Please suggest. Main concerns are: 1. Looking natural 2. No puffy/plumb look/result 3. Cost I am undecided between Ulthera and Radiesse or Juvederm.
Best Long Term Filler - or Should I Try Ulthera?
Doctor Answers (19)
Ulthera-vs-Fillers or Both
Based on your photo it seems that most of your issue is in the midface and is lack of volume. While Ulthera can provide some lifting in he midface, I think the most predictable option for you is adding a filler. This will also reduce the depression of the cheek fold. Furthermore if you end up with a slight loss of subcutaneous fat after Ulthera you may find yourself requiring more volume to achieve the result you are looking for. Both of the fillers you mentioned are effective for adding volume to the midface with the one of the advantages of the radiesse is that the syringe is 1.5 cc as compared to 0.8 cc for a syringe of Juvederm. This may cost you less depending on the pricing of the fillers.
Ultherapy vs Filler
In our experience, Ultherapy can help to tighten up the mid face but your major aesthetic problem appears to be volume loss. For this area, both Radiesse and Juvederm will work well. This is a tricky area for filler, so choose who you have do it carefully.
Ulthera for tightening, fillers for volume: not the same
There isn't really much overlap between what Ulthera does vs what injectable fillers do. If there is some early skin laxity then Ulthera can be very effective, but fillers will add volume to replace what is missing. From the picture you posted, the skin tone appears good but there is some hollowing along what we call the "tear trough" from the inside corner of the eye obliquely down the cheek. Go for a filler and either Radiesse or Juvederm should give a good long-term result.
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Consider a combination of Juvederm Ultra and Juvederm Voluma.
Ulthera and Pelleve : Two technologies that drive me nuts!!!!
Ulthera is hyped as a face-lifting and neck tightening technology that is revolutionary because of its use of focused ultrasound that creates ridiculously high amounts of heat in tiny little spots underneath your skin. The thought is that a line of these spots will create a vector of pull or lift. Well, the results are difficult to appreciate (if you do not take a post procedure picture with an elevated chin which makes the neck appear tighter) and the long term results are just sad. The heat deep in the face must dissipate and no matter how focal energy delivery is, healthy facial fat suffers. It has been around long enough to have many patients see the horrible eyelid retraction and fat atrophy that it can cause. I see young patients in my practice, who otherwise would not need a surgical intervention, present with discontent after these treatments that need blepharoplasty and canthal suspension as well as fat grafting to restore them to reasonable aesthetics.
Pelleve is a radiofrequency device, actually a powerful electrosurgical generator for cutting cauterizing and fulgarating tissue that for marketing reasons developed a special handpiece with lower power settings branded as a cosmetic intervention to increase market share. The results of Pelleve are sometimes even more devastating. This is because Ulthera charges doctors every time they push the button for a pulse which results in generally limited energy delivery.
With most of these technologies one should consider themselves lucky if no result is seen because changes caused are usually negative. I encourage patients to avoid the latest name branded repackaging of last years' disastrous technology and to find a plastic surgeon who has resisted the urge to join corporations to shake money out of patients. Many of us including myself use ultrasound, radiofrequency and other technologies under true surgical judgement and let experience and knowledge guide us to offer reasonable treatments that do not harm patients instead of following directions from sales representatives with business degrees on how to alter someones face.
Also if you are going to let someone deliver energy near your eye, make sure they are a surgeon that understands the surgical anatomy, do's and don't's, risks and potential complications. Otherwise there is no way you will avoid them!
If you are impressed with before and after pictures of a neck or face, look at the position of ear landmarks to eye landmarks, hold a straight edge to the picture and you will likely see a relatively elevated angle in the post picture that will explain any improvement. If the ears are not in the picture, well now you know why. Also be careful with lighting flash and exposure settings as well as frank manipulation.
Be careful it is not pretty out there!
Ultherapy vs. dermal fillers
Ultherapy will not add volume to a face, but it will tighten the face and occasionally negate the need for facial fillers. However, as we age we do tend to lose volume in our faces, and despite the tightening effects of Ultherapy, fillers are often a useful addition in the preservation and restoration of a youthful appearance. In you situation, based on the photo, Ultherapy may be the best choice, though may not fully correct all the areas on concern. Another argument for Ulthera is that the results are permanent vs temporary in the case of most fillers. Again, the best option is to budget for both.
Ultherapy lifts and tightens, fillers restore volume
Ultherapy and fillers address different issues. Ultherapy uses ultrasound technology to lift and tighten the subcutaneous tissues of the face. Fillers, such as Radiesse and Juvederm, restore volume to the areas of the face that have lost it. If your issue is that you feel that your skin is sagging a bit and want the tissues of your face to look a bit more lifted, then Ultherapy is the way to go. If you are concerned that there are areas of your face that look hollow and deflated or there are prominent folds, then fillers will help restore volume and natural contours to your face. There are many patients who would benefit from both Ultherapy and fillers. Both Ultherapy and fillers can produce very natural looking results as long as they are performed by someone who is experienced and knowledgeable.
You also wanted to know which lasts longer. The longevity of these treatments vary by the individual. On average, the Ultherapy results last anywhere from 1 year to a year and a half. Juvederm lasts approximately 6-9 months and depends on which part of the face it is used. Radiesse can last up to a year. Sculptra, which is not a filler, is an injectable which stimulates your body to lay down your own collagen. The results of Sculptra last approximately 2 years.
Depending on how many areas of your face you want treated with Ultherapy or how much filler you would need to restore adequate volume, the costs may be pretty comparable. If you are trying to decide between Ultherapy and fillers, I would recommend you base your choice on what specific concerns you have about your face (laxity vs volume loss) rather than cost or longevity. Hope this helps!
Dr. Sarmela Sunder
Beverly Hills and Los Angeles