Does it Make a Big Difference Who Performs Ulthera on You?

Is it so important who does Ulthera treatment - plastic surgeon, dermatologist or even nurse? I see here very different results and I wonder why somebody have good results and many any improvement even if they are 30 , 35 or 40 years old. What do the results depend on?

Doctor Answers (10)

Ulthera provider - does it matter who performs service?

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I have had Ultherapy in my practice since 2011, and I have found that my own results have improved with time as I have learned to customize and taylor my protocols to each patient.  I do have aestheticians that provide Ulthera but I also do a fair number of patients myself.  I have found that very soon after I received the device, I started increasing the amount of energy used to where I was using twice the recommended protocol.  This made a big difference in outcomes.  Ulthera then changed their protocol to increase the overall amount of energy towards the end of 2012.  Since then, I have further increased the amount of energy we deliver to patients.  I work very closely with my aestheticians and often develop the treatment plan together, even if they perform the procedure.  This way, I get to help customize the plan for the individual patient.

One thing to bear in mind, when you go to a core board certified aesthetic provider (e.g. Plastic Surgeon, Dermatologist), they are usually the ones leading advancing the use of these technologies.  The technology companies, however, need to grow so they quickly start selling to a lot of non-core customers.  So I would say it does matter what type of practice you go to, and how involved the the doctor is with your consultation and treatment plan.

Ultherapy and facial tightening / lifting may be related to the provider

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The non invasive tightening and lifting of facial features with Ultherapy ultrasound treatment has evolved over the last several years. Newer transducers allow different levels of the dermis to be treated giving, potentially, a better result. To say that a doctor does a better treatment than a nurse would not be valid if that doctor isn't using the newest technologies available. There are developments also in the technique that the provider may or may not have been practicing.

Physicians are able to modify the treatment customized to the individual patient's concerns. Some people are asymmetric and the treatment can purposely be delivered with greater lines of Ultherapy in the areas that deserve more attention.

Experience is important. Knowledge of anatomy is important and communication with the patient. If a nurse is doing the procedure in a doctor's office, then the doctor(s) are usually supervising the treatment in the sense of ensuring that the nurse is trained adequately. Requirments allowing or not allowing nurses to provide such treatment is regulated by each state differently.

Ronald Shelton, MD
Manhattan Dermatologist
5.0 out of 5 stars 33 reviews

The results from Ultherapy depend upon the technique used by the provider

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The results from Ultherapy depend upon the technique used by the provider. In our office, our nurse provides Ultherapy because she has extensive experience with it and is a consultant and works with the company that developed the technology. Plastic surgeons, dermatologists, and nurses can all perform the procedure.  However, their knowledge and experience with the technology determines what frequency they will use for each individual situation which will ultimately determine the success of the results. If a practice offers Ultherapy, make sure the machine is being used consistently and that you have the treatment by a provider that is most proficient in its use.

Does it Make a Big Difference Who Performs Ulthera on You

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The question of who does a procedure is a complicated one, encompassing many questions regarding qualifications, training, and patient customer service. In general Ulthera has an excellent program to train interested physicians and nurses on performing the procedure. The device is very intuitive, and allows for good control as one does a treatment.


However, in my practice, I have often noted that with ablative technologies like Ulthera, having a practitioner who has extended experience with these technologies can help achieve better results. The ability to visualize tissue response and make subtle adjustments in the treatment protocol can greatly enhance the outcomes. 

Farhan Taghizadeh, MD
Albuquerque Facial Plastic Surgeon
4.0 out of 5 stars 16 reviews

Experience counts

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Although standard therapeutic protocol is similar, there are many "expert" treatment protocols that can be performed by an experience Ultherapy provider.  I do recommend that you search well experienced medical professional.

Chang Son, MD
Fort Lee Dermatologist
5.0 out of 5 stars 1 review

Ulthera Practitioners

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The FDA-cleared Ultherapy procedure has been established to be safe and effective in clinical studies and tens of thousands of patient treatments worldwide. In addition, every Ultherapy practitioner undergoes extensive hands-on training, so you can schedule your Ultherapy procedure with complete confidence. In selecting a practitioner, it is important to find someone who is experienced and has achieved positive results with his or her patients. It does not matter so much whether it is a doctor or nurse, but rather their expertise or experience. 

I think it matters a ton!

