Facial rejuvenation with non-invasive energy-based techniques and fillers

Facial rejuvenation with non-invasive energy-based techniques and fillers

Facial rejuvenation with non-invasive energy-based techniques and fillers

For many years, some institutions have been attempting to use non-invasive (i.e. non-surgical) methods for facial rejuvenation, in response to increasing public demand.

At regular intervals, reports appear in the media of new ‘miracle treatments’ that claim to make surgical face and neck lifts entirely unnecessary. Doctors are often quoted as experts in these methods, and patients testify to the results with photographs to support their claims. The list of such devices, treatments and injectable substances is immense. In particular, we are talking about things like RADIOFREQUENCY (‘RF’), High Intensity Focused Ultrasound (‘HIFU’) and BIOSTIMULATORS.

We would like to warn consumers that many of the posts that appear online and on social media are sponsored by the industry, which often means that commercial interests take precedence over patients’ welfare.

Although some of these treatments have in fact been demonstrated to produce minimal visible improvements to several characteristics, such as a certain tightening of the skin, reduction of sagging cheeks, reduced wrinkles, etc., there is an important caveat!

To date, there is absolutely no non-surgical treatment whatsoever that comes close to the result of a competently performed facelift. You might object that all you want is a slight improvement, and that these treatments won’t do any harm anyway.

But this is exactly where the problem lies. All too often, patients who have undergone one or more of these treatments will ask for a ‘real’ facelift some time later, because their facial tissues have sunk again or because they did not feel that the method had a sufficient effect.

In fact, a number of world-renowned facial surgeons have warned over the past five years of disastrous scenarios in patients who had previously been treated with the methods above (RF, HIFU or biostimulators). Surgery turns out to be particularly difficult because the subcutaneous tissues have been scarred by these methods, reducing the blood flow to the skin. The injected substances are often found under the skin in the form of hard lumps and fibrotic tissue, etc. This has also been our experience in recent years.

This means that, a facelift or neck lift operation is far more technically challenging if such methods have been used in the past, and the risk of complications such as adhesions, irregularities, haemorrhage, nerve injuries and even skin necrosis is much greater.

Along with dozens of renowned colleagues, we would like to warn all our patients only ever to consider treatments with RF, HIFU, or biostimulators if they are absolutely sure that they will never want to undergo surgery for a facelift, neck lift or forehead lift later on.



In summary, only fillers based on hyaluronic acid are safe enough to fill small volume deficiencies temporarily (e.g. in nasolabial folds, the corners of the mouth, cheekbones, etc.). The reassurance that all hyaluronic acid spontaneously disappears completely is starting to be questioned in scientific literature.

When facial surgery is conducted after previous injections of hyaluronic acid, we recommend removing the remaining hyaluronic acid by injecting the enzyme hyaluronidase (which dissolves the hyaluronic acid). We are a great advocate of volume correction by injecting the patient’s own fat (lipofilling). If done professionally, this produces the best and most natural results in the long term.

We strongly advise against treatments such as HIFU and radiofrequency for the face and neck.


Please see the enclosed article, published in top scientific journal Plastic & Reconstructive Surgery.