摘要

Objectives: This presentation aims to anatomically analyze age-related changes in facial structure and demonstrate that selecting appropriate non-invasive skin tightening devices—such as high-intensity focused ultrasound (HIFU), monopolar radiofrequency (RF), and other RF or laser-based technologies—based on those changes leads to successful clinical outcomes. The study also clarifies differences in treatment effects resulting from device-specific concepts and examines their influence on facial fat volume. Introduction: In Japan, two major topics dominate discussions on non-invasive skin tightening: (1) how conceptual differences between devices affect treatment outcomes, and (2) whether these treatments reduce facial fat. However, the essence of facial aging lies in anatomical changes such as gravitational descent of superficial fat compartments and the weakening of supportive structures. Therefore, assessing how each device’s energy characteristics and depth of action respond to these anatomical aging patterns is crucial to achieving optimal clinical results. Materials / method: Subjects aged 20–70 underwent treatments using multiple skin tightening devices, including HIFU and monopolar RF. Device selection was made based on individual anatomical findings. Three-dimensional imaging analysis was performed to evaluate skin and tissue movement, as well as volume changes, across 14 superficial facial fat compartments. Differences in tissue responses were analyzed based on each device’s mechanism of action. Results: HIFU predominantly produced vertical lifting, particularly in the lateral facial regions, while RF induced multidirectional tissue mobilization, especially in the central face including the nasolabial area. No significant reduction in fat volume was observed with any device, confirming the ability to achieve lifting while preserving facial volume. Combination treatments tailored to anatomical goals yielded more pronounced lifting effects than either modality alone. Conclusion: Accurate identification of anatomical aging changes and the selection of suitable HIFU or RF devices accordingly can greatly enhance the effectiveness of non-invasive skin tightening. This study provides clear answers to ongoing debates regarding differences in device concepts and concerns over fat reduction. As new technologies continue to emerge, understanding device mechanisms and designing anatomy-guided treatment plans will remain essential to successful facial rejuvenation.