Forbidden areas for HIFU therapy: How to avoid complications?

1. What is HIFU and why are there limitations?

HIFU (High-Intensity Focused Ultrasound) is a non-invasive technology that uses focused ultrasound waves to stimulate collagen synthesis and achieve a lifting effect. HIFU generates strong thermal energy, which requires strict adherence to restrictions when treating certain areas.

📌 According to FDA (2019), incorrect application of HIFU can lead to temporary or even permanent side effects.

2. Prohibited areas where HIFU is contraindicated

2.1. Area around the eyes

• Anatomy: Thin skin (<2 mm), close to the eyeball
• Risks:
  • Injury to the orbicularis oculi muscle
  • Temporal asymmetry (in 3% of cases, Aesthetic Surgery Journal, 2020)
  • Dry eyes, drooping eyelids, visual disturbances
• Source: PubMed, 2020

2.2. Thyroid gland

• Risks:
  • Disorders in hormonal function
  • Damage to glandular tissue
• Source: Journal of Cosmetic Dermatology, 2021 (ScienceDirect)

2.3. Lateral part of the neck

• Anatomy: Facial nerves, large blood vessels (e.g. external jugular vein)
• Risks:
  • Neuritis
  • Thrombosis
• Source: Plastic and Reconstructive Surgery, 2018 (NCBI)

2.4. Midline of the face (nose, hump)

• Risks:
  • Uneven result
  • Pain due to bone energy absorption
• Source: Ultherapy White Paper, 2022

2.5. Bony prominences (cheekbones, jaw)

• Risks:
  • Periosteal injury
  • Intense pain
• Source: Ultrasound in Aesthetic Medicine, Schonauer, 2021

2.6. Pigmented lesions (birthmarks, melanomas)

• Risks:
  • Stimulation of pigment or tumor cells
• Source: FDA Recommendations, 2019

3. Conditionally permitted areas (subject to strict conditions)

3.1. Upper eyelid

• Conditions:
  • Depth ≤ 4 mm
  • Reduced energy ≤ 0.5 kJ
• Source: Dermatologic Surgery, 2023

3.2. Neck (excluding midline)

• Conditions:
  • Reduced energy ≤ 0.5 kJ
• Source: Dermatologic Surgery, 2023

4. Key safety factors

4.1. Qualification of the therapist

• Special HIFU training
• Certificate from a recognized institution
• Source: FDA Guidelines

4.2. Equipment quality

• Recommended devices: Ultherapy, Ultraformer III, Doublo
• Source: Aesthetic Surgery Journal, 2022

4.3. Preliminary assessment of the patient

• Skin analysis
• Marking risk areas before the procedure

5. Alternatives for risk areas

For the eye area:

• Radiofrequency therapy (RF)
• Microcurrent therapy
• Advantage: controlled depth of impact

For pigmented lesions:

• Laser therapy
• Cryotherapy

6. Frequently Asked Questions

Is it possible for HIFU to cause permanent nerve damage?
✔️ Yes – especially with improper treatment of the neck and the area above the collarbone.
Source: Plastic and Reconstructive Surgery, 2018

Why is the midline of the face risky?
✔️ Due to energy absorption by the bones, which can lead to pain and uneven results.
Source: Ultherapy, 2022

7. Conclusion and recommendations

HIFU is an effective method for non-surgical lifting, but:
✔️ Requires strict adherence to contraindications
✔️ Should only be performed by qualified professionals
✔️ Requires high-quality equipment and an individual approach

Advice to customers:
✔️ Always require qualification documents
✔️ Check the equipment and certificates
✔️ Don't hesitate to ask questions

8. Additional resources and scientific literature

Sources:

• "Safety and Efficacy of High-Intensity Focused Ultrasound in Aesthetic Medicine" - Dermatologic Surgery, 2015
• "Consensus Recommendations for Aesthetic Use of HIFU in Asians" - Journal of Cosmetic and Laser Therapy, 2018

Databases:

• PubMed
• ScienceDirect

Regulatory authorities:

• FDA (USA)
• EMA (EU)