ENERGY-BASED DEVICES STIMULATING COLLAGEN FOR NON-SURGICAL LIFTING: A COMPARATIVE REVIEW OF HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) AND RADIOFREQUENCY (RF) TECHNOLOGIES

Abstract

The boom in the global market for non-invasive face-lifting has spurred rapid development of energy-based devices, including high-intensity focused ultrasound (HIFU) and radiofrequency (RF). This review addresses how the collagen neogenesis mechanisms, clinical outcomes, safety and new strategies for combining HIFU and RF (monopolar, bipolar and fractional microneedling) vary. We performed a systematic review of peer-reviewed clinical studies with histological confirmation and objective assessments between 2015 and 2025. The review highlights HIFU to deep SMAS (3.0-4.5 mm), with superior lifting (2.1-2.3 mm at 6 months), and RF pan-dermal contraction, with excellent skin texture changes (47% improvement on VISIA). Both techniques fail to completely correct severe ptosis. The key missing evidence is that there is no Level 1 evidence for the use of combined HIFU+RF, all studies use subjective GAIS instead of objective 3D imaging, and zero long-term histological evidence supporting neo-collagen formation beyond 24 months. We offer an algorithmic treatment based on the degree of laxity. Combination therapy (HIFU followed by microneedling RF) is promising but needs to be confirmed with prospective randomized clinical trials.