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I think it is really important to search for a doctor that is experienced in this procedure.  I personally belive that perfomring a good thourough treatment is technically challenging.  Look for an experienced dermatologist or plastic surgeon and make sure that it is that person that performs it.  you are spending a lot of money and dont settle for a nurse or an aesthetician.  Ask for their credentials.  How long have they been doing it?

Cameron Rokhsar, MD
New York Dermatologic Surgeon
4.5 out of 5 stars 32 reviews

Results from Ultherapy depend on several factors

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Ulthera, which uses micro-focused ultrasound for noninvasive skin lifting, works by precise placement of thermal stimulation under the skin. The body responds to this by remodeling the collagen layer, so because it is ultimately the body's response that determines the result there is some inherent variability. Age, thicklness of the skin, and other factors are probably more important than who does the procedure provided that they are well-trained. However, Ultherapy must be done under the supervision of a physician if the doctor does not do it.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 30 reviews

Variability in results, is it user dependent?

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Anyone using Ulthera goes through some standard courses provided by the company on how to use it. That being said, there are risks with using any devise and there are many variables, some of which are user dependent, and others risks are related to how well trained the user is in anatomy and the physics behind using the devise.

Anatomy- There are areas where nerves reside and it is important to avoid hitting a sensory or motor nerve with the deep transducer. Ulthera is the only devise that can reach the deeper tissue planes and nerve injury is a possibility if not performed correctly. Superficial transducers are safe to use in all areas of the face except around the eyelids.

Anesthesia- Some feel the pain induced by Ulthera treatments is significant, and if the patient isn't properly treated, with oral meds, topical and/or subcutaneous anesthesia, nitrous oxide, etc there can be problems treating them. If the patient is uncomfortable and moves or jerks during firing the transducer the transducer can lift from the skin producing an epidermal injury. I believe most of the injuries reported around the posterior jaw line, or along the jaw line are related to lifting of the transducer from the skin. The pain is most intense along bony areas, such as the jaw, temple and forehead.

Upside down- Understanding the device, the transducer is filled with water and there are bubbles within the water. The ultrasound head slides back and forth along an arm firing the sound waves through the water, through the gel on the face and focused in the dermis or deep tissues of the skin. If the transducer is turned upside down the bubbles interfere with sound transmission and cutaneous injury may occur. Again, this usually occurs along and under the jaw line. This often manifests as small welts, or as small white dots. Often this resolves quickly within hours to a few days.

Individual Protocols- Many of us have developed or personalized the use of Ulthera to the patient. If the neck is more lax we will use more passes along these regions with the superficial or deep transducers for better results. These protocols deviate from the "templated' protocols provided by the company. I have done high density treatments of up to 1,000 lines per patient in older individuals with less elastic skin. This is twice the density of treatment recommended by the company. This comes with experience and observation of how patients respond to treatment. The more the cases performed, the more experience we develop. Experience I believe is important.

I hope this helps. Ask your physician about potential complications and if they have had any problems with their treatments. I believe in trained hands Ultherapy is very safe and very worth while.


Curt Samlaska, MD
Las Vegas Dermatologist
5.0 out of 5 stars 2 reviews

Ultherapy - Why end results vary may or may not depend on technician

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Ultherapy is still a fairly new technology so as time passes, we will likely see improved results.

Since Ultherapy is ultrasound and not a laser, the technical expertise is not as critical as it would be for certain other technologies (though you certainly want to be certain your provider is well trained). This makes it an appropriate procedure to be provided by trained medical staff as well as physicians and surgeons.

The variables that exist with Ultherapy outcomes include

  • Age - younger people have more robust collagen response so they will typically get faster and better results.
  • Patient health - again this affects how the skin and body respond to the intentional injury to tissue. If your body is already attending to illness, there is less available to respond to new stimulus.
  • Amount of energy delivered. Ultherapy can be customized, so some patients may have more total energy delivery than others. With Ultherapy this is called "lines".
  • BMI - Fat is not affected in the process, so someone with more facial fat may not see the underlying structural lift as much as someone who is leaner
  • Technician skill - this is one of your concerns and it does matter. Ultherapy treatment energy is focused at predetermined depths and this requires that the technician - no matter if a physician or a nurse - be constantly paying attention to the system screen to target appropriately.

Photography - Many practices don't have dedicated photo studios so the changes in lighting and position will affect how well you see actual results. And some post photos are taken earlier than the 6 month "end" point, again not fully representing actual outcome.

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.