Fotona 4D vs Ultherapy (HIFU) vs Thermage vs Filler Lifts: What Are the Differences?

If you are considering a non-surgical facelift treatment, you've come to the right place. The number of options for non-surgical facelifts have increased drastically in recent years, thus making it complicated when it comes to choosing the right one.

non surgical facelift

What is a Non-Surgical Facelift?

A non-surgical face-lift can include a number of different treatments and procedures that aim to address the effects of aging. Non-surgical options for facelifts fall into three categories: replenishing lost volume, resurfacing the superficial skin and tightening deeper tissue. Generally, a range of treatments are used in combination to achieve your overall facial rejuvenation goals.
There are 3 different categories of non-surgical face lifts that can achieve lifting without plastic surgery:
  1. Energy-based
  2. Filler-based
  3. Thread lift-based
The energy based category is the biggest group with various technologies and jargons, thus could be overwhelming and confusing for you as a consumer.

Different depths of penetration for different energy devices for non-surgical facelift

There is no clear path suited to everyone because the procedures used will be dependent on your individual goals. Generally, a range of treatments are used in combination to achieve your overall facial rejuvenation goals.

We will cover the pros and cons of the popular non-surgical facelifts.

1. Fotona 4D Non-Surgical Facelift

Fotona 4D has 4 state of the art lasers that are each designed to enhance your complexion in a unique way. Each one can be adjusted to provide a precise degree of treatment to suit your needs.

Furthermore, they can be combined to achieve a facelift-like result with the added benefit of enhanced skin tone and texture. This fully customised experience can also help protect your skin from damage stemming from overly aggressive treatment.

Fotona 4D Laser Face Lifting indications:
  1. Skin laxity and tightening 
  2. Lines 
  3. Nasolabial fold 
  4. Wrinkles 
  5. Loss of volume 
  6. Uneven tones and texture 

Pros of Fotona 4D:
  1. More effective than Thermage.
  2. No needles or injections needed. Less invasive than threadlifts.
  3. Relatively cheaper than Ultherapy and Thermage.
Con of Fotona 4D:
  1. Not easily available. Not all aesthetic clinics or beauty salons will have this device.

2. Ultherapy (First Generation High Intensity Focused Ultrasound)

Ultherapy (HIFU treatment) delivers High Intensity Focused Ultrasound (HIFU) energy in a bullet-like manner to cause instant tightening of the Superficial Musculo Aponeurotic System (SMAS) layer of the face, stimulating collagen production without cutting the skin surface. The SMAS is the muscular layer that plastic surgeons pull and tighten in a surgical facelift procedure.

Ultherapy provides an instant and immediate lifting effect, followed by collagen stimulation over the next 3 months. Both effects are induced by the ultrasound energy. It's also very safe because the machine allows ultrasound visualization of the different structures and layers under the skin, allowing the operator to precisely target the right tissue - there's almost no chance of burns with this treatment.

Pros of Ultherapy:
  1. Instantly visible lift seen (forehead, eyebrows, cheeks, jowls, neck) with further improvement over 3 months.
  2. No needles or injections needed.
  3. FDA-cleared, non-invasive procedure that lifts and tightens the neck, chin and brow, and improves lines and wrinkles on the chest.
  4. Able to reduce the size of chubby cheeks.
Cons of Ultherapy:
  1. Treatment is pretty painful, although a pain score of 5 - 8/10 can be brought down to 1 - 2/10 with a nerve block.
  2. Efficacy of treatment is variable due to energy level and shot count having variations between different operators.
  3. Not suitable if you are thin-skinned and don’t have much fat on your face.

3. Thermage CPT

Thermage uses a radiofrequency (RF) device to heat the deep, collagen-rich layers of your skin. The heat helps remodel existing collagen and produce new collagen, which improves skin smoothness and texture.

