In this article, we’ll take a look at HIFU (High Intensity Focused Ultrasound), a treatment using ultrasound devices.

Source: YouTube "HIFU animation"

 

Devices commonly referred to as HIFU (High Intensity Focused Ultrasound) are manufactured by various companies, with well-known examples including Ulthera, Shurink, LinearZ, VRO, and Liftera. All of these devices operate based on the same underlying principle.

 

Among them, Ulthera and Shurink are the most widely used.

 

Dermatology clinics often explain it this way:

"Ulthera has a longer-lasting effect, so one session per year is sufficient.

For Shurink, we recommend three sessions at one-month intervals. If your budget allows, go for Ulthera."

 

In this article, we’ll take a closer look at the direct comparison between the two and why there are differences in their effectiveness.

 

So, which one is more effective?

 

In my opinion, as someone who has used all the HIFU devices available on the market,
Ulthera delivers the best results when we look solely at effectiveness.

 

(Ulthera costs more than three times as much as Shurink.)

However, that doesn’t mean other HIFU devices are ineffective.

 

The reason for the difference in effectiveness between Ulthera and Shurink lies in their default energy settings.

 

Ulthera delivers better results because its base energy output is higher. That said, even with more affordable HIFU devices, if the energy is properly adjusted, you can still achieve excellent results without using high-priced machines like Ulthera.

 

In other words, the effectiveness depends not so much on the device itself, but rather on how the practitioner configures the energy settings for devices like Ulthera and Shurink.

Why Shurink Tends to Be Less Effective

 

The primary reason is that Shurink’s default energy setting is relatively low.

 

After the previous version of Shurink was discontinued, it was upgraded to the “Universe” model, which introduced a new feature called “MP mode,” where the shots are delivered in linear (line-shaped) patterns.

Unlike the traditional normal mode, which delivers energy in dot-shaped spots, MP mode emits energy in a linear pattern.

The manufacturer claims that this allows energy to be delivered evenly without gaps—but I disagree.

 

That’s because the linear pattern requires the base energy to be set lower by design.

(In line mode, the thermal spots are closer together, so using high output increases the risk of side effects.)

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The image above shows the main screen of the Ulthera device.

 

The 3mm setting uses the same energy level as the Shurink Universe, but the 4.5mm setting is noticeably higher at 0.9J.

 

Ulthera uses a dot-based method to create thermal coagulation points, unlike the linear mode used in newer Shurink models. This allows for higher energy to be applied.

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Is It Really Possible to Target the Exact Layer Accurately?

 

Marketing often claims that "ultrasound allows precise targeting of specific tissue layers."
However, in practice, it’s not that simple.

 

While it’s true that the image helps with visualization, even with Ulthera tips, applying pressure and delivering energy exactly to the intended depth is quite challenging.

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With So Many Clinics Offering HIFU Treatments, What Should You Look For?

 

In the past, many clinics used unauthorized or reused cartridges (often referred to as recycled or counterfeit tips).
However, due to increased media coverage, clinics using reused tips have become very rare.

 

Therefore, when receiving treatment with the same type of device, it’s a good idea to start by checking the price.
(A low price doesn’t necessarily mean they are using reused tips.)

 

That said, if price were the only issue, there would be no point in writing this article.

 

From here on, I’ll discuss aspects that most patients are unaware of—but are well known to experienced practitioners.

 

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Why Results Differ Even With the Same Device and Number of Shots

Source: MERZ Korea Website

 

Shots Should Be Distributed at Various Depths

 

As shown in the diagram above, HIFU devices typically come with a 1.5mm cartridge targeting the lower dermis, and 3mm and 4.5mm cartridges targeting the SMAS (muscle) layer.

 

Since every patient has different skin thickness and facial structure, using only one cartridge across the entire face would result in many of the shots being ineffective.

 

Even at the same depth, it's important to distribute the shots based on specific facial areas.

(Thicker muscle areas should receive more shots.)

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Proper Use of the Handpiece Is Essential

 

When using the 1.5mm cartridge to target the dermis, there’s no need to apply pressure.

However, when using the 3mm and 4.5mm cartridges to target the muscle layer, moderate pressure should be applied.

 

Also, avoid applying too much gel.

The patient's neck should be slightly tilted back with the head lowered, and the direction of treatment should ideally be from bottom to top, and from inside to outside.

 

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Appropriate Energy Settings (High Output) Are Required

Source: High-intensity focused ultrasound treatment for skin: ex vivo evaluation, J.H. Park (2016)

 

The principle of HIFU devices is to create thermal coagulation points (TCPs) through focused ultrasound, causing thermal injury at temperatures between 40 to 45°C in the target tissue.

 

This process stimulates regeneration in the dermis.

 

Therefore, if the energy used is insufficient or if the thermal points are inconsistent, the treatment may have little to no effect.

 

As mentioned earlier, the reason Ulthera is considered more effective is because its baseline energy output is higher.

 

If the practitioner has a solid understanding of how HIFU devices work and can safely and effectively apply higher energy, then even lower-cost HIFU devices—like those priced at one-third of Ulthera—can produce excellent results.

 

(However, in reality, higher energy levels slow down the shot speed and extend the treatment time, so many “factory-style” dermatology clinics lower the energy output for efficiency.)

 

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Summary in 3 Points

1. Ulthera and Shurink are both types of HIFU and are effective treatments for skin lifting and improving elasticity.

2. Even with the same treatment and number of shots, the effectiveness varies between clinics depending on the practitioner’s understanding of HIFU.

3. Make sure to check whether appropriate energy settings are being used and that shots aren’t applied at the same depth throughout. Being informed can help you avoid wasting your money.

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That concludes this overview of HIFU treatments.

 

I hope this information has been helpful to many of you.

 

If you have any questions about the treatment, feel free to leave a comment—I’ll be happy to respond kindly and directly.

 

I hope you find a reasonably priced clinic skilled in Ulthera and achieve great results.

 

Thank you.

 

📍 Primi Clinic
3F, 52 Seongsuil-ro, Seongdong-gu, Seoul (Primi Clinic)

 

📍 Primi Clinic
서울특별시 성동구 성수일로 52 3F (Primi Clinic)