needed to bear for the treatment to produce results.

I was told the Double Gold HIFU could produce results with low power on a relatively young person with no serious facial sagging. However, to glean the best effects from it, I was advised to take the treatment at a level between ‘uncomfortable’ and ‘painful’.

After registering at the waiting area, I was led to the treatment room to cleanse my skin. After cleansing, a cold contact gel was applied onto my skin as I was briefed on how the treatment would feel like. I was told I would not require any painkillers or numbing.

We began the treatment on low power. When the applicator was applied onto my face, it sounded like something was scraping on my bones, and there was a tingling sensation. We worked on the cheek and jawline area, followed by the jowl and neck. As I found the treatment more than bearable, we kicked the intensity up a notch for the second pass.


A few hours after the treatment, my face felt sore on the inside. I did not feel like I had been punched, but lightly slapped on both cheeks. When I chewed or spoke it felt a little tight, but otherwise there was no other major discomfort. The soreness took a few days to go away.

At the end of the fourth or fifth day, my facial skin felt tighter, and my face even felt a little smaller than before. And when I applied my makeup for the first time after the treatment, I noticed my cheekbones looked more defined than before.

I was actually surprised to feel or see any type of effects so soon as the power used for my treatment was so low.

I will definitely return for a second treatment (contingent upon prevailing Covid-19 rules and regulations); this time I will increase the intensity level by another notch!

This treatment is recommended for those who have a little facial sagging or those who want to prevent it from happening in the future, like me!

CAUTION: It is highly advisable to undergo injectable treatments such as fillers or botulinum toxin injections four to six weeks AFTER HIFU, not before.

However if for some reason you can only undergo injectable treatments before your HIFU treatment I would recommend you wait for at least four to six months as HIFU can potentially negate the effects of botulinum toxins if done too soon after treatment.

All photos by yours truly. Video by Rich Sng.

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