Pros of Thermage:
  1. Face-lift effect is subtle and gentle, recommended for younger patients between 25 - 40 years old.
  2. No needles or injections (ideal if you are fearful of injections but want some sort of facial rejuvenation).
Cons of Thermage:
  1. Thermage can’t lift moderately saggy tissues and skin in older patients. Not suitable for moderate to severe signs of facial aging.
  2. Chance of skin burns.
  3. Burning discomfort during treatment.
Collagen production might take around 6 - 12 weeks, so don't expect obvious results before 6 weeks.

4. Dermal Filler Lifts

Dermal fillers have been used to fill facial depressions, skin folds and volume loss. It was recently discovered that they are extremely effective for face-lifting as well.

Common fillers used in Malaysia nowadays are:
  • Juvederm, Restylane, Belotero, Teosyal (Hyaluronic Acid)
  • Radiesse (Calcium Hydroxyapatite)
  • Sculptra (Poly-L-Lactic acid)
  • Ellanse (Polycaprolactone)
There are various filler lift techniques for different purposes. Some of the more popular filler lift techniques include:

a. The Hairline Lift (originated by Dr Peter Huang, a renowned plastic surgeon of Taiwan) – tightening the sides of your face and jowls via fillers placed in your hairline as an anchor. This has an upward pulling force on all your facial muscles, similar to a surgical facelift effect.

b. Radiesse 3D Vector Lift - Injection of radiesse fillers like threads in vectors that will give a lifting effect.

c. The Butterfly Lift (originated by Dr Puttipong Poomsuwan of Bangkok) – lifting of the true retaining ligaments of the face. It's postulated that depositing the fillers right under those ligaments causes a pressure tenting effect on those ligaments, and thus skin tightening and a "lift" can be witnessed immediately.

Pros of dermal filler lifts:
  1. Instant visible lift seen (cheeks, jowls, smile lines). Good for last-minute lifting before big events.
  2. No downtime.
Cons of dermal filler lifts:
  1. Unable to lift moderate to severely saggy faces.
  2. Large volume of fillers (3 - 7 CCs) needed for full face treatment.
  3. Risk of a chubby-looking face or lumpy skin in inexperienced hands.

5. Threadlifts

The popularity of threadlifts has increased considerably over the past few years. This is largely due to the desire to achieve face lifting without surgery.
how do threadlifts work
The most common types of thread lifts would be the Korean PDO threads and Silhouette threads which are US FDA approved. We do get enquiries on Serdev suture lift but this is an old technique and the trend is moving towards more modern techniques.

Serdev Sutures® are often referred to as “thread lifts". This is incorrect, due to the different characteristics of both techniques. “Thread lifts” use “barbed threads”, which are not sutured, nor fixed, but free floating in subdermal fat tissue, while Serdev Sutures® use semi-elastic absorbable sutures, which are fixed to immobile skeletal structures.

Pros of Korean Threadlift:
  1. Instant visible lift seen which will further improve in 3-4 months (forehead, eyebrows, cheeks, jowls, smile lines, neck, double chin) .
  2. Most dramatic lifting effect among all the listed treatments.
  3. Versatile and suitable for all faces.
Cons of Korean Threadlift:
  1. Skill-Dependent – 8 out of 10 doctors who learn how to perform Korean thread-lifts eventually do not offer it.
  2. High chance of not having any results if not done properly.
  3. Downtime of 3 - 7 days (bruising, swelling, pain). This can be highly minimized in experienced hands. My patients have a downtime of 1 - 2 days.
  4. Chance of side effects in inexperienced hands (thread extrusion, thread migration).
  5. Many low-quality threads made in Korea have flooded the market (be careful of the cheap Korean threads which may have more side effects).

6. Dysport Dermalift (Intra-dermal skin tightening & facelift)

Dysport is another brand of 'botulinum toxin' (the most popular brand being 'Botox'). Dysport Dermalift utilizes tiny injections of Dysport into the skin layer to stimulate skin tightening and increased production of collagen.

