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Fotona 5D vs 4D vs Thermage FLX vs Ultherapy vs HIFU: What’s the Difference?

Fotona 4d laser lift sagging skin

Notice that your face is looking saggier of late? We feel you.

Saggy skin is one of the biggest bugbears we as aesthetic doctors have to deal with in our daily practice. Correspondingly, non-invasive skin tightening and lifting treatments are, by my reckoning, increasingly popular as people become more savvy about looking their best as they age.

Cue, Fotona5D Laser Lift, a recent entry into the non-invasive skin lifting and tightening market. It is a treatment pioneered by aesthetic doctors at SL Aesthetic Clinic, improving upon the original Fotona4D protocol. Unlike conventional laser treatments which only improve our skin’s surface, Fotona5D does much more than that.

In an aesthetic world already crowded with numerous skin tightening treatments, it is only natural to feel confused. I will share with you the key differences between these treatments and hopefully help you determine the most suitable treatment for you. 

Before you read on on my comparison between these skin lifting treatments, read more about Fotona5D here.

Fotona5D vs Fotona4D

Fotona4D is one of Fotona’s key skin tightening and lifting treatment since 2017. By itself, Fotona4D is an effective treatment using 4 different and complementary lasers which is suitable for almost all skin types. At SL Aesthetic Clinic, we have further improved the protocol by adding a 5th tightening laser (hence 5D) and also expanded the areas treated.

The 5th laser utilises Fotona’s proprietary Er:YAG SMOOTH® mode which is ideal for skin tightening. The intense, controlled superficial skin heating powerfully and safely stimulates collagen remodelling and initiates neocollagenesis (collagen formation). The effect is an overall improvement of laxity and elasticity in the treated areas.

While the Fotona4D protocol only includes the face and front of the neck, our Fotona5D protocol expands the treated areas to include the frontal hairline and back of the neck. Tightening the skin over the frontal hairline has a lifting effect on the eyebrows. Tightening the skin over the back of the neck improves the appearance of the front of the neck as well. This enlarged treatment area results in tighter skin from our face to our entire neck.

Fotona5D vs Thermage FLX

Thermage FLX is the 5th generation skin tightening treatment from Solta, USA. It utilises Mono-polar Capacitive Radio-frequency energy to deliver heat into the skin layers to stimulate collagen.

In my clinic, I prefer to use Thermage FLX for crepey, thinner Caucasian-type skin rather than saggier, heavier Asian-type skin. This is mainly because the Radiofrequency energy does not penetrate as deeply into the skin as compared to the Long-pulsed Nd:YAG laser used in Fotona5D. 

The Thermage FLX protocol includes the face and the front of the neck, but does not include the back of the neck. Laxity at the back of the neck will aggravate neck lines and make our neck skin appear more loose.

As with all the other non-Fotona skin tightening treatments, Thermage FLX does not improve skin clarity. The last step of Fotona4D and Fotona5D is a superficial laser which improves skin texture and polishes away surface imperfections. This additional benefit gives a pleasant pearly finish to the skin, in addition to the tightening and lifting effect.

The Fotona5D Laser Lift is a more comfortable treatment compared to Thermage FLX when performed at the recommended settings. It does not require the application of numbing cream and does not feel comparatively as hot or painful as Thermage FLX. With that said, however, we would recommend applying numbing cream for all skin tightening treatments for increased comfort.

Fotona5D vs Ultherapy

Ultherapy is a skin-tightening treatment from Merz Aesthetics, USA. It uses ultrasound energy to lift and tighten the dermis and underlying fibromuscular layer that holds the skin in place. The ultrasound energy is delivered deep into the skin, heating up the specific skin layers to 60 to 70 degrees Celsius. At this temperature, thermal coagulation of proteins occurs and collagen is stimulated.

Ultherapy is suitable for all skin types, including Asian type saggy skin. However, the layers treated are very distinct i.e. 3 mm and 4.5 mm below the skin’s surface. The intervening skin layers are not treated as the ultrasound energy is only precisely deposited at the particular depth. On the other hand, Fotona5D tightens skin through the entire thickness of skin, including the mucosa lining in our cheeks and externally.

Just like all the other non-Fotona skin tightening treatments, Ultherapy does not improve the skin’s surface. The last step of Fotona4D and Fotona5D is a superficial laser which improves skin texture and polishes away surface imperfections. This additional benefit gives a pleasant pearly finish to the skin, in addition to the tightening and lifting effect.

Fotona5D is a more comfortable treatment compared to Ultherapy when performed at the recommended settings. It does not require numbing cream and does not feel as painful as Ultherapy. Ultherapy can be more uncomfortable over bony areas such as along the jawline and forehead.

The standard Ultherapy protocol includes the face and neck, but does not include the areas adjacent to the mouth, back of the neck and the central part of the neck in front of our windpipe. This is so as not to damage nerves or other important structures under the skin. Hence, Fotona5D tightens a larger area of skin compared to Ultherapy. 

Fotona5D vs HIFU/Sofwave

HIFU (High Intensity Focused Ultrasound) is the name of a group of aesthetic devices that use ultrasound energy to tighten skin, similar to Ultherapy. There are many brands on the market, such as Ultraformer 3, Doublo and Sygmalift. The machines originate from different countries, depending on the brand and manufacturer.

Another brand that uses HIFU technology is Sofwave, but the main difference between itself and the rest of other HIFU machines is that Sofwave can only reach at a single depth of 1.5mm underneath the skin, which is comparatively shallower than other HIFUs.

The differences between Fotona5D and HIFU are similar to that of Ultherapy. However, the key difference is that while Ultherapy only needs to be done once a year, HIFU treatments typically require multiple sessions a year for similar results. HIFU machines also do not have the real-time ultrasound visualisation of the skin layers like Ultherapy. This makes it less accurate as visualisation helps the physician determine if the energy is being deposited in the right layers of the skin for optimal results.

Comparison Summary

I hope I’ve helped you familiarise yourself with the various non-invasive energy-based skin tightening and lifting treatments available in Singapore.

For your convenience, here’s a simpler, tabulated comparison (best viewed on desktop). If you’re still unsure which treatment is best for you, just drop me an email or schedule an appointment to get a personalised consultation.

[21 Nov 2020] A blog post by Dr. Gabriel Wong

Medical Aesthetic Doctor
Dr. Gabriel Wong – Photographer Enthusiast
MBBS, Singapore

Having graduated from the Yong Loo Lin School of Medicine – Dr Gabriel Wong worked in several hospitals in Singapore where he honed his medical acumen.

Fate was at work when he met Dr Kelvin Chua, which sparked his interest in aesthetic medicine.

Growing from strength to strength under the tutelage of Dr Chua, Gabriel developed an eye for detail and beauty – perfectly in tune with aesthetic medicine, a confluence of art and science.

He applies this in a range of non-invasive procedures such as Botox treatments, soft tissue augmentation (Dermal Fillers with the Cannula Method), skin rejuvenation with lasers (Fotona5D Laser Lift), and effective acne and acne scar treatments (Fractional CO2 Laser, subcision).

In his free time, Gabriel loves to travel in search of that perfect snapshot. His works of art have won praises by many patients.

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