Written & reviewed by Dr Tan Ying Zhou (Dr YZ Tan) | Last reviewed: March 2026
Thermage and HIFU are two of the most popular non-surgical face lifting treatments available in Singapore today — but they work differently, target different skin depths, and suit different ageing profiles. At Mizu Aesthetic Clinic in Singapore, we offer both Thermage FLX and medical-grade HIFU (Ultraformer MPT and Ultherapy Prime), and our recommendation is always based on each patient’s individual ageing profile.
Understanding the differences between the two treatments — and which ageing profile each is better suited for — can help patients have a more informed conversation with their doctor before making a decision. This guide introduces a simple framework to
Wrinkles, fine lines, loose skin and saggy areas appear on our faces as we age. Much of this is due to the loss of collagen from our skin.
The dermis layer in our skin is approximately 80% Type I collagen (the most abundant type of collagen in our body), and another 15% consists of Type III collagen, fibroblasts, elastin and hyaluronic acid. Together, they are key components of our skin’s extracellular matrix and provide it with structure, elasticity and firmness.
From our mid to late 20s, our body’s own regenerating capability and production of collagen decreases. Despite our best efforts, we lose 1-2% of our collagen levels in the skin every year.
While surgery such as a “surgical face-lift” used to be the only option for treatment of wrinkles and skin laxity, a variety of non-surgical, non-invasive options are available in Singapore today. Thermage and HIFU systems are two excellent examples of such, and we will be discussing them in more detail here.
As we age, there are generally 3 categories of ageing styles we fall into, with each ageing style exhibiting distinct ageing traits. While we will almost certainly have a mix of features, this is a useful guide to explain how different treatments may be more suitable for different individuals.
The 3 aging styles are: “The Sinker”, “The Sagger” and “The Wrinkler“.
“Sinkers” are characterized by volume loss around key areas of the face such as the temples, mid-face and cheeks. This can cause a sunken, “hollowed-out” or gaunt appearance. Between Thermage and HIFU, Thermage is probably more suitable for sinkers as it does not melt fats and accelerate the gaunt appearance. Sinkers may also see more benefit with a combination of skin tightening treatments including dermal fillers to combat the volume loss.
“Saggers” commonly complain of loose skin and tissue. This is due to the loss of elasticity in addition to collagen. HIFU is useful to stimulate skin tightening of the SMAS layer to achieve a deeper lifting effect; while melting some excess fat and tissue in the lower face helps to turn back the clock too.
“Wrinklers” have predominantly wrinkly skin, often located around the eyes, brows and lips. Anti-wrinkle treatments would be able to achieve effective, visible results for these, but for a longer-lasting treatment, Thermage and/or HIFU can be used. A person with multiple wrinkles and fine lines on the brows, around the eyes and face may benefit more from Thermage, while one with wrinkles and also saggy skin may be more suitable for a HIFU.
Both Thermage and HIFU systems both use energy to invoke and restore collagen production in the dermal layer of the skin. However, the type of energy used is different: Thermage uses radio frequency (RF) energy while HIFU uses ultrasound (US) energy.
The heat energy generated from both Thermage and HIFU are able to penetrate the surface of the skin to the dermis layer to stimulate the production of collagen.
The first tissue tighening device to debut in the USA and approved by FDA since 2002, Thermage uses monopolar radiofrequency technology to deliver heat to the deep dermis. It uses a technique known as bulk heating to tighten saggy skin, smooth wrinkles and stimulate new collagen production.
The primary response from the radiofrequency energy is immediate collagen contraction. This gives the tightening effect, followed by a secondary response of wound healing, which involves collagen remodelling and new collagen deposition. This causes the treatment effect to last for months after the initial skin tightening treatment.
Bulk heating by radiofrequency is generally considered diffused under the skin. This enables Thermage to give an effective full-face rejuvenation and tightening effect.
Thermage heats the skin downwards from the surface (“top-down”); this makes it beneficial to treat superficial skin problems well – such as very fine early wrinkles, enlarged pores, superficial scars and even acne. Thermage is hence useful for improving skin texture too.
HIFU machines, such as Classys’ Ultraformer and Ultherapy uses high-intensity focused ultrasound (HIFU), also known as micro-focused ultrasound (MFU), to deliver heat to deep facial tissues (heating from “inside-out”, as opposed to “top-down” for Thermage).
This allows HIFU to target multiple depths under the skin, ranging from 1.5mm, 3.0mm to 4.5mm. The depth of 4.5mm reaches the sub-dermis and subcutaneous tissues and is deeper than what Thermage can achieve. Hence, HIFU can tighten deep tissues in addition to the skin.
At the depth of 4.5mm, HIFU targets the superficial musculoaponeurotic system (SMAS), which is a thin, band-like muscle which spans the lower half, sides of face as well as the neck. The SMAS is also the same muscle which is targeted by plastic surgeons when doing a surgical “face-lift”! This makes HIFU systems very efficient in lifting saggy lower face and neck tissues.
To me, the beauty of Thermage and HIFU systems is that their results are completely genuine and permanent (unlike fillers or threads, which can “dissolve” away) – this is because they stimulate your body’s own mechanisms of collagen production. Collagen produced through this means is hence natural, safe (they are manufactured by your own fibroblast cells after all!), and long-lasting.
Of course, we continue to age and eventually, our collagen levels decrease again and signs of aging appear. This usually happens in 12-18 months and this may be when a repeat skin tightening procedure may be beneficial.
Scientific studies and clinical trials have been performed to evaluate the effectiveness of both radiofrequency and HIFU-based treatments for skin tightening and lifting. It has been found that skin and tissue tightening continues for 3 months after the end of radiofrequency treatment, and that subsequent remodelling and re-orientation of collagen bundles and the formation of new collagen is achieved over months after treatment.
Dr YZ Tan, Medical Director of Mizu Aesthetic, notes:
“In my clinical experience, the treatment approach for acne scarring is highly individualised. The type of scar — whether rolling, boxcar, or ice pick — influences how we set the device parameters and how we structure the treatment plan. For some patients, combining RF microneedling with PDRN booster injections may support the skin’s repair process. A proper consultation and skin analysis is always the starting point, as every patient’s skin responds differently.”
The information provided in this blog post is for educational and informational purposes only and should not be considered medical advice. Always consult with a healthcare professional or dermatologist before starting any new skincare routine or treatment, especially if you have existing skin conditions or concerns. Results may vary from person to person, and individual needs may require different approaches.
Dr Tan Ying Zhou, known as Dr YZ Tan, is the founder and Medical Director of Mizu Aesthetic Clinic.
His journey into aesthetics began with a medical degree from St. George’s, University of London, followed by an internship in Dermatology at the National Taiwan University Hospital.
Some of his favourite aesthetic procedures include nose augmentation and anti-ageing solutions, and he also serves as a trainer for emerging aesthetic doctors.
His philosophy revolves around personalised treatments tailored to each individual’s ageing concerns, aiming to transform the ageing process gracefully into a pleasant journey towards confidence and wellness.
