By Dr Chung WL | IYAC Aesthetic Clinic

If two different aesthetic devices can both tighten skin, does it really matter which one is chosen?

At IYAC Aesthetic Clinic, our approach has been shaped by over 20 years of clinical experience with microfocused ultrasound with visualisation (MFU-V), high-intensity focused ultrasound (HIFU), and radiofrequency (RF) treatments.

Over the years, we have learnt to look beyond the machine itself. The more important questions are: what are we trying to achieve, how is energy delivered, and is the treatment truly appropriate for the individual?

 

Why We Developed the Firming Circuit

Skin and underlying tissue do not recognise machine brand names. They simply respond to the physical effects of thermal energy delivered at specific depths.

RF and focused ultrasound work in distinct ways and serve different clinical goals:

• RF Skin Tightening focuses on improving overall skin firmness, refining skin texture, and softening heaviness around the eyes (such as hooded upper eyelids).
• HIFU targets deeper structural layers to refine lower-face contours and definition.

Because facial anatomy and degrees of laxity vary from person to person, the optimal approach depends on individual structural needs.

This realisation led to the development of the Firming Circuit—a combined protocol that uses both RF and HIFU when both overall tightening and targeted lower-face contouring are needed. Rather than simply offering the newest or most trendy device, the focus remains on selecting the appropriate technology and settings for the specific concern being addressed.

 

What Our Clinical Audit Revealed

To better understand and continually improve our treatment outcomes, we conducted an internal clinical audit of patients who underwent RF Skin Tightening and our Firming Circuit protocol.

The review showed that approximately 84% of patients were satisfied with their results, with visible photographic improvement observed in the majority of cases across both groups.

Interestingly, these findings align closely with international clinical data. A 2025 systematic review of 42 studies on microfocused ultrasound with visualisation (MFU-V) reported that approximately 84% of patients self-reported aesthetic improvement. Although these findings involve different technologies and patient populations, they provide a useful reference point for understanding patient-reported outcomes in energy-based skin tightening.

However, both the published literature and our internal audit highlight an important clinical reality: visible photographic improvement does not automatically translate into patient satisfaction.

Skin tightening can improve skin laxity, but energy-based devices cannot correct mid-face volume loss (such as hollow cheeks), a naturally broad lower jaw, or more advanced structural sagging. A treatment may produce measurable photographic improvement and successfully tighten the skin, yet still leave the patient’s primary concern unresolved.

The audit also reinforced another crucial principle: higher energy settings or higher treatment intensities do not automatically produce better results. Understanding the root cause of facial ageing, managing expectations, and customising treatment parameters remain far more important.

 

What This Means for Skin Longevity

As explored in our previous article on Skin Longevity: What Will Your Skin Look Like in 10 Years, maintaining skin quality over time is not about repeatedly chasing the latest machine. It is about understanding how the face and skin evolve with age, then making thoughtful, long-term decisions.

• Early skin laxity with preserved facial volume responds differently than advanced sagging accompanied by structural volume loss.
• Some concerns respond well to energy-based devices, while others require complementary or alternative care.
• With energy-based treatments, achieving a subtle, natural refinement is the most realistic and appropriate outcome.

Regularly auditing clinical results allows us to recognise what works well, address where expectations were missed, and continually refine protocols.

 

The IYAC Takeaway

The ideal skin-tightening treatment is not necessarily the newest or most powerful device available—it is the one best suited to individual facial anatomy, skin health, and treatment goals.

Ultimately, achieving meaningful results relies on careful patient selection, clear expectations, and a commitment to continuous clinical review.

 

Clinical Note & Audit Summary

Audit Details: This internal retrospective practice audit evaluated 53 patients (30 underwent RF Skin Tightening; 23 underwent the Firming Circuit protocol). Among 49 patients with documented feedback, 41 (83.7%) reported satisfaction with their outcome. Visual photographic improvement was documented in 29/30 RF patients and 21/23 Firming Circuit patients.

These findings are observational and intended for internal protocol refinement; they do not constitute a comparative clinical trial. Individual suitability, treatment response, and longevity vary based on personal anatomy and lifestyle factors. A formal clinical assessment is required before undertaking any treatment.

 

References

1. Amiri M, Ajasllari G, Llane A, Casabona G, Pavicic T, Sevi J, et al. Microfocused ultrasound with visualization (MFU-V) effectiveness and safety: a systematic review and meta-analysis. Aesthet Surg J. 2025;45(3)–NP94. doi:10.1093/asj/sjae228.
2. Austin GK, Struble SL, Quatela VC. Evaluating the effectiveness and safety of radiofrequency for face and neck rejuvenation: a systematic review. Lasers Surg Med. 2022;54(1):27–45. doi:10.1002/lsm.23506.
3. Fabi SG, et al. A systematic review of the efficacy of microfocused ultrasound for facial skin tightening. Int J Environ Res Public Health. 2023;20(2):1522. doi:10.3390/ijerph20021522.
4. Ayatollahi A, Gholami J, Saberi M, Hosseini H, Firooz A. Systematic review and meta-analysis of safety and efficacy of high-intensity focused ultrasound (HIFU) for face and neck rejuvenation. Lasers Med Sci. 2020;35(5):1007–1024. doi:10.1007/s10103-020-02957-9.
5.  Alhaddad M, Wu DC, Bolton J, Wilson MJ, Jones IT, Boen M, et al. A randomized, split-face, evaluator-blind clinical trial comparing monopolar radiofrequency versus microfocused ultrasound with visualization for lifting and tightening of the face and upper neck. Dermatol Surg. 2019;45(1):131–139. doi:10.1097/DSS.0000000000001653.
6. Ling J, Zhao H. A systematic review and meta-analysis of the clinical efficacy and patients’ satisfaction of micro-focused ultrasound (MFU) treatment for facial rejuvenation and tightening. Aesthetic Plast Surg. 2023;47(5):1806–1823. doi:10.1007/s00266-023-03384-1.