Ultherapy Vs Thermage for Skin Tightening

Keep in mind these are only tools and by themselves are neither good nor bad.  A scalpel is neither good nor bad but can be used to perform beautiful surgery or make a terrible mess.  That being said, these devices are commonly used by practitioners with no formal training in plastic and reconstructive surgery and thus no understanding of what interventions, forces structures and vectors make a beautifully rejuvenated face.  Now that Thermage has a long history, people are begining to understand that the patients are nearly universally displeased to enraged with their results.  I have seen several difficult reconstructve cases resulting from them paying for aesthetic enhancement with Thermage. 

 

Now comes Ulthera the new better thermage and can you guess what is happening. . . the same thing.  I personally do not like deep heating of the face.  it causes the absorbtion and atrophy of fat which over time makes patients look aged and there is no control of vectors.  When a plastic surgeon restores a face with a facelift, there are multiple different vectors created with different forces to create a natural concavity and convexity.  The contraction forces created by these technologies are concentric and pull equally in all directions, flattenening the faces- a very undesirable form.

 

I use infrared energy(Sciton SkinTyte) mostly when skin and tissue tightening is the goal,  I like it because it is gentler and not as deeply penetrating.  I really dont think there is anything wrong with a well trained plastic and reconstructive surgeon using any of these devices in a responsible manner after explaining the risks and benefits to their patients.  I think these technologies are applicable for moderate correction of neck laxity but should really be of limited application in the face because of the inability to control form.  Aesthetic form with wrinkles and laxity is much preferable to unaesthetic form with smooth skin.  There is no question that significant tightening can be achieved, but at what cost?  Remember whether a scalpel, thermage or ultherapy, the hands holding the device are much more important than the device.  Make sure the hands are connected to an experienced and well trained plastic and reconstructive surgeon so that you can benefit from their experience, knowledge and insight.

 

 

All the best,

 

Rian A. Maercks M.D.

I want to start by mentioning that this question was posed 6 years ago! the answer to this question has certainly changed over this time span. Allow me to explain. Thermage was introduced 10 years ago. I had one of the first units in Los Angeles. The origional Thermage was very painful and occasionally resulted in burns or slight indentations. Some patients got amazing results and others benefited marginally. A few years later Thermage NXT was introduced. It was less painful and more consistent. Finally Thermage CPT became even more reliable and 2-3 times more effective. I have used all 3 machines and still have patients who come for skin tightening on a yearly basis. Once you have a great result with a machine you want to continue using the same modality. Ultherapy was introduced 6 years ago. We nor have the 3rd generation machines with the deep-see hand piece. It is powerful and consistent. I find that patient do better with mild oral sedation. Yes- it is very uncomfortable. I personally perform both procedures and get great results. Both machines are tools and the results are very operator dependent. It all depends on how many pulses (line) and what settings and how the pulses are applied. generally speaking I prefer Ulthereapy a little more. I am able to physically see the tissue that is being treated on my screen. please look for an experienced physician and have realistic expectations.

Ultherapy and Thermage treatments can not be compared. They are very different. Thermage utilizes Radio Frequency technology. It heats the tissue at various depths. Heating the tissue produces collagen remodeling and some skin tightening. It is a less affective modality for tightening the skin. vs Ultrasound that the Ulthera machine utilizes. Ulthera uses ultrasound to deliver a small focused heat source to deeper tissues. It can be applied with great precision at the level of the SMAS(a collagen rich layer under the facial skin). It also has the advantage of imaging to confirm you are at the correct depth.

Ulthera™ has only recently been approved by the FDA for use in the US. It has, however, been available in Asia and in Europe for several years, and preliminary results have been impressive. Ulthera™ is currently only being offered to select physicians within the US who have significant facial aesthetic practices, many of whom are involved in research and clinical studies as well.
To refer to Ulthera™ as a "gizmo" is to discredit the technology behind the device. Unlike Thermage ™ , which many doctors and patients have found to be disappointing, Ulthera is the first device that uses ultrasound technology to stimulate the body's own collagen response for lifting and tightening the skin and underlying soft-tissue of the face. This system also uses acoustic imaging to enable the physician to see the layers of soft tissue beneath the skin prior to treatment to ensure a uniform and accurate application of the ultrasound waves. This differs significantly from any other device that is currently on the market which typically use radio frequency or lasers to stimulate the skin.
While Ulthera is not going to yield the dramatic results of a surgical face-lift, many patients in my practice prefer the subtle, yet significant tightening and lifting of the skin that Ulthera provides. It is less expensive than a traditional facelift or MACS lift, has no downtime, and no bruising or swelling. I see Ulthera™ as one tool in a full spectrum of options we have available to help patients achieve their desired outcome for facial rejuvenation. Physician credentials and experience, communication, education and expectation of the patient are all key to having an optimum outcome, regardless of whether the procedure is surgical or non-surgical.

Ultherapy is a non-invasive procedure that lifts the neck, chin and brow, and improves lines and wrinkles on the upper chest. As we age, collagen breaks down, resulting in loss of skin strength and elasticity. For tissue tightening, Ultherapy is ideal for the lower face and neck and we often combine it with CO2 laser or Morpheus8 to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Ultherapy procedure delivers consistent energy to the SMAS layers or deep layers of skin  by using ultrasound technology under direct visualization to lift the sagging skin.Where as Thermage is a  radiofrequency device which delivers the energy into the tissue layer with out direct vision. Both procedures can be effective, but have many limitations,  the results are usually seen after 6 months. The Ultherapy results depends upon multiple factors such as the degree of sagging, age of the patient, the knowledge of anatomy and the experience of the person who performs. In our office all Ultherapy procedures are performed by a Board Certified physician. I firmly believe Ultherapy is a better choice since I can see all the tissue layers before delivering the energy.
Best
Dr. Shanthala

Ultherapy is a more effective treatment for skin tightening. Ulthera allows us to use a monitor to visualize and concentrate on the desired area. Ulthera also allows us to target deeper layers of the skin, giving us better results. 

We carry both Ultherapy and Thermage and they both have place in our clinic. While both treatments offer collagen stimulation through the use of heat there are distinct difference that can set one apart from the other. Thermage uses a patented radio frequency technology to heat the skin, stimulating existing collagen and promoting new collagen. Ultherapy is Ultrasound which goes to work deep in the skin's surfacing creating new collagen. Its because of the imaging we're able to deliver energy in the right areas for a more customized lift. During consultations we help our patients deciding which is the better treatment for them based on many factors such as  extent of skin laxity, areas they want to address and over all desired results. 

Thank you for the question. Thermage and Ultherapy both use energy to restore and rebuild collagen production in the dermal layer of the skin. But Ulthera uses ultrasound energy that can usually reach deeper into the dermal layer, even down to the fat and SMAS, to provide more dramatic and noticeable skin tightening. Thermage uses radio frequency energy at only one depth. Both create heat, which tightens the skin from under the surface. The person performing Ultherapy often has more control over the depth of treatment than a person performing Thermage therefore choosing a qualified technician is key.

Ultherapy has pretty much surpassed the results that Thermage can accomplish on the face.  In addition, Ultherapy continues to do a great job at skin tightening and skin lifting in the jawline, neckline, brows, and decolette.  The area around the eyes and lips work well too but usually require more than one treatment in my opinion.  

I have 5-6 years experience with Ultherapy, and have had several demos with the Thermage.  Therefore, I am biased, but believe that the Ultherapy gives better results with less discomfort than the Thermage.