Akefu is an elderly-looking man with a slightly stocky build, said to be 89 years old. His arms and legs are noticeably slimmer than the rest of his body. He wears a dark-colored bowler hat and suit, along with a lightly colored scarf with a pattern of irregular "-" shaped slits cut into it. He also wears dress shoes and uses a cane to walk.
Later in the story, Akefu is depicted as having a thin furrowed face with prominent cheekbones, sunken eyes, and a large nose. His most notable features are a beard styled into multiple short spikes and a monocle on his right eye. His hair is lightly colored and much thicker than what a human at his supposed age would have. Much like his subordinate Wu Tomoki, the hair on the sides of his head is stylized into many round shapes. The hair on the top of his head is much more natural, although appearing somewhat unkempt. His sideburns feature a similar pattern, but are shaven into rectangles instead.
If one is aware of his calamity power, then one will see his true form as a Stand.
Akefu is a rather elusive figure despite holding an incredibly prestigious title. He demonstrates an antisocial behavior, completely ignoring Josuke Higashikata, Yasuho Hirose, and Rai Mamezuku, probably on purpose. As the head doctor of TG University Hospital, Akefu seems proud to present the Locacaca 6251 to an audience. He is also a professional and so the first thing he does with the journalist Taoka is to exchange business cards with him. Akefu is a calm individual because his automatic power allows him to get rid of any potential enemy before they can even harm him. Thus, when Taoka threatens to exposes the Locacaca Organization's illegal clinical trial, Akefu calmly points out how disaster may strike the journalist before leaving. Likewise, he calmly confronts Josuke and Mamezuku when he is forced to go to the laboratory. Befitting a doctor he is also curious. After he succesfully took damage from Josuke's bubbles he was left wondering about the Spin, its nature, and whether or not it followed the chain of logic
- Main article: Wonder of U
Akefu's true identity is a sentient, humanoid Stand named Wonder of U.
Akefu's true form is a Stand. Most people will see him as the head doctor of TG University Hospital and treat him as such, but those who are aware of his calamity power will discern his true form as a Stand.
As a physician in charge of an entire hospital, it can be inferred that Akefu is knowledgeable on both general medical knowledge, as well as medicinal applications of the Locacaca fruit.
Akefu's identity was stolen from an actual human doctor, who was a graduate of TG University Hospital. Tooru uses his identity to infiltrate the hospital with Wu Tomoki, Urban Guerrilla, and Poor Tom, becoming the head doctor. Akefu is stated to have a long and illustrious career as a doctor and to have even received medical awards for his work, although these accomplishments may have been achieved by the original Akefu. Due to his honorary position, he is no longer involved in any actual medical practice. Akefu and the rest of the Locacaca Organization conducted research on the Locacaca fruits and its potential as a medicine, using Tamaki Damo's group as subordinates and staff to perform unofficial human trials, and also testing their medicine on Holy. At one point, Akefu becomes acquainted with Mitsuba Higashikata and poses in a photo together with her.
Akefu seems to have some kind of relation with Mamezuku's Father, as he attended his funeral. Furthermore, Akefu is implied to have been responsible for the calamities that affect the Mamezuku family.
Akefu is pursued by Josuke Higashikata, Yasuho Hirose, and Rai Mamezuku. Completely ignoring them, Akefu sends his ability after the three and makes his getaway on a bus. He's later spotted by Mitsuba Higashikata at both her son's elementary school and on the property surrounding the Higashikata House.
Josuke and Mamezuku discover that Akefu is scheduled to give a lecture on regenerative medicine. Deciding to pursue him to that lecture causes Akefu's Stand to activate and attack them just as the rain begins to fall. Cornered by the rain and the police, Josuke decides to let the raindrops shoot through him and be brought to the hospital. Meanwhile, Akefu keeps stalking the Higashikata Family and his ability causes disaster after disaster for them, with Tsurugi's illness triggering at the same time.
On the day of the lecture, Akefu unveils his product, the Locacaca 6251, to the public. He presents his new medicine and its processes. Meanwhile, Josuke is again attacked by Akefu's ability and eventually revises his plans.
On the day of the harvest, Akefu is again seen by Mitsuba and Yasuho lurking near the Higashikata House but also by Rai Mamezuku just outside of the police station. At the Higashikata House, his ability causes a string of events that leads to the new Locacaca being exposed. As Jobin argues with Norisuke and eventually takes him out, Akefu finally takes action. He enters the Higashikata House and approaches the family. Mitsuba sees him passing by the door frame of the corridor outside of Tsurugi's room, pass through a computer screen, the glass panels of the bookcases, passing through the bathroom, the window near the bed, a frame, and then slipping under the bedsheets. Jobin, warned of his presence by Mitsuba, summons his Stand Speed King and attacks him. Soon enough, Akefu's ability causes another calamity and Jobin is drained of his blood, his potted Locacaca rolling towards the door to the garage.
At the TG University Hospital, Akefu is scheduled to meet with a reporter from the science journal "Pangea Land", Taoka. However, Taoka shows Akefu footage of Holy Joestar-Kira, the secret Locacaca laboratory, and a sample of the fruit inside of a jar. Taoka accuses Akefu of conducting illegal human trials and is ready to pursue him. Akefu thus raises the possibility of the sample being a fake and theorizes that Taoka must have touched the fruit, and that some juice may have slid into a small cut on his hand. Akefu leaves Taoka, trusting his ability to kill the reporter for him, and goes towards Josuke. As he walks toward the Locacaca laboratory at the gynecology department, it is shown that the head doctor and the Stand are the same entity.
- “Today! I, Satoru Akefu... have something to this place... for the sake of all of you out there. What I have in this case... "Locacaca 6251" (150 grams). This is both an implant-like tool I developed as well as a living regenerative substance! All that one must do is inject it inside the body under proper conditions and the affected area will transform to be as good as new! There is no need for cell cultivation or surgery! And therefore no risk of inflammation due to incompatibilities! Whether it's a broken knee or joint or brain tissue lost in a concussion, going beyond regeneration, it will bring about an 'exchange' for sound health!”
- “...Did you perhaps... Come here... Intending to pursue me?”
- “The point where those on a long journey are most likely to meet with an accident... is just before returning home. This long running journey is over, I have obtained the New Locacaca, and both you and I will be soon returning home...”
- “First, you will have to deal with this lone 'Rock Insect'. 'Dododo De Dadada'. Before you go home, why don't you take a look... ...at what you can see if you get up from that chair...?”
- “The New Locacaca is moving from where it is now to where I am. The flow is carrying it. It is not in a flow where you can obtain it. The flow, you see, is that you will get up from that chair. It is certain that you will stand up to pursue me. I am "Wonder of U" and the flow is always a calamity.”
- “There is nothing at all you have permission to possess. Be it a pear orchard or a single New Locacaca...!!!”
- The covers of Ultra Jump 2020 Issue #5, JJL Volume 23, JJL Chapter 96 and JJL Chapter 104 all feature imagery of multiple instances of Satoru Akefu levitating in the sky, bearing resemblance to the work Golconda of Belgian artist René Magritte.