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Is Pelleve or Ultherapy Better to Tighten Skin?

I have a thin face and am looking for tightening around the mouth and lower face.

Doctor Answers (14)

Pelleve or Ultherapy?

Ultherapy is generally performed as a single treatment wherein intense-focused ultrasound creates intense heat very quickly in the treated area of skin.  Pelleve treatment is given in several sessions, and within each session five passes of the treated area are performed, bringing the temperature of the skin beneath the surface to the same endpoint temperature as with Ultherapy.  The reason Pelleve hurts less is probably because the temperature is brought up slowly over a period of minutes rather than instantaneously with each pulse. At the target temperature of 65 to 70 degrees Celcius within the skin, immediate tightening ocurs, and fibroblasts are stimulated to produce increased amounts of structural proteins over the ensuing months.  

Both are effective, and each has advantages in terms of more or less pain, more or less time or money required. I have personally seen more reproducible results with Pelleve, ie every patient seems to get better, whereas the results with Ultherapy can be great but are a little unpredictable.

i hope this helps!

New York Dermatologist
5.0 out of 5 stars 5 reviews

Ultherapy vs. Pelleve

While both treatments help with wrinkle reduction (and are effective), they are very different. 

Pelleve uses radio frequency to tighten the skin.
Ultherapy uses ultrasound technology to physically lift the skin - almost like a noninvasive face lift.

The Ultherapy goes down much deeper into the dermis - 4mm while the Pelleve barely hits 1.5mm.
Three sessions of Pelleve treatments are needed to see optimal results while only one session of Ultherapy is needed.

San Antonio TX

Sanjiv Kumar, MD
San Antonio Ophthalmologist
5.0 out of 5 stars 1 review

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!

Rian A. Maercks, MD
Miami Plastic Surgeon
5.0 out of 5 stars 36 reviews

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Pelleve and Ultherapy work on different levels of collagen, so they are both good!


I describe these treatments, along with Botox and fillers, to my patients as a Peanut Butter and Jelly sandwich laying on a plate.  The Pelleve works on the top layer of the skin (the top bread), the Fillers and Botox work in the middle, like Peanut Butter and Jelly, and the Ultherapy works on the lower most level (below the fat) like the lower level of bread.  

There is no way to affect all these areas with just one treatment, so this is a huge benefit to doing all of these together.  

Joel Schlessinger, MD
Omaha Dermatologist
5.0 out of 5 stars 22 reviews

Ultherapy vs Radiofrequency (Pelleve) for skin tightening


I think there is a place for both, and we offer both treatments.  I have more faith and confidence in Ultherapy for deep tissue tightening because of the focused depth of treatment.  Pelleve is working via a bulk heating strategy.  This is helpful in some areas that are to delicate and not as well treated by Ultherapy such as lower and upper eyelids. 



Arthur N. Falk, MD
Albany Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Pelleve` Versus, Ulthera Which Better Tightens the Skin


Hi Manny,

Ulthera is the only treatment that delivers precise energy at the levels necessary to both lift and tighten the muscles and skin of the face, neck, and eyebrows. Ultherapy uses micro focused ultrasound energy to create deep heat that results in immediate contraction as well as long term new collagen production. In a single treatment Ulthera can accomplish much more than multiple treatments of other radiofrequency technologies such as Pelleve`, Exilis, Accent XL, and Thermage. Good luck and be well. 

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Ultherapy or Pelleve


Both procedures act to induce new collagen formation.  We evaluated both devices and elected to add Ultherapy to our practice because it was more precise.  That said, we do not treat the lips because the tissue is too thin in this area.   A new hand piece will be available for the lips later this year.  You can wait or you may want to look at a laser resurfacing procedure as an alternative for skin tightening of the upper and lower lips.

Joseph Campanelli, MD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 7 reviews

Ulthera for the lower face - Los Angeles


Ultherapy provides very effective improvement in the lower face and neckline. I use the procedure to address sagging skin and muscle fascia. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 49 reviews

Ultherapy vs. Pelleve


Studies have shown that Ultherapy treatments provide optimal results. Through our own experience with skin tightening, we choose to use the Ulthera skin tightening system.

Kimberly Butterwick, MD
San Diego Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Ultherapy and Pelleve


Both of these procedures work well.  Ulthera is the one time treatment and Pelleve works with a series of treatments.  Ulthera may be a bit more painful than Pelleve, but new protocols have made the ulthera treatments much more tolerable.  So both work – as do most of the RF therapies for skin tightening and ultrasound therapy like ulthera.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.