Pros of Dysport Dermalift:
  1. Instantly visible lift seen (forehead, eyebrows, cheeks, jowls, neck) with further improvement over 1 week. Good for last-minute lifting before big events.
  2. Cheaper than other procedures.
  3. Able to reduce the width of your face.
  4. Best effects seen if you have mild facial sagging.
Cons of Dysport Dermalift:
  1. Highly-skilled doctor required as side effects like ptosis, asymmetrical smile may occur in less-experienced physicians.
  2. Intra-dermal injections can be quite painful for some patients.
  3. Small chance of urticaria after treatment (rare but easily managed).
This unique way of using Dysport (a brand of Botulinum toxin) originated from Korea when Dr Lee Young Seob, a renowned plastic surgeon, wanted a better alternative to injecting Botox into facial muscles (which is what the majority of doctors worldwide and Singapore are doing). Instead of injecting Dysport into the muscle layer, Dr Lee experimented with injecting Dysport in the skin layer (or intradermally). He found that this caused a contraction effect of the skin layer for 6 months, causing an immediate face-lifting effect without the frozen results of intra-muscular Botox!

Botox vs Dysport note: According to the FDA, it takes a minimum of two times more units of Dysport® to get the same effect as Botox®. So, if the patient has opted for Botox® and received 20 units, the same patient will need 40 units of Dysport® for an equivalent treatment.

Fotona vs Thermage

While both use heat to stimulate collagen growth in the deeper skin layers, Thermage uses radiofrequency to heat tissues from the outside, whereas the treatments like the Fotona Starwalker VERSA3 and Dynamis PIANO heats deep tissues, sparing the skin surface.

Radiofrequency devices like Thermage CPT and Exilis, radiofrequency works by heating the surface layers more so than the deep layers.

There is no way to deliver heat from the inside with a non-invasive radiofrequency device. Some RF devices try to cool the surface to make it more comfortable, but this also reduces effectiveness.

With the Fotona Starwalker VERSA3 and the Dynamis PIANO, however, long to ultra-long pulse laser beams selectively target deep skin layers to tighten fat and ligaments, whilst bypassing the surface skin layer (Journal of the Laser and Health Academy).

Fotona Laser vs Pico Laser

Fotona StarWalker® PQX is Fotona's picosecond laser technology and the newest addition to the highest performance StarWalker® laser family. One of the things that makes the innovative StarWalker® PQX laser system stand out from the competition is that it delivers highest Pico Power & Energy, which, combined with a wide range of sophisticated state-of-the art accessories, offers speed combined with precision in treatments.

Fotona 5D vs Ultherapy

Fotona 5D Laser Lift is a treatment pioneered by aesthetic doctors at SL Aesthetic Clinic, improving upon the original Fotona4D protocol. Unlike conventional laser treatments which only improve our skin’s surface, Fotona 5D does much more than that.

The 5th laser utilises Fotona’s proprietary Er:YAG SMOOTH® mode which is ideal for skin tightening. The intense, controlled superficial skin heating powerfully and safely stimulates collagen remodelling and initiates neocollagenesis (collagen formation). The effect is an overall improvement of laxity and elasticity in the treated areas.

While the Fotona 4D protocol only includes the face and front of the neck, Fotona 5D protocol expands the treated areas to include the frontal hairline and back of the neck. Tightening the skin over the frontal hairline has a lifting effect on the eyebrows. Tightening the skin over the back of the neck improves the appearance of the front of the neck as well. This enlarged treatment area results in tighter skin from our face to our entire neck.

The standard Ultherapy protocol includes the face and neck, but does not include the areas adjacent to the mouth, back of the neck and the central part of the neck in front of our windpipe. This is so as not to damage nerves or other important structures under the skin. Hence, Fotona 5D tightens a larger area of skin compared to Ultherapy.

Just like all the other non-Fotona skin tightening treatments, Ultherapy does not improve the skin’s surface. The last step of Fotona 4D and Fotona 5D is a superficial laser which improves skin texture and polishes away surface imperfections. This additional benefit gives a pleasant pearly finish to the skin, in addition to the tightening and lifting effect.

Key Takeaways

The most important key takeaway is that you should never attempt this procedure with a non-licensed provider as a way to save money. This could not only result in dangerous side effects, but you’ll likely be unhappy with the work and may have to get it done all over again.

Related: Picosure vs Picoway


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